"Can I have a baby safely if I have sickle cell?"
This is a question on the minds of many aspiring mothers with sickle cell.
Getting through pregnancy and labour is a lot for anyone to manage.
But when you're dealing with the stresses that sickle cell places on life, it can make your wonder whether pregnancy is going to add fuel to the fire.
Obviously I can't relate personally but its something I've been thinking about more since my wife's pregnancy.
So let me start with just answering the question to save you from anxious anticipation.
Women with sickle cell can become pregnant, and many go on to have successful pregnancies and healthy babies.
However, pregnancy with sickle cell is considered higher risk.
So what does higher risk mean exactly?
It means that pregnancy places additional demands on your body. So closer monitoring and more specialist support is needed compared to someone without sickle cell.
The same way that if you were carrying a tray of champagne glasses across the room you'd take extra care not to trip up.
During pregnancy, some women experience more painful crises, worsening anaemia or infections. There's also higher risk of acute chest syndrome, blood clots and pregnancy-related high blood pressure.
For the baby, there's a greater chance of slower growth, a lower birth weight or being born prematurely.
Everyones individual risk varies. For some it's smooth sailing, for others it's a storm of all of the above.
And how it goes depends on factors which doctors can identify from your past medical history.
The key idea is that they can then give you a personalised plan to navigate around them.
This is why speaking to your haematology team before you start trying for a baby is so important.
They can review your health and discuss how pregnancy may affect your sickle cell. They can also tag team with a specialist maternity team to cover all the care you'll need.
What about medications?
Hydroxyurea has got to go unfortunately.
But not for the reason you probably think. Hydroxyurea doesn't prevent you from becoming pregnant. However, it's not recommended during pregnancy because of concerns about how it could affect the developing baby.
Before trying for a baby please don't stop taking it and try to manage your sickle cell alone.
Speak to your haematology team so they can tell you when to stop it and create a plan for managing your sickle cell without it.
General advice is to stop 3 months before trying for a baby. Add that to the months it may take to get pregnant, the pregnancy itself and then maybe breastfeeding and it could be a couple of years without it.
So subbing in an alternative effective treatment for that period is really important.
And lastly before you even think about any of this I have to say -
Please ask your partner to have a haemoglobin genotype test from a reliable lab!
This'll help you understand the chance of your baby inheriting sickle cell disease.
(Read when love meets genetics if you and your partner have incompatible genotypes)
Remember, sickle cell can also occur when a sickle gene is combined with another haemoglobin gene, such as haemoglobin C or beta thalassaemia.
To summarise pregnancy with sickle cell isn't risk-free, but there's no need to lose hope.
With the right preparation, support and treatment plan from a specialist team you trust you'll be fine.
Stay Healthy,
Lewis
