50 years ago, people with sickle cell disease (SCD) were discouraged from becoming pregnant, but now most should be supported if they choose to pursue a pregnancy. They and their providers, however, should be aware of the physiological changes of pregnancy that aggravate SCD and pregnancy’s unique maternal and fetal challenges. Any maternal endothelial damage from a poorly perfused placenta has the potential for being superimposed on the endothelial damage of SCD. The immunological …