Pregnancy in individuals with sickle cell disease (SCD) presents substantial risks to maternal and fetal health, characterized by an increased likelihood of vaso-occlusive crises and thromboembolic complications. Hydroxyurea (HU), a medication demonstrating improved health outcomes in SCD, is limited in its use during pregnancy due to concerns of teratogenicity based on animal studies. Recent scrutiny suggests the possibility of overestimating the teratogenic effects of HU, as the dosages and administration methods in animal studies differ from clinical practice. Additionally, several case studies and case series have reported minimal occurrences of fetal malformations or adverse outcomes in pregnancies involving HU. Consequently, there is a need for further research for managing SCD-associated pregnancy, considering the potential benefits and risks associated with medications such as HU, with the aim of optimizing maternal and fetal health outcomes. This systematic review and early stages of meta-analysis aim to address the gap in the literature by compiling available data on the use of HU at any stage of pregnancy and the subsequent maternal-fetal outcomes. The primary objective is to evaluate whether the perceived teratogenic effects of HU have been overestimated and whether its utilization could potentially reduce the incidence of maternal-fetal complications. In conclusion, the baseline maternal and fetal outcomes associated with SCD pose significant challenges globally, with a pronounced impact observed in low- and middle-income countries. The current guidelines for managing SCD-associated pregnancy lack efficacy, emphasizing the need for extensive research to generate reliable data. By examining the effects of HU during pregnancy, this systematic review and early stages of meta-analysis aim to provide critical insights to improve clinical decision-making and add to the existing literature regarding the safety of HU in pregnancy.
Barbera, Julie, "Teratogenic or Therapeutic? A Systematic Review of Hydroxyurea Use in Pregnancy" (2023). Master of Public Health Capstone Presentations. Presentation 493.