WHO Releases First Global Guidelines to Improve Pregnancy Care for Women with Sickle Cell Disease
The World Health Organization (WHO) has released its first global guideline for the management of sickle cell disease (SCD) in pregnancy. This initiative seeks to address a maternal and infant health issue. SCD is a common inherited blood disorder involving crescent- shaped red blood cells that can block blood flow and cause dire health outcomes. The risk of mortality increases with SCD in pregnancy and pregnant women who suffer from the disease have higher rates of obstetric emergencies than those without SCD.
Sickle Cell Disease with its Effects
Sickle cell disease is an inherited blood disease. It causes red blood cells to become rigid and sickle-shaped, and these cells can block blood flow from blood vessels. Symptoms of SCD include severe pain, anaemia, and susceptibility to infections. Depending on prevalence, SCD can be found in high incidence in malaria endemic locations. Most cases of SCD are in sub-Saharan Africa.
Risks Associated with Pregnancy
Pregnancy poses additional risks for SCD disease women. Compared to women without SCD, these women have five- fold increased risk of dying during and after pregnancy. Hypertensive disorders of pregnancy, pre-eclampsia, and outcomes for their babies like still birth and low birth weight are very common in SCD pregnant women. WHO would like to initiate better outcomes with targeted care offered by using the WHO guidelines.
WHO Guidelines
The new WHO guidelines contain more than 20 recommendations based on current evidence and these recommendations include areas of focus are folic acid and iron supplementation, management of pain crises, infection prevention, safeguarding women with sickle cell disease against social stigma, encouraging individualised care that respects women’s needs.
Multidisciplinary Care is Important
Providing care for SCD during pregnancy requires a team of healthcare professionals experienced in treating SCD. This team could be composed of haematologists, obstetricians, midwives, and possibly paediatricians. Each professional on a multidisciplinary team will provide comprehensive care and assist in the decision-making process for women living with SCD.
Research and Development Needs
Research investment in sickle cell disease (SCD) remains under developed and unfunded, especially as it relates to pregnant and breastfeeding women. The WHO has called for more controlled clinical trials to evaluate the safety and efficacy of treatment options for these populations. This guideline is part of a broader effort to combat noncommunicable diseases in pregnancy.
Government Initiatives – India
In India, the government has initiated the National Sickle Cell Anaemia Eradication Mission, screening millions of individuals as well as developing additional treatment options. A government investment was announced to aid the development of drugs to treat SCD; this is particularly important for tribal populations who are disproportionately affected by SCD.
Future Directions
The WHO guideline creates a framework to begin a series of guidelines focusing on management of chronic diseases in pregnancy. Future guidelines are expected to include many different conditions, given the increasing burden of chronic disease in maternal and neonatal health.