Sickle cell disease and pregnancy

Sickle cell disease (also called SCD) is a condition in which the red blood cells in your body are shaped like a sickle (like the letter C). Red blood cells carry oxygen to the rest of your body. In a healthy person, red blood cells are round and flexible. They flow easily in the blood. A person with SCD has red blood cells that are stiff and can block blood flow. This can cause pain, infections and, sometimes, organ damage and strokes.

CD is a kind of anemia. Anemia happens when you don’t have enough healthy red blood cells to carry oxygen to the rest of your body.

What causes SCD?

SCD is inherited. This means it’s passed from parent to child through genes. A gene is a part of your body’s cells that stores instructions for the way your body grows and works. Genes come in pairs — you get one of each pair from each parent.

Sometimes the instructions in genes change. This is called a gene change or a mutation. Parents can pass gene changes to their children. Sometimes a gene change can cause a gene to not work correctly. Sometimes it can cause birth defects or other health conditions. A birth defect is a health condition that is present in a baby at birth.

You have to inherit a gene change for sickle cell from both parents to have SCD. If you inherit the gene change from just one parent, you have sickle cell trait. This means that you have the gene change for SCD, but you don’t have SCD. When this happens, you’re called a carrier. A carrier has the gene change but doesn’t have the condition.

Sickle cell trait cannot become SCD. Rarely people with sickle cell trait show signs of SCD, but this is unusual. Most don’t.

Can you pass SCD or sickle cell trait to your children?

Yes. But it depends on both you and your partner. If you and your partner both have SCD, your baby will have SCD.

If you and your partner both have sickle cell trait, there’s a:

  • 3-in-4 chance (75 percent) that your baby won’t have SCD
  • 1-in-2 chance (50 percent) that your baby will have sickle cell trait
  • 1-in-4 chance (25 percent) that your baby will have SCD
  • 1-in-4 chance (25 percent) that your baby won’t have SCD or sickle cell trait

A genetic counselor can help you understand your chances of passing SCD or sickle cell trait to your baby. A genetic counselor is a person who is trained to help you understand about how genes, birth defects and other medical conditions run in families, and how they can affect your health and your baby's health.

Ask your health care provider if you need help finding a genetic counselor. Or contact the National Society of Genetic Counselors.

How can you find out if you have SCD or sickle cell trait?
There are two types of tests that can tell you if you have SCD or sickle cell trait. Both are safe to take during pregnancy. Your partner can have the tests, too.

  1. A blood test
  2. A swab of cells inside your mouth. This means your provider rubs a cotton swab against the inside of your cheek to get some cells.

You and your partner may want to be tested if:

  • SCD or sickle cell trait runs in either of your families. To help you find out, take your family health history. This is a record of any health conditions and treatments that you, your partner and everyone in both of your families have had. Use this family health history form and share it with your health care provider.
  • You’re black or Hispanic. In the United States, SCD is most common among these groups. SCD affects about 1 in 500 black births and about 1 in 36,000 Hispanic births in this country.
  • Your family’s ancestors are from Africa, the Caribbean, Greece, India, Italy, Malta, Sardinia, Saudi Arabia, Turkey, or South or Central America.

Can you find out if your baby has SCD or sickle cell trait during pregnancy?

Yes. If you or your partner has SCD or sickle cell trait, you can have a prenatal test to find out if your baby has SCD or sickle cell trait.

You can have either of these tests:

  • Chorionic villus sampling (also called CVS). This test checks tissue from the placenta for birth defects and genetic conditions. You can get CVS at 10 to 12 weeks of pregnancy.
  • Amniocentesis (also called amnio). This test checks amniotic fluid from the amniotic sac around your baby for birth defects and genetic conditions. You can get this test at 15 to 20 weeks of pregnancy.

Talk to your provider or genetic counselor if you’re thinking of having either of these tests.

Can SCD cause problems during pregnancy?
With regular prenatal care, most women with SCD can have a healthy pregnancy. But if you have SCD, you’re more likely than other women to have health complications that can affect your pregnancy. These complications include pain episodes, infection and vision problems.

During pregnancy, SCD may become more severe, and pain episodes may happen more often. Pain episodes usually happen in the organs and joints. They can last a few hours to a few days, but some last for weeks.

During pregnancy, SCD may increase your risk of:

  • Miscarriage, when a baby dies in the womb before 20 weeks of pregnancy
  • Premature birth, when birth happens too early, before 37 completed weeks of pregnancy
  • Having a baby with low birthweight (less than 5 pounds, 8 ounces)

How is SCD treated during pregnancy?

If you have SCD and you’re pregnant or planning to get pregnant, talk to your health care provider about the medicines you’re taking. Your provider may change your medicine to one that’s safe for your baby during pregnancy.

For example, hydroxyurea is a medicine that may help prevent red blood cells from sickling. It’s used to treat SCD pain episodes. However, it isn’t recommended during pregnancy because it may increase the risk of birth defects.

Your provider also can treat other problems related to SCD and pregnancy. For example, your provider can help you find ways to treat pain episodes that are safe during pregnancy.

For more information

Centers for Disease Control and Prevention (CDC)

National Heart, Lung and Blood Institute

Sickle Cell Disease Association of America

Last reviewed January 2013

See also: Sickle Cell Disease, Genetic counseling, Your family health history, Newborn screening

Most common questions

What is mononucleosis?

Mononucleosis (also called mono) is an infection usually caused by the Epstein-Barr virus (EBV). It’s sometimes caused by another virus called cytomegalovirus (CMV). EBV and CMV are part of the herpes virus family. Mono is most common in teenagers and young adults, but anyone can get it. Mono is called the “kissing disease” because it’s usually passed from one person to another through saliva. In addition to kissing, it can also be passed through sneezing, coughing or sharing pillows, drinks, straws, and toothbrushes.

You can have mono without having any symptoms. But even if you don’t get sick, you can still pass it to others. Symptoms can include:

  • Achy muscles
  • Belly pain
  • Fatigue (feeling tired all the time)
  • Fever
  • Sore throat
  • Swollen glands in your neck

If your symptoms don’t go away or get worse, tell your health care provider. He’ll most likely do a physical exam and test your blood to find out for sure if you have mono.

There’s no vaccine to prevent mono. There’s also no specific treatment. The best care is to take it easy and get as much rest as you can. It may take a few weeks before you fully recover.

Can Rh factor affect my baby?

The Rh factor may be a problem if mom is Rh-negative but dad is Rh-positive. If dad is Rh-negative, there is no risk.

If your baby gets her Rh-positive factor from dad, your body may believe that your baby's red blood cells are foreign elements attacking you. Your body may make antibodies to fight them. This is called sensitization.

If you're Rh-negative, you can get shots of Rh immune globulin (RhIg) to stop your body from attacking your baby. It's best to get these shots at 28 weeks of pregnancy and again within 72 hours of giving birth if a blood test shows that your baby is Rh-positive. You won't need anymore shots after giving birth if your baby is Rh-negative. You should also get a shot after certain pregnancy exams like an amniocentesis, a chorionic villus sampling or an external cephalic version (when your provider tries to turn a breech-position baby head down before labor). You'll also want to get the shot if you have a miscarriage, an ectopic pregnancy or suffer abdominal trauma.

I had a miscarriage. How long should I wait to try again?

Before getting pregnant again, it's important that you are ready both physically and emotionally. If you don't need tests or treatments to discover the cause of the miscarriage, it's usually OK for you to become pregnant after one normal menstrual cycle. However, it may take longer for you to feel emotionally ready to be pregnant again. Everyone responds differently to a miscarriage. Only you will know when you are ready to try to get pregnant again.

Are gallstones common during pregnancy?

Not common, but they do happen. Elevated hormones during pregnancy can cause the gallbladder to function more slowly, less efficiently. The gallbladder stores and releases bile, a substance produced in the liver. Bile helps digest fat. When bile sits in the gallbladder for too long, hard, solid nuggets called gallstones can form. The stones can block the flow of bile, causing indigestion and sometimes serious pain. Staying at a healthy weight during pregnancy can help lower your risk of gallstones. Exercise and eating foods that are low in fat and high in fiber, like veggies, fruits and whole grains, can help, too. Symptoms of gallstones include nausea, vomiting and intense, continuous abdominal pain. Treatment during pregnancy may include surgery to remove the gallbladder. Gallstones in the third trimester can be managed with a strict meal plan and pain medication, followed by surgery several weeks after delivery.

©2013 March of Dimes Foundation. The March of Dimes is a non-profit organization recognized as tax-exempt under Internal Revenue Code section 501(c)(3).