Outcomes of pregnancies affected by hemoglobin H disease

Tongsong, Theera; Srisupundit, Kasemsri; Luewan, Suchaya

doi:10.1016/j.ijgo.2008.10.010

Cited by 32 publications

(34 citation statements)

References 18 publications

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“…Hydrop foetalis can be the outcome of pregnancy of mothers with Hb H disease,67–68 and in fact, according to a report on hydrop foetalis in Thailand by Taweevisit and Thorner (2008),69 3.8% were related to Hb H disease. Ong et al (1977)70 reported that Hb H disease probably had no adverse effect on pregnancy, although Tantiweerawong et al (2005)71 found that Hb H disease may adversely affect maternal and fetal health, causing in particular low birth weight.…”

Section: Delivery Outcomes Of Pregnancies and Breast-feedingmentioning

confidence: 99%

Pregnancy in Thalassemia

Origa¹,

Comitini²

2019

Mediterr J Hematol Infect Dis

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Therapeutic advances, including the availability of oral iron chelators and new non-invasive methods for early detection and treatment of iron overload, have significantly improved the life expectancy and quality of life of patients with thalassemia, with a consequent increase in their reproductive potential and desire to have children. Hundreds of pregnancies have been reported so far, highlighting that women carefully managed during preconception usually carry out a successful gestation and labour, both in case of spontaneous conception and use of assisted reproductive techniques. A multidisciplinary team including a cardiologist, an endocrinologist and a gynaecologist, with the supervision of an expert in beta-thalassemia should be involved. During pregnancy, a close follow-up of maternal disorders and of the baby's status is recommended. Haemoglobin should be maintained over 10 g/dL to to allow normal foetal growth. Chelators are not recommended during pregnancy; nevertheless, it may reasonable to consider restarting chelation therapy with desferrioxamine towards the end of the second trimester when the potential benefit outweighs the potential foetal risk. Women with non-transfusion-dependent thalassemia who have never previously been transfused or who have received only minimal transfusion therapy are at risk of severe alloimmune anaemia if blood transfusions are required during pregnancy. Since pregnancy increases the risk of thrombosis three-fold to four-fold and thalassemia is also a hypercoagulable state, the recommendation is to keep women who are at higher risk -such as those who are not regularly transfused and those splenectomised- on prophylaxis during pregnancy and during the postpartum period. Keywords:Pregnancy, Thalassemia major, Thalassemia intermedia, Haemoglobin H disease, Counselling

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Section: Delivery Outcomes Of Pregnancies and Breast-feedingmentioning

confidence: 99%

Pregnancy in Thalassemia

Origa¹,

Comitini²

2019

Mediterr J Hematol Infect Dis

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“…Regarding the thalassemia disease in women, physiologic changes during pregnancy worsen the severity of anemia and are significantly associated with an increased risks of fetal growth restriction, preterm birth and low birthweight [ 3 – 5 ]. There are some reports on pregnancy outcomes among women with thalassemia trait [ 6 , 7 ], but, to our knowledge, no report on the risk of adverse pregnancy outcomes when compared with pregnant women without thalassemia trait has been published.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy outcomes amongst thalassemia traits

Hanprasertpong

Kor-anantakul

Leetanaporn

et al. 2013

Arch Gynecol Obstet

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ObjectiveTo compare the pregnancy outcome between pregnancies affected and not affected by thalassemia trait.MethodsA retrospective case–control cohort study was conducted on singleton pregnant women who attended antenatal care and delivered at Songklanagarind Hospital. All of the participating thalassemia trait pregnant women were diagnosed based on hemoglobin typing and/or DNA analysis. A ratio of around 1–1 was used to compare their pregnancy outcomes with normal pregnant women.ResultsSeven hundred thirty-nine thalassemia trait and 799 normal pregnant women were included in the study. All of the women were Thai nationals living in the Southern Region of Thailand and nearly all of them had spontaneously conceived. Maternal complication rates of gestational diabetes, preterm birth, antepartum bleeding, postpartum bleeding, shoulder dystocia and puerperal morbidity, and the rates of neonatal complications: macrosomia, fetal weight <2,000 g, intrauterine growth restriction (IUGR), stillbirth, low Apgar score (<7) at 1 and 5 min and NICU admission, were not significantly different between the two groups. The rate of pre-eclampsia, however, was significantly different, with RRs of 1.73 (CI 1.01–3.00).ConclusionThe thalassemia trait condition did not affect the risk of gestational diabetes, postpartum hemorrhage, stillbirth, preterm birth and puerperal morbidity. However, pre-eclampsia should be warranted especially among nulliparous and high-BMI pregnant women.

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“…Pregnancy in HbH disease may be complicated mainly with anemia [12]. A study by Tongsong et al has shown that common obstetric complications such as antepartum hemorrhage, preeclampsia, and postpartum hemorrhage are not significantly associated with HbH disease [13] but Tantiweerawong et al have found that HbH may adversely affect maternal health [14]. …”

Section: Discussionmentioning

confidence: 99%

“…While a significant proportion of pregnancies in TI women was complicated by IUGR in a Lebanese study, blood transfusions during pregnancy do not seem to decrease the risk of IUGR as well as other complications [15]. On the contrary, Tongsong et al demonstrated that there are several benefits of frequent transfusions during pregnancy in HbH disease, like the prevention of growth restriction, suggesting that a strict control of hemoglobin levels could result in better outcome [13]. Data from nonthalassemic cohorts suggests that hemoglobin levels above 10 g/dL during gestation are recommended for optimal fetal growth and preclusion of preterm delivery [16].…”

Section: Discussionmentioning

confidence: 99%

Pregnancy Complications in a-Thalassemia (Hemoglobinopathy H): A Case Study

Politou

Dryllis

Efstathopoulou

et al. 2018

Case Reports in Obstetrics and Gynecology

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Thalassemia intermedia (TI) is a clinical definition which represents a wide spectrum of thalassemia genotypes but mainly includes patients who do not require or only occasionally require transfusion. An uncommon case of a 32-year-old Greek woman, para 1, at the 22nd week + day 3 of gestation with thalassemia intermedia (she was splenectomized), where her pregnancy was complicated with portal vein thrombosis, splenic thrombosis, and partial HELLP, is described. This is a generally uncommon event in thalassemia intermedia. She had no transfusion as her hematologist consulted and she took anticoagulation therapy. Thus, we present for the first time in the literature a case of HbH a-thalassemia pregnant woman whose pregnancy was complicated with portal vein thrombosis, splenic vein thrombosis, and partial HELLP; she was treated with anticoagulation therapy and she had a successful outcome.

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Outcomes of pregnancies affected by hemoglobin H disease

Abstract: In spite of attempts to keep hemoglobin levels sufficiently high (>7.0 g/dL), pregnancies with HbH disease were significantly associated with increased risks of fetal growth restriction, preterm birth, and low birth weight.

Cited by 32 publications

References 18 publications

Pregnancy in Thalassemia

Pregnancy in Thalassemia

Pregnancy outcomes amongst thalassemia traits

Pregnancy Complications in a-Thalassemia (Hemoglobinopathy H): A Case Study

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