A systematic review published in Discover Public Health highlights the significantly higher rates of maternal and perinatal complications among pregnant women with sickle cell disease in Sub-Saharan Africa. The study analyzed previous clinical research, revealing critical gaps in treatment and concerning unexpected risks to this population.
The review included observational studies and clinical trials, focusing on a region representing over 75% of global sickle cell births. It found that pregnant women with sickle cell disease face severe maternal and neonatal complications, centralizing on the physiological challenges that pregnancy imposes on this group. Notably, the researchers pointed out that standard interventions, such as low-dose aspirin, may not be effective and could even pose risks.
Sickle cell disease, a group of genetic disorders caused by mutations in the beta-globin genes, leads to the formation of abnormal hemoglobin S. This condition can cause painful vaso-occlusive crises, increased blood cell destruction, and damage to vital organs. During pregnancy, women’s bodies experience significant changes that can exacerbate sickle cell disease symptoms, leading to recurrent health crises and compromised placental blood flow.
The authors conducted a thorough search of medical databases, including PubMed and the World Health Organization’s Global Index Medicus, up to December 31, 2025. They identified nine studies suitable for the review, which revealed wide discrepancies in maternal and perinatal mortality rates. The studies originated from Nigeria, Ghana, and Côte d’Ivoire, with maternal mortality ranging from zero in certain Nigerian hospitals to 7.5% in others. These figures align with previous reports indicating that maternal mortality in the region can reach 12%.
Among the common complications reported were vaso-occlusive crises and severe anemia. In some cohorts, the incidence of vaso-occlusive crises was as high as 42.9%. Additionally, anemia affected 39.3% to 63.8% of participants, leading to frequent blood transfusions and, in some cases, maternal deaths. Pregnancy-related conditions like hypertension and preeclampsia were reported at rates significantly exceeding those in the general African population.
The review also noted alarming perinatal outcomes, with preterm births occurring in 18.2% to 33.3% of pregnancies. Low birth weights affected 30% to 38% of infants, while stillbirths varied from 10% to 20.4% among mothers with severe sickle cell genotypes. Poor placental health was identified as a major factor contributing to these outcomes, although the studies did not systematically evaluate placental conditions.
One approach that showed promise involved a multidisciplinary care model in Ghana, which resulted in a significant decrease in maternal and perinatal mortality rates after implementation. However, this was based on a single-center, retrospective study, leaving room for uncertainty regarding broader applicability.
Conversely, the review highlighted potential risks associated with routine pharmaceutical interventions. The PIPSICKLE trial from Nigeria indicated that low-dose aspirin did not prevent complications and may have increased maternal death rates among participants, raising questions about its use in this population.
The authors emphasized a lack of data regarding the safety and efficacy of disease-modifying agents like hydroxyurea during pregnancy in Africa. Concerns over potential risks have limited its prescription despite evidence from various studies suggesting its benefits.
In conclusion, the review underscores that substantial evidence gaps hinder effective clinical decision-making for pregnant women with sickle cell disease in Sub-Saharan Africa. The limited geographic scope of existing studies necessitates further comprehensive, multicenter trials and community-based research to improve maternal and neonatal health outcomes in this vulnerable population.
