{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T09:08:06Z","timestamp":1789117686965,"version":"build-2803163510"},"reference-count":32,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Sickle cell thalassemia (HbS\u03b2-thal) and related sickle cell disease (SCD) genotypes are associated with substantial maternal, fetal, and neonatal morbidity during pregnancy. This systematic review aimed to summarize pregnancy outcomes and clinical management strategies in women with HbS\u03b2-thal and related hemoglobinopathies, with an additional narrative comparison to sickle cell trait (SCT)\u2014a distinct, heterozygous, and generally benign carrier state that is not a form of SCD. Methods: A systematic literature search was conducted in PubMed, MEDLINE, Web of Science, EMBASE, and Scopus for studies published between 2016 and 2026 using terms related to sickle cell anemia, sickle cell disease, sickle cell thalassemia, HbS\/beta-thalassemia, sickle cell trait, pregnancy outcomes, maternal complications, neonatal outcomes, fetal outcomes, and clinical\/obstetric management. Studies reporting maternal, fetal, or neonatal outcomes were included, while letters, commentaries, conference abstracts, and presentations were excluded. Study selection followed PRISMA principles. Risk of bias was assessed using appropriate tools according to study design, including the Newcastle\u2013Ottawa Scale (NOS), AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews), SANRA (Scale for the Assessment of Narrative Review Articles), and CARE (CAse REport) guidelines. SCT terms were included in the same search strategy, so that SCT studies were retrieved and screened through the same PRISMA process and are reported as a prespecified comparator subgroup. Results: Fourteen studies met the inclusion criteria: ten reporting outcomes in HbS\u03b2-thal and related SCD genotypes and four reporting outcomes in SCT. The most frequently reported maternal complications were severe anemia, vaso-occlusive crises (VOCs), preeclampsia, thromboembolic events, infections, acute chest syndrome, cesarean delivery, and postpartum complications, which led to a significant increase in hospitalization rates. Fetal and neonatal outcomes were also unfavorable, with increased rates of preterm birth, low birth weight, intrauterine growth restriction, placental insufficiency, and neonatal intensive care admission. Placental vascular malperfusion and low maternal hemoglobin were important mechanisms underlying fetal growth restriction. By contrast, the included SCT literature suggested outcomes generally closer to the general obstetric population, with a smaller number of specific associations (e.g., preeclampsia, intrauterine fetal death) reported inconsistently across studies. Conclusions: Pregnancies complicated by HbS\u03b2-thal and related hemoglobinopathies remain high-risk and require early identification, preconception counseling, multidisciplinary care, close antenatal surveillance, individualized transfusion strategies, and postpartum thromboprophylaxis when indicated. Prospective genotype-specific studies, particularly isolating HbS\u03b2-thal from broader SCD cohorts, are needed to optimize evidence-based management.<\/jats:p>","DOI":"10.3390\/diagnostics16182933","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T08:17:42Z","timestamp":1789114662000},"page":"2933","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Implications of Sickle Cell Thalassemia on Pregnancy Outcomes: A Systematic Review"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9296-3688","authenticated-orcid":false,"given":"Angeliki","family":"Gerede","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Democritus University of Thrace, 691 00 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofoklis","family":"Stavros","sequence":"additional","affiliation":[{"name":"Third Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, University General Hospital\u00a0\u201cATTIKON\u201d,  124 62 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7716-1521","authenticated-orcid":false,"given":"Anastasios","family":"Potiris","sequence":"additional","affiliation":[{"name":"Third Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, University General Hospital\u00a0\u201cATTIKON\u201d,  124 62 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2177-953X","authenticated-orcid":false,"given":"Efthymios","family":"Oikonomou","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Democritus University of Thrace, 691 00 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2990-640X","authenticated-orcid":false,"given":"Chrysi","family":"Christodoulaki","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Chania General Hospital \u201cSt. George\u201d, 733 00 Chania, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aikaterini-Lydia","family":"Vogiatzoglou","sequence":"additional","affiliation":[{"name":"Third Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, University General Hospital\u00a0\u201cATTIKON\u201d,  124 62 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5895-6887","authenticated-orcid":false,"given":"Christos","family":"Chatzakis","sequence":"additional","affiliation":[{"name":"Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, \u201cAretaieion\u201d University Hospital, 115 28 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8899-3040","authenticated-orcid":false,"given":"Ekaterini","family":"Domali","sequence":"additional","affiliation":[{"name":"First Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, Alexandra Hospital, 115 28 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikoletta","family":"Koutlaki","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Democritus University of Thrace, 691 00 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4967-2505","authenticated-orcid":false,"given":"Makarios","family":"Eleftheriadis","sequence":"additional","affiliation":[{"name":"Second Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, \u201cAretaieion\u201d University Hospital, 115 28 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1055\/s-0042-1742314","article-title":"Main Complications during Pregnancy and Recommendations for Adequate Antenatal Care in Sickle Cell Disease: A Literature Review","volume":"44","author":"Figueira","year":"2022","journal-title":"Rev. Bras. De Ginecol. E Obs."},{"key":"ref_2","first-page":"e41165","article-title":"A Comprehensive Review of Pregnancy in Sickle Cell Disease","volume":"15","author":"Shegekar","year":"2023","journal-title":"Cureus"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.18203\/2320-1770.ijrcog20231256","article-title":"Pregnancy in sickle cell thalassemia: Double trouble!","volume":"12","author":"Sunanda","year":"2023","journal-title":"Int. J. Reprod. Contracept. Obs. Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1111\/bjh.17671","article-title":"Management of sickle cell disease in pregnancy. A British Society for Haematology Guideline","volume":"194","author":"Pavord","year":"2021","journal-title":"Br. J. Haematol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1007\/s00277-021-04697-4","article-title":"Pregnancy outcome in women with transfused beta-thalassemia in France","volume":"101","author":"Virot","year":"2022","journal-title":"Ann. Hematol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Habibi, A., Cannas, G., Bartolucci, P., Voskaridou, E., Joseph, L., Bernit, E., Gellen-Dautremer, J., Charneau, C., Ngo, S., and Galact\u00e9ros, F. (2023). Outcomes of Pregnancy in Sickle Cell Disease Patients: Results from the Prospective ESCORT-HU Cohort Study. Biomedicines, 11.","DOI":"10.3390\/biomedicines11020597"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"9069054","DOI":"10.1155\/2016\/9069054","article-title":"Pregnancy in Sickle Cell Disease Is a Very High-Risk Situation: An Observational Study","volume":"2016","author":"Elenga","year":"2016","journal-title":"Obstet. Gynecol. Int."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"E328","DOI":"10.1002\/ajh.25643","article-title":"Third trimester and early postpartum period of pregnancy have the greatest risk for ACS in women with SCD","volume":"94","author":"Asare","year":"2019","journal-title":"Am. J. Hematol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"340","DOI":"10.5005\/jp-journals-10006-1724","article-title":"A prospective study to compare the maternal and fetal outcomes among sickle cell disease and trait women","volume":"11","author":"Dora","year":"2019","journal-title":"J. South Asian Fed. Obstet. Gynaecol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1111\/bjh.20009","article-title":"Maternal and perinatal outcomes of sickle cell disease in pregnancy: A nationwide study in France","volume":"206","author":"Corsia","year":"2025","journal-title":"Br. J. Haematol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"E346","DOI":"10.1055\/s-0039-1695743","article-title":"Adverse Pregnancy Outcomes in Women with Sickle Cell Trait","volume":"9","author":"Wellenstein","year":"2019","journal-title":"AJP Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1111\/aogs.14622","article-title":"Association of sickle cell trait with adverse pregnancy outcomes in a population-based cohort","volume":"102","author":"Hulsizer","year":"2023","journal-title":"Acta Obstet. Et Gynecol. Scand."},{"key":"ref_13","first-page":"e28610","article-title":"Sickle Cell Trait and Adverse Pregnancy Outcomes: Is There a Link?","volume":"14","author":"Buhusayyen","year":"2022","journal-title":"Cureus"},{"key":"ref_14","first-page":"e2023002","article-title":"Adverse Pregnancy Outcomes in Sickle Cell Trait: A Prospective Cohort Study Evaluating Clinical and Haematological Parameters in Postpartum Mothers and Newborns","volume":"15","author":"Ali","year":"2023","journal-title":"Mediterr. J. Hematol. Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s12959-018-0179-z","article-title":"Sickle cell disease, sickle trait and the risk for venous thromboembolism: A systematic review and meta-analysis","volume":"16","author":"Noubiap","year":"2018","journal-title":"Thromb. J."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Pintova, S., Cohen, H.W., and Billett, H.H. (2013). Sickle Cell Trait: Is There an Increased VTE Risk in Pregnancy and the Postpartum?. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0064141"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"B11","DOI":"10.1016\/j.ajog.2020.04.032","article-title":"Society for Maternal-Fetal Medicine Consult Series #51: Thromboembolism prophylaxis for cesarean delivery","volume":"223","author":"Pacheco","year":"2020","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1136\/thoraxjnl-2019-213796","article-title":"Pulmonary complications for women with sickle cell disease in pregnancy: Systematic review and meta-analysis","volume":"75","author":"Inparaj","year":"2020","journal-title":"Thorax"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1111\/bjh.16518","article-title":"Pregnancy in sickle cell trait: What we do and don\u2019t know","volume":"190","author":"Wilson","year":"2020","journal-title":"Br. J. Haematol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.ijgo.2006.02.007","article-title":"Sickle cell disease and pregnancy in Bahrain","volume":"93","author":"Rajab","year":"2006","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_21","first-page":"e64995","article-title":"Pregnancy Outcomes Among Women with Sickle Cell Disease in Bahrain: A Case-Control Study","volume":"16","author":"Marhoon","year":"2024","journal-title":"Cureus"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"5299","DOI":"10.18203\/2320-1770.ijrcog20175232","article-title":"Fetomaternal outcome in sickle cell hemoglobinopathy in a tertiary care centre of North Kerala, India","volume":"6","author":"Kalam","year":"2017","journal-title":"Int. J. Reprod. Contracept. Obs. Gynecol."},{"key":"ref_23","first-page":"857","article-title":"Pregnancy in Sickle Cell Disease and Fetomaternal Outcomes in Different Sickle Cell Genotypes: A Systematic Review and Meta-Analysis","volume":"32","author":"Aghamolaei","year":"2022","journal-title":"Ethiop. J. Health Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"4744","DOI":"10.1182\/blood-2025-4744","article-title":"Pregnancy related complications and placenta pathology in pregnant women with sickle cell disease","volume":"146","author":"Nwachukwu","year":"2025","journal-title":"Blood"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Sorrentino, F., Maffei, L., Caprari, P., Cassetta, R., Dell\u2019anna, D., Materazzi, S., and Risoluti, R. (2020). Pregnancy in Thalassemia and Sickle Cell Disease: The Experience of an Italian Thalassemia Center. Front. Mol. Biosci., 7.","DOI":"10.3389\/fmolb.2020.00016"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/1750-1172-5-11","article-title":"Beta-thalassemia","volume":"5","author":"Galanello","year":"2010","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_27","first-page":"419","article-title":"Pregnancy and sickle cell hemoglobinopathies: Results with and without prophylactic transfusions","volume":"62","author":"Cunningham","year":"1983","journal-title":"Obstet. Gynecol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"E2291","DOI":"10.1055\/s-0043-1771050","article-title":"Contemporary Obstetric and Neonatal Outcomes in Sickle Cell Disease: A Retrospective Cohort Study","volume":"41","author":"Hachey","year":"2024","journal-title":"Am. J. Perinatol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e70007","DOI":"10.1002\/rfc2.70007","article-title":"Sickle Cell Disease and Sickle Cell Trait on Cura\u00e7ao: Pregnancy-Related Outcomes and Complications: A Retrospective Cohort Study from a Single Centre","volume":"3","author":"Hammoud","year":"2024","journal-title":"Reprod. Female Child Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"77","DOI":"10.3329\/cbmj.v13i1.71083","article-title":"Effect of Beta Thalassemia Trait in Pregnancy","volume":"13","author":"Roy","year":"2024","journal-title":"Community Based Med. J."},{"key":"ref_31","first-page":"e108206","article-title":"Screening for \u03b2-Thalassemia Trait in Pregnant Women with Microcytic Hypochromic Anemia and Its Impact on Pregnancy Outcomes","volume":"18","author":"Bamrah","year":"2026","journal-title":"Cureus"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1182\/bloodadvances.2023011636","article-title":"Pregnancy outcomes and iron status in \u03b2-thalassemia major and intermedia: A systematic review and meta-analysis","volume":"8","author":"Vlachodimitropoulou","year":"2024","journal-title":"Blood Adv."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/18\/2933\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T08:37:02Z","timestamp":1789115822000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/18\/2933"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,11]]},"references-count":32,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["diagnostics16182933"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16182933","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,11]]}}}