Pregnancy in patients with myelodysplastic syndromes (MDS)

Pregnancy and myelodysplastic syndrome: an analysis of the clinical characteristics, maternal and fetal outcomes

OBJECTIVE

To investigate the clinical characteristics, management, maternal and fetal outcomes in pregnant patients with myelodysplastic syndrome (MDS).

METHODS

A retrospective analysis was conducted on 25 pregnant women with MDS between June 1998 and January 2013. The clinical data were summarized. These patients were divided into poor outcome group and control group, and regression analysis was conducted to find the risk factors for maternal and fetal outcomes.

RESULTS

Five patients developed premature birth, five patients developed postpartum hemorrhage, one patient developed postpartum acute cardiac failure and one patient developed postpartum cerebral infarction. Twenty out of the 25 patients underwent complete follow-up and 17 newborns were normal during follow-up. The regression analysis shows anemia and gestational hypertension are the primary risk factors for poor outcomes, whereas age, first onset of hematological disease, WBC count and platelet count are not significantly associated with the outcomes.

DISCUSSION

Anemia and gestational hypertension may be the primary risk factors for poor maternal and fetal outcomes in pregnant patients with MDS. To avoid maternal and neonatal complications, a minimum of hemoglobin level >70 g/L, platelet count >30 × 10(9)/L and WBC count >3 × 10(9)/L, are recommended. Close monitoring on blood routine, maternal complications and active supportive treatment are recommended.

Management of hematological malignancies during pregnancy

The management of hematological malignancies during pregnancy is a challenging endeavor, which not only requires technical skills and knowledge by the clinicians but also requires sound clinical judgment and compassion, keeping in mind the patient and family preferences and, ultimately, the wellbeing of the neonate. The incidence of hematological malignancies during pregnancy is rare, ranging from 1 in 1,000 to 1 in 10,000 deliveries, impeding the design and execution of large prospective studies. The purpose of this review is to evaluate the limited existing data and make useful suggestions in the management of acute and chronic leukemias, Hodgkin and non-Hodgkin lymphomas, plasma cell myeloma, and other hematological malignancies, such as myelodysplastic syndromes and hairy cell leukemia, during pregnancy.