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Blood Diseases and Pregnancy

Sickle Cell Disease and Thalassemia

By Jennifer Lacey

According to Ira Bragg-Grant, executive director of the ASCAA, this is an extremely important step that all couples attempting to conceive a child should make. "Quite certainly, genetic counseling, education and testing are excellent components to prenatal health and family planning," says Bragg-Grant.

Radhika Sawh, national director of patient services for the Cooley's Anemia Foundation agrees. "Genetic counseling is absolutely mandatory if a couple decides to get pregnant," says Sawh.

A genetic counselor can help refer a couple for testing, which includes a blood test called hemoglobin electrophoresis. Adrena Johnson-Telfair, a certified physician assistant and former associate director of clinical services at the University of Alabama Comprehensive Sickle Cell Center in Birmingham, Ala., says this test should be performed on both prospective parents.

Proper prenatal care from an obstetrician who handles high-risk pregnancies, as well as continued visits to a hematologist, are necessary for a pregnant woman with sickle cell disease or thalassemia.

This is especially important for women with thalassemia, says Dr. Bridges. "Only recently have women with thalassemia major been able to become pregnant, because the iron overload interferes with ovulation," says Dr. Bridges. "Those who do become pregnant are followed closely, as are mothers with sickle cell disease."

The intake of folic acid in healthy women prior to conception and during pregnancy is important in preventing newborn neural tube defects. For women with sickle cell disease or thalassemia, it's even more important because their red blood cells are destroyed faster than normal. "Destruction of red cells causes loss of folic acid," says Dr. Bridges. "Folic acid deficiency during pregnancy can exacerbate anemia, sometimes to life-threatening degrees."

Complications that arise during pregnancy in normal healthy women often occur in higher rates for women with sickle cell disease or thalassemia. They are at risk for going into premature labor/delivery, and the baby may be born with a low birth weight. High blood pressure and the possibility of developing gestational diabetes are also risks that may face these moms-to-be.

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• Talk about it!