Medication review for
pregnancy:
·
Emphasize folic acid
supplements;
·
Stop (DFX) and
vitamin C;
·
Stop
angiotensin-converting enzyme inhibitors;
·
Change oral
hypoglycemic agents to insulin;
·
Stop biphosphonates;
·
Give calcium and
vitamin D supplements.
Pregnancy care:
·
Monitor cardiac
function closely;
·
Increase frequency of
transfusion;
·
Maintain
pretransfusion hemoglobin level above 10 g/dl;
·
Carry out serial
ultrasound scans to monitor fetal growth;
·
Encourage breast
feeding (unless HIV positive);
·
Resume parenteral
chelation after delivery;
·
Give contraceptive
advice or restart estrogen replacement;
·
Resume biphosphonates
after breast feeding is finished; (Suzan, 2005).
Risks associated with pregnancy:
All patients should be made
aware that pregnancy per se does not alter the natural history of thalassemia.
If pregnancy is managed in a multidisciplinary setting, the foetal outcome is
usually favourable with a slight increase in the incidence of growth
restriction. It has been shown that the risk of pregnancy-specific
complications such as ante-partum haemorrhage and pre-eclampsia in thalassemia
are similar to the background population. It has also been shown that DFO is
not required during pregnancy in patients that are not iron overloaded and that
have adequate cardiac function prior to pregnancy. Serum ferritin is likely to
alter by 10℅ despite increase in frequency of blood transfusion. The aim during
pregnancy is to maintain pre-transfusion haemoglobin concentration above 10g/dl
(Aessopos et al., 1999).
High rate of gestational and
other complications have been reported; these include intrauterine fetal-growth
retardation and preterm labour, attributed to low hemoglobin levels of the
mothers during gestation, which lead to fetal hypoxia (Ansari et al.,
2006).
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