Pregnancy and Delivery in Patients with Mastocytosis Treated at the Polish Center of the European Competence Network on Mastocytosis (ECNM)

Abstract

ObjectiveTo present current guidelines regarding treatment of mastocytosis in pregnancy on the example of observed patients.DesignCase control national study.SettingPolish Center of the European Competence Network on Mastocytosis (ECNM).Population or Sample23 singleton spontaneous pregnancies in 17 women diagnosed with mastocytosis in years 1999–2014, before becoming pregnant.MethodsProspective analysis outcomes of pregnancies and deliveries.Main Outcome MeasuresSurvey developed in cooperation with the Spanish Instituto de Estudios de Mastocitosis de Castilla-La Mancha (CLMast), Hospital Virgen del Valle, Toledo, Red Espańola de Mastocitosis (REMA), Spain.ResultsAll 23 pregnancies resulted from natural conception. Obstetrical complications recorded in the first trimester included spontaneous miscarriage (5 pregnancies). Four patients delivered preterm, including one delivery due to preeclampsia at 26 weeks which resulted with neonate death due to extreme prematurity. Five women delivered via cesarean: four due to obstetrical indications and one due to mastocytosis, during which no anesthesia related complications were recorded. Of patients delivering vaginally, two received extradural anesthesia, three required oxytocin infusion due to uterine hypotonia. No labor complications were recorded. In one woman with pregnancy-induced hypertension, early puerperium was complicated by the presence of persistent arterial hypertension. One neonate was born with the signs of cutaneous mastocytosis. Another neonate was diagnosed with Patau syndrome. Four women were treated for mastocytosis prior to conception and continued therapy after becoming pregnant. One patient was put on medications in the first trimester due to worsening of her symptoms. Pregnancy exerted only a slight effect on the intensity and frequency of mastocytosis-related symptoms observed. Worsening of the disease-related symptoms was documented in only four patients (23%). None of the patients showed the signs of anaphylaxis, either before becoming pregnant, or during pregnancy and puerperium.ConclusionsThere is no contraindication to pregnancy when mastocystosis-related pathologies are under appropriate medical control.

Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations

“…47 However, caution has been recommended with atracurium, mivacurium, and other drugs with marked histamine-releasing effect, and these drugs should only be used if clinically indicated. 61 The perioperative course of patients with mastocytosis, including parturients 93 and children, 94 is usually uncomplicated. 61 The management of perioperative anaphylaxis in mastocytosis must be adapted to the severity of the clinical features.…”

Management of a Parturient with Mast Cell Activation Syndrome: An Anesthesiologist’s Experience

“…Data from studies on pregnancy and delivery in patients with mast cell disorders is reassuring [ 10 , 15 ]. Mast cells exhibit a beneficial function in pregnancy by contributing to implantation, placentation, and fetal growth.…”

Systemic Mastocytosis, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology

“…Spontaneous miscarriages and worsening of symptoms related to mast cell activation have been reported in 20% to 30% of pregnant women with mastocytosis. [152][153][154] Symptoms related to mast cell mediator release have been observed in 11% of patients without any fatal outcome. 154 SM is not a contraindication to a successful pregnancy.…”