Sickle Cell Disease - Pregnancy, Reproduction, and Sickle Cell Disease

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Men can have priapism (an erection lasting 4 or more hours), which can lead to sexual problems. Women face high-risk pregnancies, which could also worsen sickle cell symptoms. 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</div> <div class="block block-layout-builder block-extra-field-blocknodehealth-topicscontent-moderation-control"> </div> <div class="block block-layout-builder block-field-blocknodehealth-topicsfield-hide-social-media-icons"> <div class="field field--name-field-hide-social-media-icons field--type-boolean field--label-hidden field__item">0</div> </div> </div> </div> <div class="layout layout--twocol-section layout--twocol-section--25-75"> <div class="layout__region layout__region--first"> <div class="block block-nhlbi-health-topics block-nhlbi-book-navigation component-health-topics-menu"> <div class="view-health-topics-menu view-id-health_topics_menu view-display-id-block_1 component-health-topics-red"> <div class="view-header nav-heading"> <div class="nav-header-inner"> <a href="" hreflang="en">Sickle Cell Disease</a> </div> <div class="nav-button-wrapper"> <a class="button nav-button" id="component-submenu-toggle" href="javascript:void(0);"> <span 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class="section-menu-item subnav-link"> <a href="/health/sickle-cell-disease" aria-label="What Is Sickle Cell Disease?-Sickle Cell Disease" hreflang="en">What Is Sickle Cell Disease?</a> </li> <li class="section-menu-item subnav-link"> <a href="/health/sickle-cell-disease/causes" aria-label="Causes and Risk Factors -Sickle Cell Disease" hreflang="en">Causes and Risk Factors </a> </li> <li class="section-menu-item subnav-link"> <a href="/health/sickle-cell-disease/symptoms" aria-label="Symptoms-Sickle Cell Disease" hreflang="en">Symptoms</a> </li> <li class="section-menu-item subnav-link"> <a href="/health/sickle-cell-disease/diagnosis" aria-label="Diagnosis-Sickle Cell Disease" hreflang="en">Diagnosis</a> </li> <li class="section-menu-item subnav-link"> <a href="/health/sickle-cell-disease/sickle-cell-trait" aria-label="Sickle Cell Trait-Sickle Cell Disease" hreflang="en">Sickle Cell Trait</a> </li> <li class="section-menu-item subnav-link"> <a 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layout__region--second"> <div class="field field--name-field-health-topic node-theme-red field__item block block-nhlbi-health-topics block-nhlbi-health-topics-book-name"> <div>Sickle Cell Disease</div> </div> <div class="block block-layout-builder block-field-blocknodehealth-topicstitle"> <h1 class="field field--name-title field--type-string field--label-hidden responsive-container responsive-container-constrained field__item"><span class="ht-kicker">Sickle Cell Disease </span>Pregnancy, Reproduction, and Sickle Cell Disease<hr> </h1> </div> <div class="block block-addtoany block-addtoany-block"> <div class="responsive-container responsive-container-constrained"> <span class="a2a_kit a2a_kit_size_24 addtoany_list" data-a2a-url="https://www.nhlbi.nih.gov/health/sickle-cell-disease/pregnancy" data-a2a-title="Pregnancy, Reproduction, and Sickle Cell Disease"> <a class="a2a_dd addtoany_share" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.nhlbi.nih.gov%2Fhealth%2Fsickle-cell-disease%2Fpregnancy&title=Pregnancy%2C%20Reproduction%2C%20and%20Sickle%20Cell%20Disease"> <img src="/themes/custom/nhlbi/images/share-alt-icon.svg" alt="Share"> </a> <a class="a2a_button_email"></a> <a class="a2a_button_print"></a> </span> </div> </div> <div class="language-switcher-language-url block block-language block-language-blocklanguage-content" role="navigation"> <div class="responsive-container responsive-container-constrained"><h2 class="visually-hidden" aria-label="Switch to Espanol">Language switcher</h2><ul class="links"><li hreflang="en" data-drupal-link-system-path="node/92857" class="is-active" aria-current="page"><a href="/health/sickle-cell-disease/pregnancy" class="language-link is-active" hreflang="en" data-drupal-link-system-path="node/92857" aria-current="page">English</a></li><li hreflang="es" data-drupal-link-system-path="node/92857"><a href="/es/salud/enfermedad-de-celulas-falciformes/embarazo" class="language-link" hreflang="es" data-drupal-link-system-path="node/92857">Español</a></li></ul> </div> </div> <div class="block block-layout-builder block-field-blocknodehealth-topicsfield-component-page-links"> <div class="responsive-container responsive-container-constrained"> <div class="component-lab-banner-links component-page-links component-page-links-theme-red" id="component-page-links-holder"><strong class="component-page-links-kicker">IN THIS ARTICLE</strong> <ul id="component-page-links-ul"> </ul> <div id="component-page-links-more-button" class="component-page-links-more-button"><a class="component-page-links-more-button-a" href="javascript:void(0);">View More</a></div> <div id="component-page-links-less-button" class="component-page-links-less-button hidden"><a class="component-page-links-less-button-a" href="javascript:void(0);">View Less</a></div> </div> </div> </div> <div class="block block-layout-builder block-field-blocknodehealth-topicsfield-component-sections"> <div class="field field--name-field-component-sections field--type-entity-reference-revisions field--label-hidden"> <div class='field__items'> <div class="paragraph component component-section component-theme-white component-section-theme-white component-section-node-theme- paragraph--type--component-section paragraph--view-mode--default"> <div class="responsive-container responsive-container-constrained"> <div class="field field--name-field-component-section-content field--type-text-long field--label-hidden clearfix field__item"><p><img data-entity-uuid="9574c911-bdfb-4885-9f95-0d737cd10880" data-entity-type="file" alt="smiling pregnant woman with son" class="align-right b-lazy" width="1000" height="563" data-src="/sites/default/files/inline-images/Smiling%20Pregnant%20Person%20and%20Child.jpg" src="/modules/custom/nhlbi_blazy/images/clear.png">Sickle cell disease can affect sexual organs and other parts of the body in ways that affect quality of life and reproduction. </p><p>Pregnancy puts extra stress on a woman’s body, raising the risk of sickle cell complications. Having sickle cell disease also raises the risk of problems with the pregnancy and with the developing baby.</p><p>Men with sickle cell disease are more likely to experience priapism, an erection lasting at least 4 hours. This can cause psychological distress and sexual dysfunction. It requires medical attention from a specialized healthcare provider called a urologist.</p><p>If you have biological children, they have a risk of <a href="https://www.nhlbi.nih.gov/health/sickle-cell-disease/causes" rel="noreferrer">inheriting</a><em> </em>sickle cell trait or sickle cell disease, depending on the other parent’s sickle cell status. Genetic counseling can help you make decisions about reproduction and plan for pregnancy.</p></div> </div> </div> <div class="paragraph component component-section component-theme-white component-section-theme-white component-section-node-theme- paragraph--type--component-section paragraph--view-mode--default"> <div class="responsive-container responsive-container-constrained"> <h2 class="field--name-field-component-section-titl component-section-section-title">Family planning</h2> <div class="field field--name-field-component-section-content field--type-text-long field--label-hidden clearfix field__item"><p>For women with sickle cell disease, some birth control options are safer than others. Talk with your healthcare provider about the best option for you. </p><p>Some types of birth control include the female  <span data-entity-type="node" data-entity-uuid="662d4b0d-f3ca-4b94-a41a-7b9ec0ce1bde" data-embed-button="node" data-entity-embed-display="entity_reference:entity_reference_entity_view" data-entity-embed-display-settings="{"view_mode":"default","data-glossary-capitalization":"none","data-glossary-plural":"none","data-glossary-style":"0|0|0"}" data-langcode="en" class="entity-embed-glossary_term embedded-entity"> <a class="glossary-term" href="#" title="Definition of hormone " alt="Definition of hormone" data-term="hormone" data-pronunciation="HOR-moan" data-definition="Substance made in glands throughout the body. Hormones are released into the blood to travel throughout the body to control other body functions." role="link"> hormone </a> </span>  estrogen. Estrogen may raise your risk of stroke and blood clots. Talk to your healthcare provider about progesterone-only birth control. </p><p>Women taking hydroxyurea should stop taking it before becoming pregnant, during the pregnancy, and while breastfeeding.</p></div> </div> </div> <div class="paragraph component component-section component-theme-white component-section-theme-white component-section-node-theme- paragraph--type--component-section paragraph--view-mode--default"> <div class="responsive-container responsive-container-constrained"> <h2 class="field--name-field-component-section-titl component-section-section-title">Sickle cell disease and the menstrual cycle</h2> <div class="field field--name-field-component-section-content field--type-text-long field--label-hidden clearfix field__item"><p> <div data-entity-type="node" data-entity-uuid="aaebbed5-e620-4d26-b82b-7dce1b1b47b9" data-embed-button="node" data-entity-embed-display="entity_reference:entity_reference_entity_view" data-entity-embed-display-settings="{"view_mode":"callout_descriptive","data-callout-width":"half"}" class="align-right callout-embed-width-half entity-embed-callout embedded-entity" data-langcode="en"> <article class="node node--type-callout node--promoted node--view-mode-callout-descriptive red"> <div class="node__content"> <div class="component-callout-container component-callout-container-descriptive component-callout-container-descriptive-red component-callout-container-descriptive-white callout-descriptive-no-image"> <div class="callout-descriptive"> <div class="callout-descriptive-text"> <div class="field field--name-field-callout-description field--type-text-long field--label-hidden field__item"> <h3>Taking Action to Reduce Disparities in Maternal Health</h3><p>In the United States, pregnant Black women who have sickle cell disease have a risk of dying that is 10 times higher than the risk faced by pregnant Black women who don’t have the disease. The NHLBI is <a href="https://www.nhlbi.nih.gov/news/2021/systemic-racism-key-risk-factor-maternal-death-and-illness" rel="noreferrer">leading research to reduce health disparities</a> that raise the risk of death and serious illness for Black women in the United States, including those who live with sickle cell disease. </p> </div> </div> </div> </div> </div> </article> </div> Sickle cell disease can affect women’s health related to their periods. You may need hormones or contraceptive options, but some options are safer than others. You should review them carefully with your healthcare provider. If you have sickle cell disease:</p><ul><li><strong>You may have more pain crises before and during your period.</strong> Many women experience more sickle cell <a href="https://nhlbi.nih.gov/health/sickle-cell-disease/symptoms#emergency" rel="noreferrer">pain crises</a> just before and during their period. </li><li><strong>Heavy menstrual periods may raise your risk for anemia.</strong> Many women with sickle cell disease do not have heavy periods. But if you do, blood loss may raise your risk of <a href="https://www.nhlbi.nih.gov/health/anemia/iron-deficiency-anemia" rel="noreferrer">iron-deficiency anemia</a>. </li></ul></div> </div> </div> <div class="paragraph component component-section component-theme-white component-section-theme-white component-section-node-theme- paragraph--type--component-section paragraph--view-mode--default"> <div class="responsive-container responsive-container-constrained"> <h2 class="field--name-field-component-section-titl component-section-section-title">Pregnancy and sickle cell disease</h2> <div class="field field--name-field-component-section-desc field--type-text-long field--label-hidden clearfix field__item"><p> <div data-entity-type="node" data-entity-uuid="4f90bfc7-f641-4d3d-99e9-b736c7bccda3" data-embed-button="node" data-entity-embed-display="entity_reference:entity_reference_entity_view" data-entity-embed-display-settings="{"view_mode":"callout_descriptive","data-callout-width":"half"}" class="align-right callout-embed-width-half entity-embed-callout embedded-entity" data-langcode="en"> <article class="node node--type-callout node--promoted node--view-mode-callout-descriptive red"> <div class="node__content"> <div class="component-callout-container component-callout-container-descriptive component-callout-container-descriptive-red component-callout-container-descriptive-white callout-descriptive-no-image"> <div class="callout-descriptive"> <div class="callout-descriptive-text"> <div class="field field--name-field-callout-description field--type-text-long field--label-hidden field__item"> <p>Call a healthcare provider or 9-1-1 if a woman is having certain health problems during pregnancy or within 3 months after giving birth. The following symptoms <a href="https://www.cdc.gov/sickle-cell/media/fact-sheets/pregnancy/women-with-scd-and-postpartum-care.pdf" rel="noreferrer">need immediate medical care</a>: </p><ul><li>Trouble breathing </li><li>Extreme swelling of hands or face </li><li>Thoughts of harming herself or the baby </li><li>Changes in vision </li></ul><p>Also seek care right away if the baby’s movements stop or slow, or there is vaginal bleeding or fluid leaking.</p> </div> </div> </div> </div> </div> </article> </div> Sickle cell disease raises health risks for both the mother and the baby. Women with sickle cell disease are at higher risk of problems during pregnancy. If you are pregnant or planning for pregnancy, find a team of a healthcare providers who specialize in high-risk pregnancies and have experience with patients who have sickle cell disease. Meet with the team throughout your pregnancy to manage your risks. </p><p>Some sickle cell risks are linked with changes that occur in the body due to pregnancy, including:</p><ul><li>Raised  <span data-entity-type="node" data-entity-uuid="8bc0e694-e8be-45ee-8c99-7bcf99df8cde" data-embed-button="node" data-entity-embed-display="entity_reference:entity_reference_entity_view" data-entity-embed-display-settings="{"view_mode":"default","data-glossary-capitalization":"none","data-glossary-plural":"none","data-glossary-style":"0|0|0"}" data-langcode="en" class="entity-embed-glossary_term embedded-entity"> <a class="glossary-term" href="#" title="Definition of metabolism " alt="Definition of metabolism" data-term="metabolism" data-pronunciation="meh-TA-buh-lih-zum" data-definition="Chemical changes that occur in living cells or organisms. These changes make energy to fuel important life functions." role="link"> metabolism </a> </span> </li><li>Higher hormone levels that raise the risk of blood clots</li><li>Serious anemia</li><li>Additional pain crises</li></ul><p>Having sickle cell disease also raises women’s risk of dying while pregnant and for some months after giving birth.</p></div> </div> </div> <div class="paragraph component component-section component-theme-white component-section-theme-white component-section-node-theme- paragraph--type--component-section paragraph--view-mode--default"> <div class="responsive-container responsive-container-constrained"> <h2 class="field--name-field-component-section-titl component-section-section-title">Risks for the pregnant woman</h2> <div class="field field--name-field-component-section-content field--type-text-long field--label-hidden clearfix field__item"><p><a href="https://www.nichd.nih.gov/health/topics/preconceptioncare" rel="noreferrer">Preconception and prenatal care</a> are key to managing risks to the pregnant person and the developing baby. </p><p>As you plan for pregnancy or early in your pregnancy, work with your healthcare provider to:</p><ul><li><a href="#_Diagnosis">Confirm</a> your own sickle cell status and the other parent’s. </li><li>Set up a plan for managing pain while pregnant or breastfeeding.</li><li>Discuss genetic counseling to assess the sickle cell risk for your developing baby and future children.</li><li>Start taking prenatal vitamins, including folic acid.</li><li>Manage your <a href="#_Medicines">medicines</a>, especially pain medicines and hydroxyurea. People who are pregnant or planning to become pregnant should not take hydroxyurea.</li><li>Have an <a href="https://www.nhlbi.nih.gov/health/heart-tests" rel="noreferrer">echocardiogram</a> to check your heart health.</li><li>Have regular <span data-entity-type="node" data-entity-uuid="2072e5ae-e7ad-42ce-953e-f987ecabd932" data-embed-button="node" data-entity-embed-display="entity_reference:entity_reference_entity_view" data-entity-embed-display-settings="{"view_mode":"default","data-glossary-capitalization":"none","data-glossary-plural":"none","data-glossary-style":"0|0|0"}" data-langcode="en" class="entity-embed-glossary_term embedded-entity"> <a class="glossary-term" href="#" title="Definition of ultrasound " alt="Definition of ultrasound" data-term="ultrasound" data-pronunciation="UL-truh-sownd" data-definition="A painless test that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that create pictures of the tissues and organs on a computer screen." role="link"> ultrasound </a> </span> scans to check the developing baby.</li><li>Decide whether you should take low-dose aspirin (81 milligrams) starting around 12 weeks of pregnancy and continuing until giving birth.</li><li>Check your blood pressure.</li><li>Learn about prenatal testing as a way to see whether the developing baby has genes for sickle cell disease or <a href="https://www.nhlbi.nih.gov/health/sickle-cell-disease/sickle-cell-trait" rel="noreferrer">trait</a>.</li><li>Decide whether to save the blood from your baby’s umbilical cord after they are born. This could potentially be used in a transplant for relatives who have sickle cell disease.</li></ul><p>You may need one or more blood transfusions while pregnant to treat anemia and serious <a href="https://www.nhlbi.nih.gov/health/sickle-cell-disease/symptoms" rel="noreferrer">symptoms</a>. Pregnant women have a higher risk of <a href="https://www.nhlbi.nih.gov/health/sickle-cell-disease/health-effects" rel="noreferrer">serious</a> health effects caused by sickle cell disease, including:</p><ul><li>Pain crises</li><li>Acute chest syndrome </li><li>Serious anemia</li><li>Serious infections, including <a href="https://www.nhlbi.nih.gov/health/pneumonia" rel="noreferrer">pneumonia</a> and  <span data-entity-type="node" data-entity-uuid="0ee3c6f4-d207-4243-9c06-9e77a176c607" data-embed-button="node" data-entity-embed-display="entity_reference:entity_reference_entity_view" data-entity-embed-display-settings="{"view_mode":"default","data-glossary-capitalization":"none","data-glossary-plural":"none","data-glossary-style":"0|0|0"}" data-langcode="en" class="entity-embed-glossary_term embedded-entity"> <a class="glossary-term" href="#" title="Definition of sepsis " alt="Definition of sepsis" data-term="sepsis" data-pronunciation="SEP-sis" data-definition="A serious illness that results when the body has an overwhelming immune response to a bacterial infection. This response triggers the release of chemicals into the blood stream, which triggers inflammation to fight infection. The inflammation can damage organs and their systems. " role="link"> sepsis </a> </span> (serious blood infection)</li></ul><p>Sickle cell disease also raises the risk of some pregnancy-related complications:</p><ul><li><a href="https://www.nhlbi.nih.gov/health/high-blood-pressure" rel="noreferrer">High blood pressure</a></li><li><a href="https://www.nhlbi.nih.gov/health/venous-thromboembolism" rel="noreferrer">Venous thromboembolism</a></li><li><a href="https://www.nichd.nih.gov/health/topics/preeclampsia" rel="noreferrer">Preeclampsia</a></li><li><a href="https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-infection-uti-in-adults/" rel="noreferrer">Urinary tract (bladder) infections</a></li></ul><p>Talk with your provider about ways to lower the risk of these complications.</p></div> </div> </div> <div class="paragraph component component-section component-theme-white component-section-theme-white component-section-node-theme- paragraph--type--component-section paragraph--view-mode--default"> <div class="responsive-container responsive-container-constrained"> <h2 class="field--name-field-component-section-titl component-section-section-title">Risks for the developing baby</h2> <div class="field field--name-field-component-section-desc field--type-text-long field--label-hidden clearfix field__item"><p>The growing baby of a pregnant person with sickle cell disease faces increased health risks. Providers will recommend steps to help lower the risks for problems that include :</p><ul><li><a href="https://www.nichd.nih.gov/health/topics/factsheets/pregnancyloss" rel="noreferrer">Pregnancy loss (miscarriage)</a></li><li><a href="https://www.nichd.nih.gov/health/topics/preterm" rel="noreferrer">Preterm (premature) birth</a></li><li>Low birth weight</li><li>Intrauterine growth restriction (slow growth of the fetus)</li><li><a href="https://www.nichd.nih.gov/health/topics/stillbirth" rel="noreferrer">Stillbirth</a></li></ul></div> </div> </div> <div class="paragraph component component-section component-theme-white component-section-theme-white component-section-node-theme- paragraph--type--component-section paragraph--view-mode--default"> <div class="responsive-container responsive-container-constrained"> <h2 class="field--name-field-component-section-titl component-section-section-title">Labor and delivery</h2> <div class="field field--name-field-component-section-content field--type-text-long field--label-hidden clearfix field__item"><p>Your provider may recommend that you give birth in a hospital that is set up for high-risk pregnancies.</p><p>Vaginal birth is usually safe for women who have sickle cell disease. The provider will likely recommend fetal monitoring during labor and delivery to check the woman and the baby for complications.</p><p> <div data-entity-type="node" data-entity-uuid="d7455724-863b-415a-b7e2-6bc7eea75cb9" data-embed-button="node" data-entity-embed-display="entity_reference:entity_reference_entity_view" data-entity-embed-display-settings="{"view_mode":"default","data-callout-width":"full"}" class="align-left callout-embed-width-full entity-embed-callout embedded-entity" data-langcode="en"> <article class="node node--type-callout node--promoted node--view-mode-callout-descriptive red"> <div class="node__content"> <div class="component-callout-container component-callout-container-descriptive component-callout-container-descriptive-red component-callout-container-descriptive-white callout-descriptive-with-image"> <div class="callout-descriptive"> <div class="callout-descriptive-image"> <div class="field field--name-field-callout-descriptive-image field--type-image field--label-hidden field__item"> <img loading="lazy" src="/modules/custom/nhlbi_blazy/images/clear.png" width="720" height="405" alt="pregnant woman looking out the woman" data-src="/sites/default/files/styles/crop_callout/public/2024-08/shutterstock_1565039914.jpg?itok=bMUR7YCZ" class="b-lazy image-style-crop-callout"> </div> </div> <div class="callout-descriptive-text"> <div class="field field--name-field-callout-description field--type-text-long field--label-hidden field__item"> <h3><span>Pregnant and Living with Sickle Cell Disease: A Push for Better Outcomes</span></h3><p>NHLBI research revealed that Black women with sickle cell disease are at very high risk of serious complications and even death. Scientists are also learning about effective treatments to help pregnant people with sickle cell disease and their babies.</p> </div> <div class="nhlbi_text_link_button nhlbi_text_link_button_red field--name-field-callout-link"> <a href="https://www.nhlbi.nih.gov/news/2023/pregnant-and-living-sickle-cell-disease-push-better-outcomes" aria-label="Read a story about one woman’s experience with pregnancy complications due to sickle cell disease. ">Read a story about one woman’s experience with pregnancy complications due to sickle cell disease. <span class="fa-left-icon fa-li fa-li-red"><i class="fas fa-chevron-circle-right"></i></span></a> </div> </div> </div> </div> </div> </article> </div> </p><h3>After giving birth </h3><p>Healthcare providers encourage women to breastfeed their newborns for at least 6 months. Talk with your provider about the medicines you’re taking while breastfeeding to make sure they are safe. </p><p>Before you leave the hospital, your baby will have a blood sample taken for <a href="https://nhlbi.nih.gov/health/sickle-cell-disease/diagnosis" rel="noreferrer">newborn screening</a><em> </em>. If the screening shows that your baby has hemoglobin S or other abnormal hemoglobin, further testing will confirm the diagnosis. </p><p>Infants whose mothers received opioid pain treatment regularly while pregnant should be checked for withdrawal symptoms.</p><p>Discuss birth control options with your provider. Certain hormone-based methods might not be safe for women with sickle cell disease.</p></div> </div> </div> <div class="paragraph component component-section component-theme-white component-section-theme-white component-section-node-theme- paragraph--type--component-section paragraph--view-mode--default"> <div class="responsive-container responsive-container-constrained"> <h2 class="field--name-field-component-section-titl component-section-section-title">Male sexual health and sickle cell disease</h2> <div class="field field--name-field-component-section-content field--type-text-long field--label-hidden clearfix field__item"><p>Men may experience priapism — prolonged, painful erections. Sickle cell disease can also raise men’s risk of problems with fertility and sexual function. </p><p>Up to 1 in 4 men with sickle cell disease experience problems that can affect fertility and sexual function, including:</p><ul><li>Lower than normal sperm count</li><li><a href="https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction" rel="noreferrer">Erectile dysfunction</a> </li><li>Low levels of the male hormone testosterone</li><li>Low sex drive </li><li>Lower <a href="https://www.nichd.nih.gov/health/topics/infertility" rel="noreferrer">fertility</a></li></ul></div> </div> </div> </div> </div> </div> <div class="block block-nhlbi-health-topics block-nhlbi-book-nav-block"> <nav id="book-navigation-92298" class="book-navigation responsive-container-constrained" role="navigation" aria-labelledby="book-label-92298"> <h3 class="visually-hidden" id="book-label-92298">Book traversal links for Pregnancy, Reproduction, and Sickle Cell Disease</h3> <ul class="book-pager"> <li class="book-pager__item book-pager__item--previous"> <h4 class="nav-label">Previous</h4> <a href="/health/sickle-cell-disease/living-with" rel="prev" title="Go to previous page"><i class="fas fa-angle-left"></i> Living With Sickle Cell Disease</a> </li> </ul> </nav> </div> </div> </div> <div class="layout layout--onecol"> <div class="layout__region layout__region--content"> <div class="block block-layout-builder block-field-blocknodehealth-topicsfield-last-updated"> <div class="field field--name-field-last-updated field--type-datetime field--label-hidden responsive-container responsive-container-constrained field__item">Last updated on <time datetime="2024-08-22T12:00:00Z" class="datetime"><span>August 22, 2024</span></time> </div> </div> </div> </div> <div class="layout layout--onecol"> <div class="layout__region layout__region--content"> <div class="block block-layout-builder block-extra-field-blocknodehealth-topicslinks"> </div> </div> </div> </div> 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