1 Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy.
2 Department of Pediatrics, University of Alexandria, Alexandria, Egypt.
3 Department of Haematology, College of Medicine and Health Sciences, Sultan Qaboos University, Sultanate of Oman.
4 Antalya Genetic Diseases Center, Antalya, Turkey.
5 Emeritus Director in Pediatrics, Children’s Hospital “Santobono-Pausilipon,” Naples, Italy.
6 First Department of Paediatrics, National Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Athens, Greece.
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with sickle cell disease (SCD) are of particular concern regarding the
significantly increased risk of pregnancy-related morbidity, mortality,
and adverse outcomes. They have limited knowledge of pregnancy and
childbirth risks, as well as of the benefits and risks of
contraceptives. Thus, there is an urgent need for appropriate
information about reproductive family planning to reduce unintended
pregnancy. Any decision regarding the use of contraceptives has to be
based on the efficacy and risk/benefit ratio of the method used. Both
the World Health Organization (WHO) and the Centers for Disease Control
(CDC) have developed, published, and updated evidence-based guidelines
for medical providers for the use of contraceptives in patients with
specific medical chronic conditions. This article provides an overview
of the present knowledge on the use of contraceptives in women with
SCD. We believe that the collaboration between health care
professionals (hematologists, obstetricians, endocrinologists, and
primary care providers) can play a major role in identifying the safer
contraceptive method to abolish the risks of unintended pregnancy and
preserve the health status of patients with SCD.
A. Clinical Implications and Hormonal Contraception in General Practice
B. Overview of Hormonal Contraceptive Choices
|Table 1. Summary of available options for hormonal contraception in adolescent and young adult women.|
C. Overview of Contraceptive Practices Followed by Women with SCD and Treatment Safety
|Table 2. Clinical, metabolic and coagulation changes associated with contraception in adolescent and young adult women with sickle cell disease. Review of the literature from 2014 to 2020.|
D. Medical Eligibility Contraception (MEC) Recommendations
|Table 3. General risk conditions that may have an impact on eligibility criteria for contraceptive use (From ref. 60 - modified).|
|Table 4. Medical eligibility for initiating and continuing combined hormonal contraception: Absolute and relative contraindications (From ref. 59 - modified).|
|Table 5. Medical eligibility for initiating and continuing progestogen-only contraception: Absolute and relative contraindications (From ref. 59 - modified).|
|Table 6. Medical eligibility for initiating and continuing intrauterine device contraception: Absolute and relative contraindications (From ref. 59 - modified).|
E. Reproductive Medical Counselling
Conclusions and Recommendations