Pregnancy and Thalassemia: Health of the Mother (p2)

It is important to consider that the physiological stress of pregnancy can potentially exacerbate some of the symptoms of thalassemia in the expectant mother. The heart, liver, and endocrine system are particularly vulnerable in the pregnant woman with thalassemia disease. Evaluation of the functioning of each of these systems prior to and throughout pregnancy is important. Therefore, continued care by a hematologist is a necessity. The hematologist is integral to monitoring the transfusion regimen, which tends to increase in pregnancy, as well as the administration and dosages of iron chelating agents and other medications. A high-risk obstetrician, or perinatologist, is also needed to monitor the health of the expectant mother, as well as her fetus.

Iron chelation
Removing excess iron through the use of chelating medication is critical to the health and longevity of the woman with thalassemia. Increased transfusion requirements during pregnancy may increase the need for chelation therapy. However, the safety of desferrioxamine (Desferal) during pregnancy has not been established; it is unclear whether this medication poses any risk to the developing fetus. Depending in part on the quantity of liver iron stores, temporarily discontinuing the use of desferrioxamine may be considered during pregnancy. Some have suggested that pregnancy itself may serve as a chelator of iron, via the uptake of free iron by the developing fetus. Though data on Desferal use during pregnancy is minimal, CHO has experienced two successful pregnancies with a beta thalassemia major patient. As she was severely iron overloaded, she received high dose Desferal through a port throughout both pregnancies. Both infants have thus far experienced no deleterious effects as a result of chelation therapy. The pregnant woman with thalassemia should discuss with her physicians the benefits and possible risks of continuing or discontinuing desferrioxamine use during pregnancy.

Cardiac function and transfusion requirements
During pregnancy, the fluid component of the blood normally increases. This can increase the degree of anemia, which leads to the need for more frequent blood transfusions. Increased anemia can also result in the heart having to work harder to get adequate oxygen to all of the body's tissues. Increased blood volume can also put stress on the heart. In thalassemia, the heart may already be under stress from the damaging effects of iron overload. Therefore, it is important to have cardiac function checked prior to and throughout pregnancy. Regular attend-ance at scheduled transfusion appointments is also critical in order to reduce anemia and lessen the work that the heart must do. <next>

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