A 27-year-old woman with homozygous sickle cell disease is planning pregnancy. She is on regular medications including hydroxyurea. Which statement regarding its use is correct?

• A Hydroxyurea should be continued throughout pregnancy as it reduces crisis frequency
• B Hydroxyurea is safe in pregnancy but must be stopped during breastfeeding
• C Hydroxyurea should be discontinued before conception because of teratogenic and cytotoxic potential ✓
• D Hydroxyurea may be started de novo in the second trimester if crises increase

Explanation

Hydroxyurea is an antimetabolite with demonstrated teratogenicity and cytotoxicity in animal studies, so standard practice is to stop it at least three months before conception and manage sickle cell disease in pregnancy with folic acid, pneumococcal vaccination, penicillin prophylaxis where indicated, and transfusion therapy for high-risk features. Continuing it through pregnancy is not accepted practice. Starting it de novo in pregnancy is also avoided because safer alternatives such as transfusion exist.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.