Management of sickle cell disease during pregnancy: experience in a third-level hospital and future recommendations

Montironi, Rodolfo; Cupaiolo, Roberto; Kadji, Caroline; Badr, Dominique A.; Deleers, Marie; Charles, Valérie; Vanderhulst, Julien; Kenz, Hanane El; Jani, Jacques

doi:10.1080/14767058.2020.1786054

Cited by 8 publications

(12 citation statements)

References 38 publications

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“…In a 28–year‐old patient with thrombocythemia who had previously experienced two stillbirths without hydroxyurea treatment, 1–2 g/day hydroxyurea treatment during the first 6 weeks of her third gestation resulted in a successful delivery of a healthy boy 68 . These findings are supportive of the potential use of hydroxyurea treatment during pregnancy to improve quality of life and pregnancy outcomes in patients with SCA 27 . In their education handbook geared toward patients, the American Society of Hematology wrote that “some women choose to stop taking hydroxyurea early in their pregnancy and then start it again during the third trimester (after 29 weeks)” to improve maternal health and fetal outcomes 72…”

Section: Clinical Case Reports Of Hydroxyurea Treatment During Pregnancymentioning

confidence: 57%

“…As aforementioned, an increasing number of patients with SCA can now survive to childbearing age. Mounting evidence indicates that pregnancy with SCA is high risk and associated with increased morbidity and mortality for both mother and fetus 3,27–32 . One of the first studies reporting maternal and fetal outcomes in patients with SCA is a multicenter study conducted in the United Kingdom during 1991–1993 32 .…”

Section: Sca and Pregnancymentioning

confidence: 99%

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Hydroxyurea treatment for sickle cell anemia during pregnancy and lactation: Current evidence and knowledge gaps

et al. 2023

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Sickle cell anemia (SCA) is a life‐threatening genetic condition contributing to high‐risk pregnancies affecting both the mother and fetus. With improved management of children with SCA, this life‐threatening hematological disorder has evolved into a chronic disease of adults, and consequently parenthood has now become a possible and important life goal for many patients. Providing continuous management with healthy red blood cell function and avoiding SCA‐associated complications, such as pain crises, acute chest syndrome, and stroke, are crucial for a healthy pregnancy. Despite its excellent safety profile in non‐pregnant adults and children, and based on theoretical concerns derived from data using animal models and supraphysiological dosing, hydroxyurea is currently contraindicated for pregnant and lactating women with SCA. Clinical experience of hydroxyurea use during pregnancy is increasingly reported, however, and has shown inconsistent results of fetal or infant adverse effects. How the hydroxyurea exposure level may correlate with pregnancy outcomes is still unclear. Accordingly, efforts should be made to systemically evaluate exposure and safety of hydroxyurea treatment during pregnancy and lactation. Novel approaches such as physiologically based pharmacokinetic (PBPK) modeling, coupled with the ex vivo human placental cotyledon perfusion assay, provide opportunities to understand hydroxyurea exposure not only in pregnant women but also in the developing fetus. Combined with animal data, research using these approaches might be able to define safe and effective hydroxyurea dosing regimens for pregnant and lactating women with SCA, when the benefits of continuing hydroxyurea treatment likely outweigh the risks of non‐treatment, by avoiding substantial morbidity and even mortality for both mothers and infants.

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Section: Clinical Case Reports Of Hydroxyurea Treatment During Pregnancymentioning

confidence: 57%

Section: Sca and Pregnancymentioning

confidence: 99%

Hydroxyurea treatment for sickle cell anemia during pregnancy and lactation: Current evidence and knowledge gaps

et al. 2023

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“…35,36 A case series of pregnant patients discontinued hydroxyurea during the first trimester only with no major teratogenic effects. 37 These reports demonstrate that hydroxyurea use may not be as toxic during pregnancy as originally thought. However, larger studies are still needed to definitively rule out the potential risk.…”

Section: Hydroxyureamentioning

confidence: 82%

Incorporation of novel therapies for the management of sickle cell disease: A pharmacist's perspective

Dela-Pena

King

Brown

et al. 2022

J Oncol Pharm Pract

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Patients with sickle cell disease (SCD) experience significant disease-related morbidity including multiorgan damage, chronic anemia, and debilitating pain crises. While hydroxyurea has been the primary disease modifying modality in SCD, novel therapies with unique mechanism of action have recently been approved. This review article examines the evidence surrounding the available SCD therapies to guide pharmacists on potential treatment selection and management strategies for patients with SCD. A systematic search of online databases was performed to identify literature on the management of SCD. While the newly approved novel agents have demonstrated clinical benefit it remains unclear how these agents fit into the treatment paradigm. Pharmacists should be aware of the data supporting the use of these novel agents to optimize use on a patient-specific basis.

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“…However, the current recommendation is to discontinue the use of HU during pregnancy due to the lack of evidence about its safety during this period and is also a current recommendation in Brazil [15,19]. Despite this, Montironi et al [6] proposed a protocol to treat SCD pregnant women using HU after the 2 nd or 3 rd trimester according to the patients sickle cell history and the severity of the disease.…”

Section: Discussionmentioning

confidence: 99%

“…However, during pregnancy, the use of HU is not recommended [5,6]. Studies in animals have shown that the use of HU during pregnancy has been shown to be potentially teratogenic in mammalian pregnancy due to its ability to initiate damage to genetic material [7,8].…”

Section: Introductionmentioning

confidence: 99%

The Use of Hydroxyurea During Pregnancy in Sickle Cell Anemia Women: A Case Series and Literature Review

et al. 2021

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Hydroxyurea (HU) has been an effective treatment for sickle cell anemia (SCA) by inducing fetal hemoglobin production as well as reducing the rate of painful crisis. The use of HU during pregnancy still has been a concerned situation due to the risk of malformation, but there is already a proposal for the possibility of the use, even during pregnancy, depending on the situation of the disease. On the other side, the potential of HU for mutagenesis and teratogenesis in humans has not been confirmed yet. This case series describe the perinatal outcomes on women at a Women's Care Center in Recife, Brazil. Women used HU early in their pregnancies and no record of malformation was report. Our sample was composed of 13 SCA women using HU just before or during pregnancy. Of these women, 4 had gotten pregnant twice by using HU and for this we have analyzed a total of 17 cases. There were no reports on malformation in any of these cases. In the literature review, we found seven studies on the use of HU in pregnancy and only one of these studies reported malformation in a fetus. We concluded that HU usage and teratogenic effects has not been confirmed in humans yet and suggested to await results of well-controlled studies to define the use of HU as a treatment for vasooculsive crises during pregnancy. Thus, we consider that this publication could be added to other cases in which have been already published where fetal malformation has not been registered yet.

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Management of sickle cell disease during pregnancy: experience in a third-level hospital and future recommendations

Cited by 8 publications

References 38 publications

Hydroxyurea treatment for sickle cell anemia during pregnancy and lactation: Current evidence and knowledge gaps

Hydroxyurea treatment for sickle cell anemia during pregnancy and lactation: Current evidence and knowledge gaps

Incorporation of novel therapies for the management of sickle cell disease: A pharmacist's perspective

The Use of Hydroxyurea During Pregnancy in Sickle Cell Anemia Women: A Case Series and Literature Review

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