Pregnancy in patients with thalassemia major: a cohort study and conclusions for an adequate care management approach.
An improvement in quality of life and survival occurred among thalassemia major (TM) patients: pregnancy in such patients has become a reality. Safe pregnancy and delivery require efforts to ensure the best outcomes. Between 2007 and 2016, 30 TM patients had 37 pregnancies. We analyzed the hematological parameters before, during, and after pregnancies and in 19 patients a cardiovascular magnetic resonance (CMR) T2* was performed. The mean age at first pregnancy was 30 ± 4 years; the current mean age is 35 ± 5 years. Twenty-four patients (80%) had a single pregnancy, five patients (17%) had two pregnancies, and one patient (3%) became pregnant three times. Seventeen pregnancies (46%) were spontaneous, 20 (64%) needed gonadotrophin-induced ovulation and/or reproductive technologies. All pregnancies resulted in live births. Seven were twin pregnancies (19%). The mean gestational hemoglobin was 9.2 ± 0.5 g/dl, lower than pre- and postpregnancy (9.8 ± 1 g/dl, p = ns and 9.6 ± 1 g/dl, p = 0.02, respectively). Median ferritin levels increased progressively (1071, range 409-5724 ng/ml, before pregnancy vs 2231, range 836-6918 ng/ml, after pregnancy, p < 0.0001). CMR before pregnancy showed a normal cardiac T2* (mean 35.34 ± 8.90 ms) and a mean liver iron concentration (LIC) of 3.37 ± 2.11 mg/g dry weight (dw). After pregnancy, the mean cardiac T2* was 31.06 ± 13.26 ms and the mean LIC was significantly increased (9.06 ± 5.75 mg/g dw, p = 0.0001). Pregnancy is possible and safe in thalassemia major. During pregnancy, iron accumulates, especially in the liver; a prompt resumption of chelation after delivery is mandatory.
Rare Diseases Center, Department of Medicine and Medical Specialities, "Ca' Granda" Foundation IRCCS, Milan, Italy. elena.cassinerio@policlinico.mi.it.
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Cassinerio
Rare Diseases Center, Department of Medicine and Medical Specialities, "Ca' Granda" Foundation IRCCS, Milan, Italy.
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Baldini
Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
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Alameddine
Rare Diseases Center, Department of Medicine and Medical Specialities, "Ca' Granda" Foundation IRCCS, Milan, Italy.
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Marcon
Infertility Unit, "Ca' Granda" Foundation IRCCS, Milan, Italy.
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Borroni
Department of Obstetrics and Gynecology "L. Mangiagalli", "Ca' Granda" Foundation IRCCS, Milan, Italy.
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Ossola
Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
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Taher
Rare Diseases Center, Department of Medicine and Medical Specialities, "Ca' Granda" Foundation IRCCS, Milan, Italy.|Department of Clinical Science and Community Health, University of Milan, Milan, Italy.
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Cappellini
D000328:Adult; D001724:Birth Weight; D001803:Blood Transfusion; D015331:Cohort Studies; D005260:Female; D005293:Ferritins / Q000097:blood; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007231:Infant, Newborn; D007501:Iron / Q000378:metabolism; D050498:Live Birth; D008099:Liver / Q000378:metabolism; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic; D011788:Quality of Life; D017086:beta-Thalassemia / Q000097:blood / Q000150:complications* / Q000628:therapy
D006454:Hemoglobins; D005293:Ferritins; D007501:Iron
Delivery; Hypogonadism; Magnetic resonance T2*; Pregnancy; Thalassemia major