WHO Issues Global Guideline for Managing Sickle Cell in Pregnancy

The guideline comes at a time when the prevalence and impact of SCD are increasing globally, particularly in regions where access to specialized maternal care remains limited.

In a milestone step toward addressing a critical global health challenge, the World Health Organization (WHO) has issued its first-ever global guideline for the management of sickle cell disease (SCD) during pregnancy. The newly released document offers comprehensive, evidence-based recommendations tailored to both high- and low-resource settings, addressing a long-standing gap in maternal healthcare for women living with this inherited blood disorder.

The guideline comes at a time when the prevalence and impact of SCD are increasing globally, particularly in regions where access to specialized maternal care remains limited.

Understanding Sickle Cell Disease and Its Risks During Pregnancy

SCD is a group of genetic blood disorders that primarily affect hemoglobin, the oxygen-carrying component of red blood cells. The condition causes red blood cells to become abnormally shaped like crescents or sickles, making them rigid and prone to blocking blood flow. This leads to a cascade of complications, including severe anemia, frequent pain episodes, organ damage, and increased susceptibility to infections.

For pregnant women with SCD, the risks are significantly heightened. Due to increased oxygen and nutritional demands during pregnancy, complications can arise swiftly and with severe consequences. Women with SCD are 4 to 11 times more likely to die during pregnancy than women without the disease. They are also at increased risk of preeclampsia, stillbirth, premature delivery, and low birth weight in infants.

“The challenges are significant, but with access to quality health care, women with SCD can experience safe pregnancies and healthy births,” said Dr Pascale Allotey, Director for Sexual and Reproductive Health and Research at WHO.

A Global Health Priority

The WHO estimates that more than 7.7 million people are living with SCD globally, a figure that has risen by over 40% since 2000. SCD is responsible for an estimated 375,000 deaths annually, and disproportionately affects people in malaria-endemic regions such as sub-Saharan Africa, where around 80% of global cases occur. The disease is also common in parts of the Middle East, South Asia, and the Caribbean, and is now emerging in non-endemic regions due to increased population migration and life expectancy improvements.

Despite its increasing prevalence, SCD remains one of the most neglected and underfunded health conditions globally. The WHO's new guideline represents a turning point in recognizing the condition’s impact on maternal and newborn health and the urgent need for standardized care practices.

Key Recommendations in the New Guideline

The WHO guideline provides over 20 clinical recommendations, covering a wide spectrum of interventions aimed at reducing maternal and neonatal risks associated with SCD. These include:

• Folic acid and iron supplementation, with region-specific guidance for malaria-endemic areas

• Pain management and crisis intervention protocols tailored to pregnant patients

• Infection and blood clot prevention, including the use of antibiotics and anticoagulants where appropriate

• Prophylactic blood transfusions to manage anemia and reduce complications

• Enhanced monitoring of both maternal and fetal health throughout pregnancy

Importantly, the guideline emphasizes individualized, respectful care, calling on healthcare providers to tailor support to each woman’s medical history, preferences, and risk factors. It also underscores the critical need to combat discrimination and stigma in healthcare settings, which often impedes proper care for women with SCD.

“It’s essential that women with SCD can access care and discuss treatment options early, ideally before conception,” said Dr Doris Chou, WHO Medical Officer and lead author of the guideline. “Empowering them with knowledge and involving experienced providers in their care is key to positive outcomes.”

The Call for Specialized Care and Better Research

Given the complexity of SCD, the guideline stresses the importance of involving a multidisciplinary team in the care of pregnant women. This may include hematologists, obstetrician-gynecologists, midwives, and pediatricians with expertise in both chronic disease and reproductive health.

Additionally, the guideline highlights the severe lack of clinical research on SCD treatments for pregnant and breastfeeding women—groups historically excluded from clinical trials. WHO calls for urgent investment in research and development to address this evidence gap and improve health outcomes for this underserved population.

A Broader Agenda on Noncommunicable Diseases in Pregnancy

This SCD guideline marks the beginning of a broader WHO initiative to address noncommunicable diseases (NCDs) in pregnancy. Future guidelines in this new series will focus on conditions such as cardiovascular disease, diabetes, mental health disorders, respiratory illness, and substance use, all of which are increasingly recognized as major contributors to maternal and neonatal morbidity and mortality worldwide.

A Call to Action

As WHO sets a new benchmark in global maternal healthcare, the message is clear: No woman should be left behind due to a preventable or manageable condition. The new guideline offers countries and care providers the tools to save lives, improve outcomes, and ensure that women with SCD receive the respectful, skilled care they deserve throughout pregnancy.

“More investment is urgently needed,” said Dr Allotey, “to expand access to diagnosis, high-quality care, and evidence-based treatment for this long-neglected disease.”