Pregnancy and Thalassemia: Health of the Baby (p4)

The health of the mother with thalassemia is inter-related to the health of her developing baby. Therefore, the importance of comprehensive thalassemia care throughout pregnancy can not be over-emphasized. In addition, the perinatologist and genetic counselor are available to address issues related specifically to the health of the baby.

Fetal Risk for Thalassemia
For a woman with beta thalassemia disease or hemoglobin E/beta thalassemia disease, there may be a chance for her fetus to be at risk for inheriting thalassemia or another inherited blood disease, due to the inherited nature of these conditions. This depends on the hemoglobin type of the father of the baby. The fetus could be at risk if the father himself has thalassemia or sickle cell disease. More commonly, a risk to the fetus occurs when the father is a carrier of a beta globin trait. These traits could include beta thalassemia trait, hemoglobin E trait, sickle cell trait, or others. A genetic counselor can arrange testing for the father of the baby and explain the inheritance of hemoglobin types.

If a couple is found to be at risk for having a baby with thalassemia or another inherited blood disease, a genetic counselor can explain this risk, as well as testing options for the baby before birth. Tests are available as early as 10 weeks of pregnancy. These tests can often tell, with a high degree of accuracy, whether a baby has thalassemia. Because these tests are invasive, they are not risk-free. A genetic counselor can explain the risks and benefits associated with each of these tests. The choice to have or decline prenatal testing is a very personal one, which depends on the beliefs and values of the individual couple. A genetic counselor can help a couple identify their own issues, which might be important to the decision-making process both before and after prenatal testing.

Risks Related to Maternal Thalassemia
Some studies have reported that chronic maternal anemia can lead to a deficiency of oxygen circulation to the fetus. Such hypoxia can be associated with an increased chance for slowed fetal growth in utero, pregnancy loss, and preterm labor and delivery. Other studies in which maternal anemia was well managed did not report evidence of an increased risk for these complications. This emphasizes again the importance of continued thalassemia care throughout pregnancy.
Women with thalassemia tend to be smaller in stature than their brothers and sisters without thalassemia. The correspondingly small pelvic bones in some women with thalassemia may contribute to the increased chance for a cesarian delivery, which was noted to be the only obstetrical complication in these women.

While any woman can develop diabetes, women with thalassemia have a higher chance of this due to iron overload. Maternal diabetes, particularly the insulin-dependent type, is known to increase the risk for birth defects. The risk for prenatal and neonatal complications, including perinatal loss, is also increased with maternal diabetes. Good control of blood sugar levels, particularly in the early stages of pregnancy, and close follow-up by a perinatologist throughout pregnancy is known to help to reduce these risks. <next>

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