Pregnancy with thalassemia: challenges and outcomes
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20181365Keywords:
Blood transfusion, High risk, ThalassemiaAbstract
Background: Thalassemia syndromes are autosomal recessive disorders and the most commonly inherited haemoglobinopathies in the world. HbE β is the most common type of thalassemia in eastern India. The objectives of the study include maternal outcome and complications like anemia, hypertensive disorders, gestational diabetes mellitus and also to study the neonatal outcome in terms of low birth weight, prematurity and other complications.
Methods: A prospective longitudinal study carried out over a period of one year from July 2016 to June 2017 in Medical College, Kolkata. Fifty antenatal thalassemic mothers over 20 weeks of gestation during study period were enrolled in after institutional ethical clearance and consent from study subjects. All necessary investigations (complete haemogram, reticulocyte counts, Ultrasounds etc.) were done followed by statistical analysis.
Results: Out of total 50 diagnosed thalassemic patients, maximum were HbE Beta Thal i.e. 54.0%. The mean level of iron in these women varied from 95.70±17.16µg/dl to 99.46±18.19µg/dl at the time of delivery and ferritin varied from 185.40±49.26µg/L vs 194.13±48.80µg/L. The mean blood transfusion done was 6.84 Units. Incidence of maternal complications were variable, PIH was found to be 26% whereas it was just 8% for GDM. The mean gestational age at delivery (Mean±SD) was 36.30±2.08 weeks. NICU admission was high (50%).
Conclusions: Pregnancy with thalassemia is considered high risk, continuous pre-conceptional, antenatal and postpartum assessment should be done for favorable outcomes.
References
Weatherall DJ. The definition and epidemiology of non-transfusion dependent thalassemia. Blood Rev. 2012;26:S3-6.
Shinar E, Rachmilewitz EA. Oxidative denaturation of red blood cells in thalassemia. Semin Hematol. 1990;27:70-82
Origa R, Piga A, Quarta G, Forni G, Longo F, Melpignano A, et al. Pregnancy and betathalassemia: an Italian multicentric experience. Haematol. 2010;95:376-81.
Chakrabarti S, Nayek H, Kanrar P, Mondal S. An observational study on thalassaemia in pregnancy and its effects with a view to find measures for reduction of its complications and improvement of maternal and perinatal outcome. J Evolut Med Dent Sci. 2014 Feb 3;3(5):1149-56.
Baxi A, Manila Kaushal, Kadhi P. Carrier screening for β-thalassemia in pregnant Indian women. Experience at a single centre in Madhya Pradesh. Indian J Hematol Blood Transfus. 2013;29(2):71-4.
Nassar AH, Naja M, Cesaretti C, Eprassi B, Cappellini MD, Taher A. Pregnancy outcome in patients with beta-thalassemia intermedia at two tertiary care centers, in Beirut and Milan. Haematol. 2008;93:1586-7.
Daskalakis GJ, Papageorgiou IS, Antsaklis AJ, Michalas SK. Pregnancy and homozygous beta thalassaemia major. Br J Obstet Gynaecol. 1998;105:1028-32.
Traisrisilp K, Luewan S, Tongsong T. Pregnancy outcomes in women complicated by thalassemia syndrome at MaharajNakorn Chiang Mai Hospital. Arch Gynecol Obstet. 2009;279(5):685-9.
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;23:33-7.
Usta IM, Rechdan JB, Koussa S, Taher AT. Pregnancy in patients with β-thalassemia intermedia: outcome of mothers and newborns. Am J of Hematol. 2006;81(7):499-502.
