My medication schedule adjustments during pregnancy and postpartum
After I became pregnant, I made two main changes to my medication schedule
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Note: This column describes the author’s own experiences with an array of treatments. Not everyone will have the same response to treatment. Consult your doctor before starting or stopping a therapy.
Ordinarily, like many other people living with sickle cell disease, I take daily medications to help manage my condition, prevent sickle cell crises, and reduce the risk of other complications. When I found out I was pregnant late last year, I needed to make a few changes to my medication schedule.
On a typical day, I take folic acid to help my body in the production of new red blood cells. Healthy red blood cells live for approximately 120 days before they break down and are recycled. However, sickle cells break down much more quickly, with an average lifespan of 10-20 days. Folic acid helps the body to replenish folate, which can become depleted in the production of new red blood cells to replenish those lost in quicker cycles.
I also take erythromycin, a prophylactic antibiotic. People with sickle cell disease often have reduced immunity, so this helps to protect against infections.
Some medications are specific to my personal health history rather than standard treatment for all sickle cell patients, namely cholecalciferol, rivaroxaban, and oxycodone (OxyContin and OxyNorm). Cholecalciferol is essentially vitamin D for bone health because I have avascular necrosis (AVN) in my shoulders and hips. I take rivaroxaban, a blood thinner, due to my history of pulmonary embolism. And I take OxyContin daily for chronic pain caused by AVN, plus OxyNorm as needed when acute pain rears its ugly head.
In addition to my daily medications, I also receive blood transfusions every six weeks.
Medication changes following pregnancy
After I became pregnant, I made two main changes to my medication schedule.
The first was to my daily oxycodone use. Although my medical team advised me that I could continue taking these medications at reduced doses, I was determined to stop them entirely during my pregnancy.
OxyContin, however, cannot be suddenly stopped. I worked closely with my medical team to create a tapering plan and followed it carefully. Because I was already about three months pregnant by the time I found out, I did have some opioid exposure during pregnancy. I share that because I know others may find themselves in the same situation. Fast-forward, and my baby was born healthy and at full term. That outcome was entirely consistent with the advice and reassurance provided by my medical team.
The second change came as more of a surprise to me. It involved my blood thinner, rivaroxaban, which is contraindicated during pregnancy. I had to stop taking it and switch to enoxaparin injections instead. As someone who is extremely squeamish, this was a difficult adjustment. Eventually, my husband had to take over giving me the injections because I struggled to do them consistently enough myself to maintain good compliance. There is absolutely no shame in asking for help. The most important thing is taking medications as prescribed and keeping both mother and baby healthy.
Most pregnant women are advised to take supplements containing folic acid and vitamin D. Because I was already prescribed both of them at much higher doses than those recommended during pregnancy, I didn’t need to make any adjustments there.
One additional challenge was severe restless legs syndrome, which I suspect was caused by a combination of pregnancy and stopping OxyContin. To help manage this, I started taking magnesium supplements.
Because I experienced sickling during pregnancy, including two serious crises that I’ll discuss in future columns, my transfusion schedule needed to be adjusted, from every six weeks to every five weeks.
As I got closer to labor, I had two exchanges in relatively quick succession, with roughly three weeks between them. This was done to reduce the risk of experiencing a crisis during labor, and in that respect, it was successful. Unfortunately, I did have a major crisis a day or two after giving birth.
My current postpartum schedule
Now that I am two months postpartum, my medication schedule remains similar to what it was during pregnancy. The main reason for this is that I am breastfeeding.
As a result, rivaroxaban remains contraindicated, so I continue to have enoxaparin injections instead. Likewise, because of the risk of opioids transferring to my baby through breast milk, I am still unable to take OxyContin or OxyNorm.
Instead, I’ve been prescribed dihydrocodeine for pain relief. Of course, this increases the likelihood that I may need to go to the hospital for what I would describe as lower-level pain crises that OxyNorm would ordinarily resolve at home. Fortunately, I haven’t had to deal with that yet.
My transfusions have now returned to their usual schedule.
Note: Sickle Cell Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Sickle Cell Disease News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to sickle cell disease.
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