Pregnancy with Sickle Cell Disease Requires MFM Referral
Yes, pregnancy with sickle cell disease (SCD) requires referral to and co-management by a Maternal-Fetal Medicine (MFM) specialist. This is a high-risk pregnancy with substantial maternal and fetal morbidity and mortality risks that necessitate specialized care. 1
Why MFM Referral is Essential
For most women at increased risk of maternal morbidity and mortality, referral to an MFM subspecialist is appropriate. 1 SCD pregnancy specifically falls into this high-risk category because:
- Pregnancy increases the rate of SCD-related complications including pain episodes, acute chest syndrome, and maternal death 1
- Maternal complications occur at high rates: 57% experience painful crises, 23% require ICU admission, and there is increased risk of preeclampsia and miscarriage 2
- Fetal complications include low birth weight, small for gestational age, stillbirth (up to 20% fetal mortality in some series), preterm delivery (5-6%), and intrauterine growth restriction due to placental insufficiency 1, 3
- Maternal mortality can reach 11.4% in some reports 3
Multidisciplinary Team Approach Required
When an adolescent or adult with SCD becomes pregnant, co-management by a hematologist with expertise in SCD and a high-risk obstetrician is essential. 1 This multidisciplinary team should include:
- MFM specialist for high-risk obstetrical management 1
- Hematologist experienced in SCD 1, 2
- Anesthesiology for pain crisis management and delivery planning 2
- Access to tertiary care center capabilities 1, 4
Level of Care Considerations
Pregnant patients with SCD should ideally be managed throughout pregnancy, delivery, and postpartum at centers with multidisciplinary teams experienced in treating high-risk diseases. 1 This is similar to recommendations for other complex medical conditions in pregnancy, where tertiary maternal health services are preferred. 4
Timing of Referral
The referral should occur:
- Preconception: When possible, women with SCD should receive preconception counseling from MFM to discuss risks and optimize health before pregnancy 1
- Early pregnancy: If pregnancy is unplanned, MFM referral should occur as soon as pregnancy is confirmed to establish the care plan 1
What MFM Management Provides
MFM specialists coordinate:
- Risk stratification and continuous risk assessment throughout pregnancy 1
- Decisions regarding transfusion therapy (prophylactic vs. on-demand) based on individual risk factors 1
- Monitoring for SCD complications and pregnancy-specific complications 5
- Delivery planning and timing 1
- Postpartum management 4
Common Pitfall to Avoid
Do not manage SCD pregnancy in a standard obstetrical setting without MFM involvement. Even women with milder SCD phenotypes or those without recent complications require specialized monitoring, as pregnancy itself increases the inflammatory and thrombogenic state that promotes vaso-occlusion. 2 The physiological changes of pregnancy (increased metabolic demand, susceptibility to infection, pro-thrombotic state, and aortocaval compression) can precipitate sickle complications even in previously stable patients. 2