Background Pregnancies with Sickle cell anemia (SCA) and Sickle cell disease (SCD) are associated with high maternal and fetal mortality. Moreover, it is associated with adverse pregnancy, fetal and neonatal complications including Pre-eclampsia/eclampsia, Pregnancy Induced Hypertension (PIH), anemia, preterm labor, vaso-occlusive crisis, fetal hypoxia, low birth weight (LBW), prematurity, intrauterine growth retardation (IUGR), low APGAR and Neonatal Intensive Care Unit (NICU) admission. Although, advancements have been noted in the management of these pregnancies, pregnancy with SCD is still accompanied with increased maternal and neonatal outcomes despite these advances. Objective The study aimed to explore the adverse pregnancy, fetal and neonatal outcomes among women with sickle cell disease compared to non-SCD women. Methods A retrospective matched case-control study compared 171 pregnancies with sickle cell disease to 171 non-sickle cell disease pregnancies in Muscat. The data was retrieved from electronic medical records and delivery registry book between Jan 2015 to August 2021. Deliveries <24 weeks or > 41weeks of gestation were excluded. Outcomes of interest included preterm labor, pre-eclampsia/ eclampsia, pregnancy induced hypertension, severe anemia, intrauterine growth retardation, fetal distress, neonatal intensive care unit admission of neonates, low birth weight, and Low APGAR score. Results Sickle cell disease women with severe anemia have increased odds of (x2=58.56, p<0.001) getting adverse pregnancy outcomes than women without anemia. Sickle cell disease mothers had 21.97 % higher odds of getting an intrauterine growth retardation baby than non-sickle cell disease mothers (x2=17.80, UOR= 2.91-166.13, p<0.001). Newborns born to Sickle cell disease mothers had 3.93 % greater odds of being admitted to Neonatal intensive care unit than newborns born to non-sickle cell disease mothers (x2=16.80, UOR= 1.97-7.84, p<0.001). Additionally, the children born to sickle cell disease mothers had 10.90 % higher odds of being born with low birth weight than children born to non-sickle cell disease mothers (x2=56.92, UOR= 5.36-22.16, p<0.001). Hemoglobin level (OR= 0.17, p<0.001, 95% CI 0.10-3.0), past medical history (OR=7.95, 7 p<0.001, 95% CI 2.39-26.43), past surgical history (OR=17.69, p<0.001, 95% CI 3.41-91.76), and preterm delivery (OR=9.48, p=0.005, 95% CI 1.95-46.23) were identified as predictors of adverse pregnancy, fetal and neonatal outcomes. Conclusion Pregnant women with sickle cell disease are at increased risk for pregnancy, fetal, newborn adverse outcomes compared to non- sickle cell disease mothers. Low rates of fetal mortality rate may reflect improved antenatal surveillance and management in Oman.