Pregnancy in Patients with Thalassemia: A Single-Center Study

Year 2024, Volume: 24 Issue: 1, 25 - 29, 07.05.2024

Selime Aydoğdu , Begum Sirin Koc , Şifa Şahin Simge Erdem Serap Karaman Zeynep Karakaş

https://doi.org/10.26650/jchild.2024.1352861

Abstract

Objective: In thalassemia syndromes, iron accumulation due to transfusion or excessive iron absorption adversely affects many organ functions, including the endocrine system. Due to advances in effective transfusion and chelation therapy in recent years a significant increase as occured in the life expectancy and quality of life of patients. This situation has also led to an increase in patients’ expectation of having children.

Methods: This study retrospectively, evaluates the transfusion characteristics, complications and conditions of the babies with regard to pre-pregnancy, pregnancy and delivery of our transfusion-dependent thalassemia patients who’ve had children and were monitored at the Istanbul University Medical Faculty, Department of Pediatric Hematology and Oncology.

Results: The study includes 15 patients with a gestational age between 22-34 (28±3,9) years, five with thalassemia major, nine with thalassemia intermedia, and one with thalassemia trait and alpha triplication. While 14 patients came for regular follow-ups, one did not. The patients on a regular transfusion program had an increased frequency of transfusions throughout pregnancy; four patients with thalassemia intermedia, who had never undergone a transfusion before, were observed to have been included in a regular transfusion program starting with the 2nd trimester of pregnancy. None of the patients developed cardiac and/or thromboembolic complications. One patient diagnosed with thalassemia intermedia and one patient diagnosed with thalassemia major each had a stillborn baby, three patients diagnosed with thalassemia intermedia had preterm babies and four other patients had babies with intrauterine growth restrictions (IUGR).

Conclusions: Thalassemia patients who are followed up with a regular multidisciplinary approach will be able to have a healthy pregnancy and children through the early recognition, prevention and treatment of complications.

Keywords

Thalassemia, pregnancy, child

Supporting Institution

yoktur

References

• Petrakos G, Andriopoulos P, Tsironi M. Pregnancy in women with thalassemia:challenges and solutions. Int J Womens Health 2016;8:441-51 google scholar
• Origa R, Piga A, Quarta G, Forni GL, Longo F, Melpignano A et al. Pregnancy and beta thalassemia:an Italian multicenter experience. Haematologica 2010;95(3):376-81. google scholar
• Galanello R. A thalassemic child becomes adult. Rev Clin Exp Hematol 2003;7(1):4-21. google scholar
• Cunningham MJ. Update on thalassemia: clinical care and complications. Pediatr Clin North Am 2008;55(2):447-60. google scholar
• Modell B, Khan M, Darlison M, Westwood MA, Ingram D, Pennell DJ. Improved survival of thalassaemia major in the UK and relation to T2* cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2008; 10(1):42. google scholar
• Telfer P, Coen PG, Christou S et al. Survival of medically treated thalassemia patients in Cyprus. Trends and risk factors over the period 1908-2004. Haematologica 2006;91(9):1187-92 google scholar
• Psihogios V, Rodda C, Reid E, Clark M, Clarke C, Bowden D. Reproductive health in individuals with homozygous beta-thalassemia: knowledge, attitudes, and behavior. Fertil Steril 2002;77(1):119-27. google scholar
• Walker EH, Whelton MJ, Beaven GH. Successful pregnancy in a patient with thalassaemia major. J Obstet Gynaecol Br Commonw 1969;76(6):549-53. google scholar
• Skordis N, Petrikkos L, Toumba M, Hadjigavriel M, Sitarou M, Kolnakou A et al. Update on fertility in thalassaemia major. Pediatric Endocrinol Rev 2004;2 (Suppl2):296-302 google scholar
• Cunningham MJ, Macklin EA, Neufeld EJ, Cohen AR; Thalassemia Clinical Research Network. Complications of beta-thalassemia major in North America. Blood 2004;1;104(1):34-9. google scholar
• Thompson AA, Kim HY, Singer ST, Vichinsky E, Eile J, Yamashita R et al. Thalassemia Clinical Research Network. Pregnancy outcomes in women with thalassemia in North America and the United Kingdom. Am J Hematol 2013;88(9):771-73. google scholar
• Gulino FA, Vitale SG, Fauzia M, Cianci S, Pafumi C, Palumbo MA. Beta-Thalassemia major and pregnancy. Bratisl Lek Listy 2013;114 (9) 523-25 . google scholar
• Cassinerio E, Baldini IM, Alameddine RS, Macron A, Borroni R, Ossola W et al. Pregnancy in patients with thalassemia major:a cohort study and conclusions for an adequate care management approach. Ann Hematol 2017;96(6):1015-21. google scholar
• Smith V, Osianlis T, Vollenhoven B. Prevention of Ovarian Hyperstimulation Syndrome: A Review. Obstet Gynecol Int 2015;2015:514159 google scholar
• Origa R and Comitini F. Pregnancy in Thalassemia. Mediterr J Hematol Infect Dis 2019;11(1): e2019019, google scholar
• Ansari S, Azarkeivan A, Tabaroki A. Pregnancy in patients treated for beta thalassemia major in two centers (Ali Asghar Children’s Hospital and Thalassemia Clinic):outcome for mothers and newborn infants. Pediatr Hematol Oncol 2006;23(1):33-37. google scholar
• Toumba M, Kanaris C, Simamonian K, Skordis N. Outcome and management of pregnancy in women with thalassaemia in Cyprus. East Mediterr Health J 2008;14(3):628-35. google scholar
• Singer ST, Vichinsky EP. Deferoxamine treatment during pregnancy: is it harmful? Am J Hematol 1999;60(1):24-26. google scholar
• Galanello R, Origa R. Beta-thalassemia. Orphanet J Rare Dis. 2010; 5: 11. google scholar
• Farmakis D, Porter C, Taher A, Cappellini MD, Angastiniotis M, Eleftheriau A. 2021 Thalassaemia International Federation Guidelines for the Management of Transfusion-dependent Thalassemia. Hemasphere. 2022 Aug; 6(8): 732e. google scholar
• Voskaridou E, Balassopoulou A, Boutou E, Komninaka V, Christoulas D, Dimopoulou M et al. Pregnancy in beta-thalassemia intermedia:20-year experience of a Greek thalassemia center. Eur J Haematol 2014;93(6):492-99. google scholar
• Nassar AH, Usta IM, Taher AM. Beta-thalassemia intermedia and pregnancy:should we anticoagulate? J Thromb Haemost 2006;4(6):1413-14. google scholar
• Kumar RM, Rizk DE, Khuranna A. Beta-thalassemia major and successful pregnancy. J Reprod Med 1997;42(5):294-298. google scholar
• Tsironi M, Karagiorga M, Aessopos A. Iron overload, cardiac and other factors affecting pregnancy in thalassemia major. Haemoglobin 2010;34(3):240-50. google scholar
• Choudhary DR, Mishra P, Kumar R, Mahapatra M, Choudhry VP. Pregnancy on imatinib: fatal outcome with meningocele. Ann Oncol 2006;17:178-79 google scholar
• Tuck SM. Fertility and pregnancy in thalassemia major. Ann N Y Acad Sci 2005;1054:300-307 . google scholar
• Daskalakis GJ, Papageorgiou IS, Antsaklis AJ, Michalas SK. Pregnancy and homozygous beta thalassaemia major. Br J Obstet Gynaecol 1998;105(9):1028-32. google scholar
• Roumi JE, Moukhadder HM, Graziadei G, Pennisi M, Cappellini MD, Taher AT. Pregnancy in p-thalassemia intermedia at two tertiary care centers in Lebanon and Italy: A follow-up report on fetal and maternal outcomes. Am J Hematol 2017;92(6):96-99. google scholar
• Aessopos A, Karabatsos F, Farmakis D,Katsantoni A, Hatziliami A, Youssef J et al. Pregnancy in patients with well-treated beta-thalassemia: outcome for mothers and newborn infants. Am J Obstet Gynecol 1999;180(2 Pt 1):360-65. google scholar