359 Pregnancy outcomes in a contemporary cohort of thalassemia patients

Abstract

Historically, women with transfusion dependent thalassemia (TDT) were considered very high risk for adverse pregnancy outcomes including death, primarily due to iron induced cardiomyopathy. However, recent advances in chelation therapy, better transfusion protocols and enhanced cardiac monitoring have resulted in markedly improved pregnancy outcomes in women with TDT. The purpose of this study is to evaluate risks of pregnancy in women with TDT in a contemporary cohort. A retrospective chart review was conducted of pregnancies in transfusion dependent women with different beta thalassemia genotypes treated at the Weill Cornell Thalassemia Center from 2005-2020. 15 women with TDT had a total of 25 pregnancies with 20 liveborns. 48% of pregnancies were achieved via ART with 4 multiple gestations but only one live set of twins (1 multifetal reduction, 1 2nd trimester loss of quadruplets, 1 2nd trimester loss of triplets due to maternal death). Pregnancy loss rate was 24% and women with TDT had high rates of hypertension in pregnancy (21%), gestational diabetes (52.4%) and post-partum hemorrhage (23.5%). Ongoing pregnancies had favorable fetal outcomes with mean GA of 38 weeks and mean birthweight of 3129g. Cesarean section rates were high (10/19 deliveries). 40% of women had diagnosis of cardiac disease before conception or during pregnancy (see Table 1). There was 1 major complication in the second pregnancy in a woman with a triplet pregnancy, known cardiomyopathy, and severe myocardial iron overload resulting in maternal death from cardiogenic shock at 18 weeks. Women with TDT who are considering pregnancy should have a thorough assessment preconception and select patients, without evidence of significant myocardial iron overload or cardiomyopathy, may safely pursue pregnancy. While many women with TDT will require ART for conception, multiple gestations should be discouraged due to poor outcomes. A multidisciplinary approach to care in pregnancy is paramount in this high-risk population with majority of patients achieving favorable pregnancy outcomes.