Читать книгу Protocols for High-Risk Pregnancies - Группа авторов - Страница 146

Management of thalassemias in pregnancy does not differ significantly from management of low‐risk pregnancies. Patients who are affected or are carriers of either alpha‐thalassemia or beta‐thalassemia should be referred for genetic counseling and partner testing to assess risk for an affected fetus. Should they be at risk of an affected fetus, diagnostic prenatal testing should be discussed and offered in conjunction with a maternal‐fetal medicine consultation.

Patients with alpha‐thalassemia trait and HbH overall have favorable pregnancy outcomes affected by mild to moderate anemia and their care should not differ significantly from routine prenatal care. Patients with beta‐thalassemia minor will often have only a mild asymptomatic anemia. There have been reports of higher rates of fetal growth restriction with beta‐thalassemia minor and therefore a third‐trimester growth ultrasound should be considered. In all patients with any form of thalassemia, regular monitoring for anemia should be performed. Iron supplementation should not exceed normal prophylactic doses of iron unless laboratory evidence of iron deficiency is noted.

Pregnancies in women with beta‐thalassemia major were rare prior to the introduction of hypertransfusion and iron chelation therapy. Reports since that time have shown overall favorable outcomes. Per the American College of Obstetricians and Gynecologists, pregnancy in women with beta‐thalassemia is only recommended for those with normal cardiac function and who have undergone prolonged hypertransfusion therapy with iron chelation. These patients are at risk of fetal growth restriction and should be monitored with serial growth ultrasounds. During pregnancy, the goal for these patients is to maintain hemoglobin levels around 10 g/dL with serial transfusions as necessary. Iron chelation therapy is typically deferred during pregnancy given the paucity of data on its safety in pregnancy.