Pregnancy and Thalassemia: Health of the Mother (p3)

Liver function
A liver biopsy may be indicated prior to pregnancy to assess the degree of iron overload. This information may be helpful in deciding whether or not to discontinue iron chelation. A liver biopsy can also help determine if there has been damage from iron deposition or previous hepatitis infection. Blood tests throughout pregnancy can also assess liver function.

Endocrine function
Individuals with thalassemia have an increased chance of developing insulin-dependent diabetes as a result of iron overload. The stress of pregnancy can worsen this condition, which can be detrimental to the health of the mother and developing baby. It is important to stabilize diabetes prior to becoming pregnant and to maintain adequate treatment throughout pregnancy. Thyroid function can also be impaired due to iron overload in the woman with thalassemia.

Splenic function
The spleen removes abnormal red blood cells from the circulation and performs important immune functions. Individuals who have thalassemia have unusually large numbers of abnormal red blood cells. The spleen becomes very active in removing these cells. This activity can enlarge the spleen making it more effective at removing even larger numbers or cells, causing a hemolytic anemia. During pregnancy, there is a greater need for hemoglobin both for normal growth and development of the fetus and due to the fact that the blood volume of the mother will increase dramatically. During this time, transfusion requirements in the pregnant woman is increased, particularly during the last trimester of pregnancy. If transfusion in adequate, the bone marrow will be suppressed and the work of the spleen can be decreased. Occasionally, this will lead to some decrease in spleen size and activity.

Nutritional needs
Pregnant women are routinely given prenatal vitamin supplements by their OB/GYN. Many of these supplements contain iron. Prenatal vitamins containing iron should be avoided by the pregnant woman with thalassemia, for whom iron overload is a concern.

Folate
Folate (folic acid) is important for cell growth and division. Therefore, during pregnancy the demand for folate increases. Folate supplementation is suggested for one month prior to conception and through the 8th week of gestation, at a minimum. This is thought to help prevent megaloblastic anemia (anemia marked by large, immature red blood cells) in women with thalassemia.

Vitamin C
Vitamin C (ascorbic acid) is administered during iron chelation (usually 100 to 250 mg with each session of chelation) to enhance the removal of iron. High doses of ascorbic acid can release a large amount of ionized iron and actually cause tissue damage, particularly in the heart. Ascorbic acid should be continued with chelation during pregnancy. Larger doses should be avoided.<next>

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