WHO recommendations on the management of sickle cell disease during pregnancy, childbirth and the interpregnancy period: web annex: evidence-to-decision frameworks
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World Health Organization
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[v], 178 p.
This web annex accompanies the WHO recommendations on the management of sickle cell disease during pregnancy, childbirth and the interpregnancy period and presents the evidence-to-decision frameworks that informed guideline development. The document examines interventions related to medication management, pain management, fluid management, thromboprophylaxis, fetal monitoring, timing and mode of birth, and interpregnancy care for women with sickle cell disease. It synthesizes evidence from systematic reviews, randomized and non-randomized studies, qualitative evidence syntheses and economic analyses to assess the benefits, harms, acceptability, feasibility, resource implications and equity considerations associated with different interventions. The publication highlights the increased maternal and perinatal risks associated with sickle cell disease, including vaso-occlusive crises, hypertensive disorders, preterm birth and fetal growth restriction. It evaluates available evidence on interventions such as prophylactic transfusion, iron supplementation, hydroxyurea, thromboprophylaxis and infection prevention, while emphasizing the generally low or very low certainty of evidence for many outcomes. The annex also considers implementation challenges in low- and middle-income settings, including access to safe blood products, specialized care, training and infrastructure, and supports transparent, evidence-informed decision-making in maternal and newborn health policy and clinical practice.
This web annex accompanies the WHO recommendations on the management of sickle cell disease during pregnancy, childbirth and the interpregnancy period and presents the evidence-to-decision frameworks that informed guideline development. The document examines interventions related to medication management, pain management, fluid management, thromboprophylaxis, fetal monitoring, timing and mode of birth, and interpregnancy care for women with sickle cell disease. It synthesizes evidence from systematic reviews, randomized and non-randomized studies, qualitative evidence syntheses and economic analyses to assess the benefits, harms, acceptability, feasibility, resource implications and equity considerations associated with different interventions. The publication highlights the increased maternal and perinatal risks associated with sickle cell disease, including vaso-occlusive crises, hypertensive disorders, preterm birth and fetal growth restriction. It evaluates available evidence on interventions such as prophylactic transfusion, iron supplementation, hydroxyurea, thromboprophylaxis and infection prevention, while emphasizing the generally low or very low certainty of evidence for many outcomes. The annex also considers implementation challenges in low- and middle-income settings, including access to safe blood products, specialized care, training and infrastructure, and supports transparent, evidence-informed decision-making in maternal and newborn health policy and clinical practice.
Keywords
Pregnancy, Pregnant People, Delivery, Obstetric, Hematologic Diseases, Anemia, Sickle Cell, Pregnancy Complications, Hematologic, Prenatal Care, Labor, Obstetric, Parturition, Postpartum Period, Evidence-Based Practice, Risk Assessment, Pain Management, Thrombosis, Fluid Therapy, Fetal Monitoring, Guidelines as Topic, prevention and control, complications, therapy, methods, standards