Evaluating Reproductive Health Recommendations in CPGs for Sickle Cell Disease: An Umbrella Review

ABSTRACT Background Individuals with sickle cell disease or trait (SCD/T) face significant reproductive health risks, highlighting the need to assess the best available evidence on their reproductive health needs. Objectives To assess the quality of SCD/T clinical practice guidelines and evaluate the key characteristics and quality of their reproductive health recommendations. Methods This systematic review followed the JBI methodology for Umbrella Reviews. Eligible CPGs required RHRs for individuals with SCD/T. Databases included PubMed, CINAHL, PsycINFO, Cochrane, Embase, Web of Science, Google Scholar, and registries, for CPGs in March 2025 without language restriction. Screening followed a three‐step process with two independent reviewers. Risk of bias was assessed using AGREE‐II and AGREE‐Rex. Data was extracted independently by two reviewers using a tool developed by the researchers. Conflicts between independent reviewers were resolved through discussion. Findings were synthesized using descriptive analyses, frequency tables, and narrative summaries. One deviation from the protocol is documented in the final review. Results Fifteen CPGs published between 2020 and 2025 were included, most of which were national‐level and peer‐reviewed. AGREE II scores ranged from 48% to 97%, with Applicability scoring lowest and six CPGs recommended for use without modification. Across the guidelines, 198 reproductive health recommendations were identified. Most recommendations focused on antenatal, intrapartum, and postnatal care (64.7%) and management‐related care stages (62.1%). Safe abortion care appeared in only one guideline. Although nine CPGs used GRADE, many did not clearly report recommendation strength or evidence certainty. AGREE‐REX identified seven CPGs as suitable for use without modification, with Values and Preferences scoring lowest. Inter‐rater reliability was high for both tools. Conclusions These findings highlight the need for more comprehensive, evidence‐based, and patient‐centered guidelines and recommendations to support high‐quality reproductive healthcare for individuals with SCD. Umbrella Review Registration Number The protocol was registered in PROSPERO, CRD42025648554.