Fertility and Pregnancy in Women with Transfusion-Dependent Thalassemia

Pregnancy, delivery, and neonatal outcomes among women with beta-thalassemia major: a population-based study of a large US database

PURPOSE

We explored the effect of beta-thalassemia major on pregnancy and delivery outcomes in non-endemic area, utilizing USA population database.

METHODS

This is a retrospective study utilizing data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. A cohort of all deliveries between 2011 and 2014 was created using ICD-9 codes. The patients with beta-thalassemia major were identified and matched to patients without beta-thalassemia based on age, race, income quartile, and type of health insurance at a ratio of 1:20. The baseline characteristics were compared between the groups using Chi-square and Fischer's exact tests, as appropriate. The univariate and multivariate analyses were conducted for pregnancy, delivery and neonatal outcomes to estimate the unadjusted and adjusted odds ratio, respectively.

RESULTS

Out of 3,070,656 pregnancies over the study period, beta-thalassemia major complicated 445 pregnancies. The patients with beta-thalassemia were more likely to have thyroid disorders and previous C-section (p-value < 0.05). There were no differences in pregnancy outcomes such as gestational hypertension, preeclampsia, gestational diabetes, and placenta previa. C-section was 30% more likely to be the method of birth (aOR 1.30, 95%CI 1.03-1.63) and there was more than three-fold increase in rate of blood transfusion (aOR 4.69, 95% CI 3.02-7.28) among participants with beta-thalassemia major. Mothers with beta-thalassemia, almost, were 70% more likely to have a neonate small for gestational age (aOR 1.68, 95%CI 1.07-2.62).

CONCLUSIONS

Women with beta-thalassemia major are more likely to give birth by C-section, require blood transfusion and have small for gestational age neonates. Counseling patients with beta-thalassemia about these risks and increased antenatal surveillance is advised.

Special considerations in assisted reproductive technology for patients with hematologic disease

Populations with hematologic disorders seeking fertility care often present with a complex clinical picture, including disease-specific sequelae and comorbid conditions. Limited literature exists to help guide fertility clinics on the management of these patients, many of whom require multidisciplinary care coordination centered on patient-specific fertility goals. Thanks to advancements in life-prolonging therapies for hematologic disorders, growing numbers of affected individuals are seeking assisted reproductive technologies for family building. Thus, it is important to be aware of the unique considerations and risks of assisted reproductive technologies for these populations and develop evidence-based care guidelines to optimize outcomes.

The impact of various types of α-thalassemia on perinatal complications and pregnancy outcomes in pregnant women

This study aims to investigate the adverse effects of different types of α-thalassemia on pregnant women and their differences, so as to provide reference for the prevention and monitoring of perinatal complications in different types of α-thalassemia pregnancy. The observation group comprised 1371 singleton pregnant women with α-thalassemia, control group comprised 680 non-thalassemia singleton pregnancies during the same period. The thalassemia genotypes of the observation group were tallied and categorized based on their respective genotypes within the group. The hemoglobin in the experimental group was lower than control group. The incidences of electrocardiographic abnormality, abnormal liver function, hypertensive disorders, gestational diabetes mellitus and thyroid disorders during pregnancy were higher in the observation group than in the control group. The incidences of preterm labor, caesarean section and postpartum hemorrhage were all higher in the observation group than in the control group. The delivery weight and neonatal hemoglobin in the observation group were lower than those in the control group. Pregnant women with α-thalassemia have more pregnancy and delivery complications than those without α-thalassemia, they should receive more frequent and standardized prenatal examination, so as to find and correct abnormal indicators in time.

The patient perspective: The struggles of living with thalassemia as an adult

Today it has become the norm for individuals diagnosed with severe forms of thalassemia who have access to hypertransfusion regimens, chelation therapy, and annual surveillance to survive well beyond childhood. However, with this improvement in prognosis and subsequent transition to adult care, it has become apparent that most adult healthcare providers, including many adult hematologists and primary care providers, are ill-prepared to care for these patients and the complications that accompany their survival into adulthood. Collaborative efforts are needed to develop comprehensive approaches to contend with the challenges faced by adult patients to ensure they are properly managed and supported.