Pregnancy in β‐thalassemia intermedia at two tertiary care centers in Lebanon and Italy: A follow‐up report on fetal and maternal outcomes

Roumi, Joseph; Moukhadder, Hassan M.; Graziadei, Giovanna; Pennisi, Martina; Cappellini, Maria Domenica; Taher, Ali T.

doi:10.1002/ajh.24690

Cited by 10 publications

(19 citation statements)

References 11 publications

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“…Out of 60 pregnancies, 11 abortions (18.3%) including six spontaneous (10%) and 5 (8.3%) for medical reasons were reported by Voskaridou et al (2014) 50. No miscarriages were reported in 11 Sardinian women with thalassemia intermedia (17 pregnancies)8 and the percentage of abortions was low (7.05%) also in 48 thalassemia intermedia patients (85 pregnancies) followed at two tertiary care centers in Lebanon and Italy 64…”

Section: Delivery Outcomes Of Pregnancies and Breast-feedingmentioning

confidence: 92%

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: 92%

Pregnancy in Thalassemia

Origa¹,

Comitini²

2019

Mediterr J Hematol Infect Dis

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“…Results showed that TI patients who were not transfused, or transfused infrequently, had lower ferritin levels and significantly higher levels of steroid hormones (Table 3) wishing to become pregnant need ovarian stimulation, modern treatment, and further investigations. 7,16,17 Moreover, this study showed that the incidence of abortions decreased to 12.4% since 2006, suggesting an increase in the quality of life and survival of patients using targeted management and follow-up. 18 Indeed, improvements over the last decade with the availability of new noninvasive methods Patients with spontaneous pregnancy had a lower age at the time of marriage and higher age at the time of blood transfusion.…”

Section: Type Of Thalassemia and Pregnancy Managementmentioning

confidence: 72%

Fertility and pregnancy in Iranian thalassemia patients: An update on transfusion complications

Takhviji

Zibara

Azarkeivan

et al. 2020

Transfusion Medicine

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Background: Despite the significant advances in thalassemia pathobiology and efficacy of chelation regimens, complications of transfusion therapy have attenuated the reproductive health of thalassemia patients. Depending on clinical profiles, we aimed to assess the fertility status and stresses among thalassemia patients who desired to have children. Material and methods: A total of 213 couples in reproductive ages were enrolled in this study in Tehran. Patients' demographic, clinical, fertility and spouse's health status were documented. We evaluated the pituitary-gonadal axis, serum ferritin, liver enzymes, and alloimmunization before planning a pregnancy and reported them as a function of spontaneous conception and transfusion dependency. Results: Data showed that 131 patients (62%) had 228 spontaneous pregnancies leading to 198 (86.6%) successful pregnancies. A significant difference was observed in spontaneous pregnancy with respect to fertility complications and transfusion dependency. In addition, the clinical conditions of spouses in patients with any spontaneous pregnancy were more thalassemia carriers (P < .05). Moreover, serum ferritin levels had a significant negative correlation with the levels of Testosterone, Estradiol, luteinizing hormone, and follicle-stimulating hormone. Furthermore, a significant positive correlation was reported with the level of liver enzymes. Finally, alanine transaminase and aspartate transaminase had a significant negative correlation with pituitary hormones. Conclusion: We suggest that organised instruction in addition to good iron chelation, especially during the puberty period, would reduce the oxidative damage and related complications in thalassemia patients. Moreover, infertility seems to be attributed to iron deposition in various endocrine organs, pituitary, reproductive system and the liver, contributing to hormonal metabolism.

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“… 66 Venous thromboembolism is the most serious complication seen in this patient population; especially in women with additional prothrombotic risk factors such as splenectomy, age and low Hb level. 67 , 68 An incidence greater than 30% of venous thromboembolic events has been reported in NTDT patients, reflecting a hypercoagulable state that is driven by several mechanisms including endothelial damage secondary to the iron-mediated free radical formation. 69 Other studies, however, show that pregnancy in NTDT patients was not shown to increase the risk of thromboembolic complications compared to non-pregnant NTDT women.…”

Section: Thalassemiamentioning

confidence: 99%

Recommendations for Pregnancy in Rare Inherited Anemias

et al. 2020

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Rare inherited anemias are a subset of anemias caused by a genetic defect along one of the several stages of erythropoiesis or in different cellular components that affect red blood cell integrity, and thus its lifespan. Due to their low prevalence, several complications on growth and development, and multi-organ system damage are not yet well defined. Moreover, during the last decade there has been a lack of proper understanding of the impact of rare anemias on maternal and fetal outcomes. In addition, there are no clear-cut guidelines outlining the pathophysiological trends and management options unique to this special population. Here, we present on behalf of the European Hematology Association, evidence- and consensus-based guidelines, established by an international group of experts in different fields, including hematologists, gynecologists, general practitioners, medical geneticists, and experts in rare inherited anemias from various European countries for standardized and appropriate choice of therapeutic interventions for the management of pregnancy in rare inherited anemias, including Diamond-Blackfan Anemia, Congenital Dyserythropoietic Anemias, Thalassemia, Sickle Cell Disease, Enzyme deficiency and Red cell membrane disorders.

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Pregnancy in β‐thalassemia intermedia at two tertiary care centers in Lebanon and Italy: A follow‐up report on fetal and maternal outcomes

Cited by 10 publications

References 11 publications

Pregnancy in Thalassemia

Pregnancy in Thalassemia

Fertility and pregnancy in Iranian thalassemia patients: An update on transfusion complications

Recommendations for Pregnancy in Rare Inherited Anemias

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