Pregnancy and Perinatal Outcomes among Women with Sickle Cell Disease in Saudi Arabia: A Systematic Review

Abstract

Background: Pregnancy in women with sickle cell disease (SCD) is associated with substantial maternal and perinatal risk. Country-specific data are needed to inform clinical pathways in Saudi Arabia, where SCD prevalence and service configurations vary by region.

Objectives: To synthesize maternal and perinatal outcomes of pregnancies affected by SCD in Saudi Arabia, compare outcomes with non-SCD pregnancies where reported, and describe sources of heterogeneity (region, era, genotype reporting, and care models).

Methods: A protocolized review adhering to PRISMA 2020 was conducted (PROSPERO registered; number masked for peer review). Searches of MEDLINE, Embase, Web of Science, CENTRAL, Google Scholar, and regional sources (through 22 Oct 2025) included English and Arabic records. Eligible designs were randomized/quasi-experimental, comparative cohorts, case–control studies, and large case series conducted in Saudi Arabia and reporting maternal and/or perinatal outcomes. Two reviewers performed screening, extraction, and risk-of-bias assessment using design-appropriate tools. Owing to heterogeneity and incomplete denominators, findings were narratively synthesized without meta-analysis.

Results: Of 630 records identified, 8 studies (8 reports) were included, spanning tertiary centers in the Eastern Province and Riyadh and regional hospitals in the southwest. Consistent signals across studies included high maternal anemia (often transfusion-requiring), frequent vaso-occlusive crises and acute chest syndrome, increased hypertensive disorders, and higher cesarean delivery and critical-care utilization versus non-SCD comparators. Perinatal risks clustered around small-for-gestational-age/low birth weight, preterm birth, stillbirth, and elevated perinatal mortality; some regional data suggested prominent growth restriction despite near-term gestation averages. Overall risk of bias was “some concerns” in two comparative cohorts and “high” in the remaining studies, reflecting confounding, retrospective selection, and variable outcome definitions.

Conclusions: SCD pregnancies in Saudi Arabia carry uniformly higher maternal and perinatal risks that are potentially modifiable through multidisciplinary, protocolized care. Harmonized national definitions, a registry, and prospective evaluations of key pathway elements are priorities.