PREGNANCY CARE AND OUTCOMES IN SICKLE CELL DISEASE: A SYSTEMATIC REVIEW MAPPED AGAINST THE WHO 2025 GLOBAL GUIDELINE

Background: Sickle cell disease (SCD) disproportionately impacts pregnancies in sub-Saharan Africa, but the World Health Organization (WHO) released its first global guidance for SCD in pregnancy in 2025. There is limited systematic evidence to support the outcomes of pregnancy in high-burden settings that meet these new recommendations.
Objective: To review and summarise existing evidence of maternal and perinatal outcomes in pregnancies complicated by SCD and to match reported care processes with the WHO 2025 recommendations.
Methods: This systematic review was conducted with a structure–process–outcome framework, according to PRISMA 2020. Observational studies and systematic reviews were identified from January 2015 to December 2025, using PubMed, Embase, Web of Science and Global Health. Studies reporting maternal or perinatal outcomes in women with HbSS/HbSC were eligible. Findings were synthesized narratively and plotted on the WHO recommendations 1a–1g.
Results: Fifteen sources were included: nine observational studies (7,579 SCD pregnancies or deliveries) and six evidence syntheses. SCD was consistently associated with elevated risks of preeclampsia (risk ratio [RR] 2.01, 95% CI 1.93–2.09), eclampsia (RR 2.62, 95% CI 2.35–2.92), venous thromboembolism (RR 10.79, 95% CI 9.52–12.22), and low birth weight (RR 1.85, 95% CI 1.75–1.96). The data from Nigeria revealed maternal mortality rates ranging from 0.3% to 20% and caesarean rates ranging from 21.6% to 80%. The mapping of guidelines identified a consistent lack of documentation for folic acid dosing, conditional iron supplementation, continuation of hydroxycarbamide, and assessment of thromboprophylaxis.
Conclusion: SCD in pregnancy is associated with substantially elevated risks of hypertensive disorders, thromboembolism, and adverse perinatal outcomes. There are important gaps in the evidence base on guideline-concordant care processes. Standardised outcome and process measures are much needed in prospective studies.