A recent study published in Haematologica (Vol. 95, Issue 3) examined pregnancy in women with thalassemia.
Entitled "Pregnancy and Beta-thalassemia: an Italian multicenter experience," the paper examined 58 pregnancies among 47 women with thalassemia major and 17 pregnancies in women with thalassemia intermedia at four centers in Italy. The study reports that conception was spontaneous in all of those with thalassemia intermedia; among those with thalassemia major, gonadotrophin-induced ovulation was required in 33 of the women.
According to the study, 91% of the pregnancies among alassemia major patients resulted in live births (45 single births, 5 sets of twins, one set of triplets). The authors also report that no secondary complications of iron overload developed or worsened during pregnancy. There was a higher prevalence of pre-term births (32.8%), but the authors state that this was primarily related to multiple pregnancies and precautionary measures. Women with thalassemia intermedia who had never been transfused or who had only minimal transfusion prior to pregnancy were found to be at risk of severe alloimmune anemia if transfusions were required during pregnancy. (Decreased hemoglobin levels necessitated transfusion in 11 of the 17 thalassemia intermedia pregnancies.) Of the 17 pregnancies in thalassemia intermedia known to the researchers, 15 resulted in live births.
The authors also state that "cardiac function was not impaired during pregnancy." One patient did experience worsening of T2* scores, but the authors suggest that this was due to the timing of the second MRI reading; as it was taken one month after delivery, the patient was still off chelation. The authors also stated that "it is strongly recommended that thalassemic women wishing to become pregnant undergo a complete evaluation of organ iron overload, including MRI T2* and SQUID, prior to pregnancy." (In the United States, Ferriscan/R2 readings are often used for liver iron rather than those provided by SQUID, together with T2* cardiac assessment.)
The study concludes that "provided a multidisciplinary team is available, pregnancy is possible, safe and usually has a favorable outcome in patients with thalassemia." The authors are state the need for larger and more detailed studies, especially in thalassemia intermedia.
Download CAF's "Fertility and Pregnancy in Thalassemia" pamphlet by clicking here
