Pregnancy in patients with β-thalassemia intermedia: Outcome of mothers and newborns

Abstract

Little is known about the outcome of pregnancy in women with b-thalassemia intermedia (TI). Over 10 years, maternal and neonatal outcomes of women with TI followed at a single thalassemia center were reviewed. Nine spontaneous pregnancies in five women with TI were studied. Six pregnancies resulted in live newborns; two were complicated by firsttrimester abortions and one by an unexplained intrauterine fetal death at 36 weeks' gestation. Two patients had splenectomy before pregnancy: one required cesarean delivery and splenectomy at 31 2/7 weeks' gestation for worsening hemolytic anemia and thrombocytopenia and another had splenectomy 8 weeks postpartum for symptomatic hypersplenism. Two patients had received transfusions before pregnancy, and two required them for the first time during pregnancy and developed antibodies, which contributed to worsening of their anemia and repeated transfusions. The mean number of transfusions received during pregnancy was 8.0 ± 5.2 units. The mean lowest hemoglobin level in pregnancy was 5.2 ± 2.0 g/dl. Cesarean delivery was performed in 42.9% of cases. Mean gestational age at delivery was 36.7 ± 3.1 weeks with intrauterine growth restriction (IUGR) complicating 57.1% of cases. In conclusion, IUGR complicates more than half of pregnancies with TI. Transfusions are needed in most cases, even in non-transfusion-dependent patients. Postpartum splenectomy might be necessary in some patients. Am. J. Hematol. 81:499-502, 2006. V V C 2006 Wiley-Liss, Inc.

The Effect of Hemoglobin Correction by Blood Transfusion on Pregnancy Outcomes in Minor and Intermedia Thalassemia Patients: A Single-Blind Controlled Randomized Clinical Trial

“…There are evidence in which anemia (100 g/l) is an independent risk factor for low birth weight and preterm delivery in non-thalassemic pregnant women (Levy, Fraser, Katz, Mazor, & Sheiner, 2005). Chronic anemia in pregnant women may result in fetal hypoxia and lead to IUGR (Nassar et al, 2006). Eyal Sheiner et al, in their study could not find significant relationship between hemoglobin level and IUGR incidence in women with thalassemia.…”

“…beta-thalassemia major (Howard et al, 2015). The pregnancy in thalassemia major is compromised by transfusion support; however, fertility is possible in the majority of patients with thalassemia intermedia (Nassar et al, 2006). Although, beta thalassemia pregnant patients suffer from anemia with hemoglobin levels of 7-10 g/dl, also have variable degrees of splenomegaly (Nassar et al, 2006) and more likely may need to blood transfusion (Benz, 2016).…”

“…Pregnancy itself leads to various physiologic changes such as relative anemia which can put potential effects on both mother and fetus (Cunningham, Leveno, Bloom, Spong, & Dashe, 2014;Nassar et al, 2006;Rahimi, 2013;Rezaee, Banoei, Khalili, & Houshmand, 2012). Therefore, it seems that pregnancy related physiologic changes intensify underline anemia in beta thalassemia patients (both minor and intermedia) and increase the risk of preterm labor, intrauterine growth restriction, and low birth weight (Hanprasertpong et al, 2013;Nassar et al, 2006).…”

“…Therefore, it seems that pregnancy related physiologic changes intensify underline anemia in beta thalassemia patients (both minor and intermedia) and increase the risk of preterm labor, intrauterine growth restriction, and low birth weight (Hanprasertpong et al, 2013;Nassar et al, 2006). Despite the limited number of stdies on pregnancy outcomes in patients with beta thalassemia minor and intermedia, it has been shown that the rate of some adverse complications such as IUGR and need a blood transfusion, especially in beta thalassemia intermedia, is high.…”

“…Despite the limited number of stdies on pregnancy outcomes in patients with beta thalassemia minor and intermedia, it has been shown that the rate of some adverse complications such as IUGR and need a blood transfusion, especially in beta thalassemia intermedia, is high. This emphasizes the collaborations between hematology and obstetric services to manage such patients (Nassar et al, 2006;Voskaridou et al, 2014). Modifying the hemoglobin concentration by transfusion therapy is one of the most effective procedures to improve hematologic and tissue oxygenation status (S. Sharma, P. Sharma, & Tyler, 2011;Voskaridou et al, 2014).…”