ABSTRACT Introduction: During pregnancy, the iron requirement increases to meet the optimal growth of the fetus and prevent iron deficiency anemia-related complications in the mother. However, in sickle cell disease (SCD) primarily due to repeated blood transfusions and hemolysis-induced recycling of iron, its supplementation during pregnancy remains questionable and may be harmful. Methods: Twenty-five pregnant women with homozygous SCD and 25 pregnant women with normal hemoglobin variants were included as cases and control, respectively. Pregnancy and sickle cell anemia (SCA) were diagnosed using standard protocols. The serum iron, serum ferritin, total iron-binding capacity (TIBC), percentage transferrin saturation and C-reactive protein were estimated, as per the manufacturer’s protocol. The complete blood count was performed. The unpaired ‘t-test’ was performed using the SPSS v23.0 and the principal component analysis (PCA) was performed using the online software MetaboAnalyst for statistical analysis. Main Results: The studied cases had significantly lower mean hemoglobin and higher mean corpuscular volume (MCV), compared to controls. The mean serum-iron, serum-ferritin and percentage transferrin-saturation in the cases were significantly higher than that of the controls, while the TIBC was lower in the cases (p < 0.0001). The mean level of serum iron, ferritin, percentage transferrin saturation and TIBC were 309.44 ± 122.40mcg/dl, 860.36 ± 624.64ng/ml, 42.6 ± 17.30% and 241.32 ± 96.30 mcg/dl, respectively, in the cases and 95.36 ± 41.90mcg/dl, 122.28 ± 49.70ng/ml, 15.83 ± 3.10% and 492.6 ± 149.40mcg/dl in the controls, respectively. Higher MCV, mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) with lower hemoglobin (Hb) were noted in the cases. The PCA revealed that the cases were more heterogeneous in terms of the variability of the iron status and hematological indices than the controls. Conclusion: The current study shows iron sufficiency in most cases of pregnancy with SCA and suggests that evaluation of iron status must be made before initiating iron prophylaxis in pregnant women with SCA, especially in regions having a high prevalence of sickle cell hemoglobinopathy. Introduction anemiarelated related mother However (SCD hemolysisinduced hemolysis induced harmful Methods Twentyfive Twenty five 2 control respectively (SCA protocols ferritin ironbinding binding TIBC, , (TIBC) Creactive C reactive estimated manufacturers manufacturer s protocol ‘ttest ttest ‘t test t ‘t-test v230 v v23 0 v23. (PCA Results MCV (MCV) controls serumiron, serumiron serum-iron serumferritin transferrinsaturation p 0.0001. 00001 0.0001 . 0001 0.0001) 30944 309 44 309.4 12240mcgdl mcgdl 122 40mcg dl mcg 122.40mcg/dl 86036 860 36 860.3 62464ngml ngml 624 64ng ml ng 624.64ng/ml 426 42 6 42. 1730 17 30 17.30 24132 241 32 241.3 9630 96 96.3 mcg/dl 9536 95 95.3 4190mcgdl 41 90mcg 41.90mcg/dl 12228 28 122.2 4970ngml 49 70ng 49.70ng/ml 1583 15 83 15.8 310 3 10 3.10 4926 492 492. 14940mcgdl 149 MCH (MCH MCHC (MCHC Hb (Hb Conclusion hemoglobinopathy (TIBC v2 (MCV 0000 0.000 000 3094 4 309. 12 8603 86 860. 62 173 1 17.3 2413 24 241. 963 9 96. 953 95. 1222 122. 158 8 15. 31 3.1 14 0.00 00 17. 3. 0.0 0.