Women with sickle cell disease are at higher risk for miscarriage, preterm labor, and vaso-occlusive crises. Clinical features, evaluation, and treatment are similar to nonpregnant patients. Management of vaso-occlusive crisis includes aggressive hydration, analgesia, and fetal monitoring (if the fetus is viable). Opiates can be used; NSAIDs should be avoided, particularly after 32 weeks' gestation. Blood transfusion should be considered when conservative measures have failed, or with severe anemia, preeclampsia, hypoxemia, acute chest syndrome, or a new-onset neurological event. Hydroxyurea should be discontinued in pregnancy.