SHM Converge Scientific Abstract ePoster Gallery-Conflicting Guidelines in Pregnancy: Shared Decision-Making for Hydroxyurea Management in Sickle Cell Disease

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The document discusses a clinical dilemma in managing <strong>hydroxyurea during pregnancy</strong> for patients with <strong>sickle cell disease (SCD)</strong>. Hydroxyurea is described as the cornerstone treatment for SCD, but its safety in pregnancy remains uncertain because human data are limited.

A central issue is the <strong>conflict between specialty guidelines</strong>:
- <strong>ASH</strong> recommends <strong>avoiding hydroxyurea during pregnancy</strong> because of concerns about teratogenicity seen in animal studies and the lack of randomized human trials.
- <strong>ACOG</strong> supports <strong>selective use in high-risk pregnancies</strong>, emphasizing shared decision making when maternal disease severity is significant.

The poster presents a case of a woman in her 30s with SCD and a history of recurrent venous thromboembolism, TIA, splenectomy, and avascular necrosis. After discovering she was pregnant, she stopped hydroxyurea and anticoagulation and subsequently experienced multiple pain crises, hospitalizations, and a DVT. Her care involved disagreement between obstetric and hematology teams, eventually leading to a shared decision to remain off hydroxyurea during pregnancy, followed by postpartum restart of therapy after further complications.

The main conclusion is that <strong>hydroxyurea management in pregnancy is controversial</strong>, and guideline recommendations may conflict when applied to individual patients. Because maternal risks can be substantial, especially in severe SCD, <strong>shared decision making</strong> is essential. The poster highlights the importance of multidisciplinary communication, patient counseling, and the role of hospitalists in coordinating care.

Asset Subtitle

Ross Schmiedeknecht

Meta Tag

Author List Heather Laird-Fick, Ross Schmiedeknecht

Category Clinical Vignettes

Concept Hydroxyurea

Concept Sickle Cell Disease

Concept Pregnancy

Concept Pain Crisis

Concept Multidisciplinary Care

Distinguished Non-Finalist

Presenter Organization Michigan State University College of Human Medicine

Presenting Author Ross Schmiedeknecht

Track Adult

Keywords

hydroxyurea

pregnancy

sickle cell disease

shared decision making

ASH guidelines

ACOG guidelines

teratogenicity

multidisciplinary care

venous thromboembolism

hospitalist coordination

Hydroxyurea

Sickle Cell Disease

Pregnancy

Pain Crisis

Multidisciplinary Care