The World Health Organization (WHO) released its first-ever global guideline on managing sickle cell disease (SCD) during pregnancy on 19th June 2025. This marked a major milestone in addressing a long-neglected yet life-threatening maternal health issue. The guideline addresses the mounting health risks women with SCD face during pregnancy. It also responds to the global rise in SCD cases, particularly in low- and middle-income countries (LMICs).
Sickle cell disease is a group of inherited blood disorders. It causes red blood cells to take on a sickle or crescent shape. This change impedes blood flow and oxygen delivery throughout the body. The result is a cascade of health complications. It includes severe anaemia, pain crises, and infections. There are also life-threatening events like stroke and organ failure. These risks increase dramatically during pregnancy.
A Critical Gap in Maternal Care
Pregnant women with SCD face up to 11 times higher risk of maternal death compared to women without the condition. The disease is also associated with elevated rates of complications such as pre-eclampsia, stillbirth, preterm birth, and small-for-gestational-age infants. Clinical protocols for managing SCD exist in high-income countries. However, there is a lack of global, evidence-based guidance. This is especially true in low-resource settings where the disease is most prevalent.
Recognizing this, WHO convened a multidisciplinary Guideline Development Group (GDG). They commissioned systematic reviews and evidence appraisals. This led to the development of 21 new recommendations. These span antenatal care, pain management, hospitalization protocols, fetal monitoring, and postnatal care.
Dr. Pascale Allotey, Director of WHO’s Department of Sexual and Reproductive Health and Research said, “With quality health care, women with inherited blood disorders like sickle cell disease can have safe and healthy pregnancies.” “This new guideline aims to improve pregnancy outcomes for those affected. With sickle cell on the rise, more investment is urgently needed to expand access to evidence-based treatments during pregnancy as well as diagnosis and information about this neglected disease.”
Why It Matters
Sickle cell disease is most common in sub-Saharan Africa. This region accounts for 8 in 10 cases globally. However, the disease also affects populations in the Middle East, Caribbean, and South Asia. Due to increased population mobility and improving life expectancy, the prevalence of SCD is expanding globally. Additionally, more women with SCD are reaching reproductive age.
Today, over 7.7 million people live with SCD, a 41% increase since 2000. Yet, despite the scale of the burden, SCD remains under-funded and under-researched, particularly in the context of pregnancy. The new WHO guideline aims to close this gap with actionable, context-sensitive recommendations.
What the Guideline Recommends
The WHO guideline includes 21 recommendations designed to support safe pregnancy outcomes for women with SCD. Key highlights include:
Medication and Supplementation
- Folic acid: For women outside malaria-endemic areas, take up to 5 mg daily. Take 400 µg daily when using sulfadoxine-pyrimethamine to avoid interaction with malaria prevention.
- Iron: Only recommended in confirmed cases of iron deficiency, due to the risk of iron overload from transfusions.
Blood Transfusions and Hydroxyurea
- Prophylactic blood transfusions may be considered for women with a history of severe pain crises or prior benefit.
- The guideline permits continued use of hydroxyurea in pregnancy after the first trimester under a shared decision-making model.
Pain Management
- Emphasizes timely, individualized pain relief plans.
- Recommends a range of medications (paracetamol, NSAIDs, opioids) with attention to dosage, pregnancy stage, and prior use.
Hospitalization and Monitoring
- Recommends thromboprophylaxis for hospitalized women, barring contraindications.
- Provides guidance on fetal growth monitoring every 3–4 weeks and individualized plans for high-risk pregnancies.
Birth Planning and Postnatal Care
- Recommends individualized decisions on timing and mode of delivery, balancing risks and the woman’s preferences.
- Advises comprehensive postnatal care, including contraception guidance, newborn screening, thromboprophylaxis, and safe breastfeeding counseling.
A Rights-Based, Person-Centered Approach
The guideline addresses clinical care and advocates for respectful, stigma-free, and individualized care. WHO emphasizes involving women in decision-making. It highlights providing mental health support. It also stresses integrating SCD care with broader maternal health services.
“It’s essential that women with sickle cell disease can discuss their care options early in pregnancy, or ideally before, with knowledgeable providers,” said Dr. Doris Chou, WHO Medical Officer and lead author of the guideline.
The guideline also calls for greater inclusion of pregnant and breastfeeding women in clinical trials. This addresses long-standing gaps in safety data. These gaps often lead to overly cautious or conflicting treatment advice.
Implementation and Global Health Impact
WHO envisions the guideline being adopted by national ministries of health. It will also be adopted by professional societies, maternal health program managers, and front-line healthcare workers. Training, pre-service education, and health system strengthening are essential to support effective implementation.
The publication is the first in WHO’s new series on noncommunicable diseases in pregnancy. Future guidelines will cover other conditions like cardiovascular disease, diabetes, and mental health. These conditions are increasingly recognized as key contributors to maternal and newborn morbidity and mortality.
The Way Forward
This revolutionary guideline is a critical step toward equity in maternal health. It is also a long-overdue investment in one of the most underserved groups in global health. As the WHO underscores, every woman deserves a safe pregnancy and birth experience. This applies regardless of where she lives or the condition she has.
“This is a call to policymakers, clinicians, and funders alike,” “The tools now exist—what remains is the will to apply them.” Dr. Allotey.
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