The Heat Is On: Climate Change Implications for Pregnant Women with Sickle Cell Disease.

Abstract

Sickle cell disease (SCD), a serious, chronic blood disorder is the most common genetic blood disease in the United States affecting 100,000 people and disproportionately affecting the African American population. Pregnancy is particularly risky for people with SCD due to higher risk of developing pregnancy-related complications compared with people without the disease. For African American pregnant women with SCD, the risk of maternal morbidity and mortality is up to 10 times higher. Physiological changes during pregnancy increase the risk of vaso-occlusive episodes (VOEs), acute chest syndrome, venous thromboembolic events, and infections. Dehydration increases risk as it triggers sickling of red blood cells, leading to painful VOEs and further increasing the risk of aforementioned complications. Climate change, observed since the mid-20th century, is evidenced by the increasing trend of global temperature, hurricanes, floods, and heat waves. Climate changes can profoundly impact people with SCD, as elevated temperatures result in increased core body temperatures, blood hyperosmolality, and dehydration. Assisted by a research librarian, a literature search was undertaken of major databases (PubMed, Embase, and Google Scholar), with delimiters of publication between 2019 and 2024 and human subjects, and 477 studies were retrieved. After meticulous screening, 20 relevant articles were analyzed. Evidence linking climate change impact to increased risk for pregnant people with SCD is lacking. Further research is needed to examine the phenomenon and mitigate this unique risk of climate change. SCD clinical guidelines stress the importance of preventing dehydration. Clinicians play a critical role in educating this vulnerable population about risks, including dehydration and exposure to extreme heat.