The Need for Contraception Guidance in Sickle Cell Disease

Defined roles and research-informed recommendations are lacking for clinicians navigating birth control with females with sickle cell.

New data presented at the American Society of Hematology (ASH) 2021 Meeting in Atlanta this weekend showed that, while pediatric hematology providers generally accept the task of discussing contraception with women with sickle cell disease, they often do so with differing result.

The findings, presented by study author Megan Askew, MD, of the Department of Pediatrics, Division of Hematology, Oncology and Stem Cell Transplantation at Columbia University Medical Center / New York Presbyterian Hospital, showed varied results in contraceptive counseling, referral, and prescription among male and female clinicians with differing degrees and experience in medicine.

In the second segment of an interview with HCPLive during ASH 2021, Askew discussed some of the key barriers to more universal contraception prescription for women with sickle cell disease—an under-matched, high-risk population. Key among the barriers may be the time a clinician may have to navigate such a discussion, and the uncertain specifics of the pediatric hematologist role.

“I think most providers agreed that it was their role and responsibility to offer some counseling and some guidance, but people train in adolescent medicine and OB/GYN do extensive fellowships to teach them these things that you may not have the same time for in your pediatric hematology training—so how do we get them that training?” Askew said. “And if we’re not the ones supposed to be doing it, getting patients to that appointment—they already have so many appointments to keep, how do we get them to another appointment?”

Askew also discussed the concept of multi-specialty clinics—“one-stop shops” for hematology patients, as well as the need for improved, research-informed guidelines for sickle cell risks including pregnancy.

“I don’t think there are, to my knowledge, any clinical guidelines for hematology providers in regards to contraceptive practices,” Askew said. “There’s a broad overlying statement that all sickle cell patients need reproductive healthcare, but not exact guidelines into how to provide that, and I think that’s something we probably need that in the future.”