Managing sickle cell disease and related complications in pregnancy: results of an international Delphi panel.

Data to guide evidence-based management of pregnant people with sickle cell disease (SCD) is limited. This international Delphi panel aimed to identify consensus among multidisciplinary experts for SCD management during pregnancy. The two-round Delphi process used questionnaires exploring seven topics (antenatal care, hydroxyurea use, transfusion, prevention of complications, treatment of complications, delivery and follow-up, and bottlenecks and knowledge gaps) developed by a steering committee. Thirteen panelists (hematologists, physiologists, obstetricians, maternal fetal medicine and transfusion medicine physicians) from the US, the UK, Turkey and France completed the first survey; 12 panelists completed the second round. Anonymized responses were collected and summarized by a contract research organization (Akkodis Belgium). Consensus/strong consensus was predefined as 75%-90% (9-10/12)/>90% (≥11/12) of panelists agreeing or disagreeing on a response to a predefined clinical scenario or statement. In several areas of SCD management, consensus was achieved: experts recommended performing at least monthly multidisciplinary antenatal follow-up, administering prophylactic aspirin for preeclampsia prevention between gestational weeks 12-36, initiating prophylactic transfusion therapy in certain cases, or choosing automated red blood cell exchange over other transfusion methods in patients with iron overload or severe acute chest syndrome. No consensus was reached on several topics including the prophylactic aspirin dose, indications for starting infection prophylaxis, routine use of prophylactic transfusions, or use of prophylactic transfusions for preventing fetal complications. These recommendations could inform clinical care for pregnant SCD patients in the absence of large clinical trials involving this population; the identified knowledge gaps can orient future research.