Maternal and Perinatal Implications of the Use of Human Recombinant Erythropoietin

Abstract

Background. The use of human recombinant erythropoietin (rHuEPO) in pregnant patients has been limited by the fear of eventual maternal and fetal repercussions (either direct or indirect). Methods. The authors present their experience with the use of rHuEPO during pregnancy, with two pregnant women with kidney transplants and in three others with chronic renal insufficiency (one with diabetic nephropathy, another dialysis dependent), all with hematocrit below 30% and adequate iron reserves. Results. Three of the patients had needed blood transfusions before beginning therapy, and another needed transfusion after significant metrorrhagia. The length of the treatment varied between 2 and 23 weeks and the hematocrit at delivery varied between 26% and 36%. Secondary effects (appearance or worsening of hypertension and seizures) were nil. There was one fetal death at 23 weeks of pregnancy (following an abruptio placentce), two neonates weighing between the 5th and the 10th percentiles, and three needing phototherapy (1 to 2 days). One year after birth, all showed a normal ponderal and neurologic development.Conclusions. Among the cases presented, no maternal and perinatal complications attributable to rHuEPO were registered. It is important that institutions report their experiences with the use of rHuEPO, given its restrictive indications and the limited experience of each institution.

Erythropoietin in the Treatment of Iron Deficiency Anemia during Pregnancy

“…However, it could rather represent a complication of the underlying renal disease, than a rHuEPO treatment-related adverse effect per se. There is no clear correlation between hypertension and rHuEPO administration, in cases with normal renal function [11,20,22]. In our study, 2 patients experienced an aggravation of their preexisting mild idiopathic hypertension during the third trimester of pregnancy, however, we did not consider it as a complication of the treatment.…”

“…These studies showed that rHuEPO administration might be used to treat certain pregnancy anemias by stimulating maternal erythropoiesis or as an alternative for patients refusing blood transfusion. However, the use of rHuEPO in pregnant patients has been limited by the fear of eventual maternal and fetal, direct and indirect sequelae [22]. Some authors are concerned that rHuEPO treatment has limited indication, and moreover that there has been little experience with its use in pregnant women, while its safety and effectiveness have not been well established [22][23][24].…”

Scope of Blood Transfusion in Obstetrics

“…Recombinant human erythropoietin is used when anaemia is caused by renal disease. It is safe to use in pregnancy and there is no reported cases of teratogenicity (Braga et al 1996).…”

Preoperative treatment of anemic women with epoetin beta

“…The attitude to homologous blood transfusions has changed and patients are less willing to accept them, due to the small but real risk of transmitting viral infections and triggering negative immunological reactions. The efficacy of recombinant human erythropoietin (EPO) in renal anemia has been demonstrated in several clinical studies (2–5). Recently several Jehovah's Witnesses, who had refused perioperative blood transfusions, were treated with EPO resulting in increased erythropoiesis and good postoperative outcome (6, 7).…”

“…C Acta Obstet Gynecol Scand 80 (2001) studies (2)(3)(4)(5). Recently several Jehovah's Witnesses, who had refused perioperative blood transfusions, were treated with EPO resulting in increased erythropoiesis and good postoperative outcome (6,7).…”