Pregnancy and Fertility in
Thalassemia Major
Despite major advance in the
understanding of and treatment for individuals with transfusion-dependent
β-thalassemia, pregnancies and fatherhood for those involved or affected are
still relatively uncommon.
Apart from hypogonadotropic
hypogonadism, the other endocrine disorders particularly relevant to fertility
and pregnancy, namely, diabetes and hypothyrodism, seem to be problems that are
amenable to relatively standard care, and they are not a significant bar to
pregnancy in the context of thalassemia (Suzan, 2005).
Spontaneous
pregnancy without hormonal assistance is reported (Skordis et al., 2004).
Although the fetal outcomes for pregnancies achieved by thalassemic parents are
remarkably successful, there are at least three important associated factors
that must be seriously considered before encouraging a thalassemic woman to
embark on pregnancy. These are cardiac impairment, liver dysfunction and the
vertical transmission of viruses. Thalassemia itself seems to have no specific
influence on the general well-being of pregnancy, and the only specific
obstetric complication is the relatively high frequency of cesarean section (Suzan,
2005).
Although delayed onset of
menarche, amenorrhea, anovulation, and infertility are relatively common in
women with thalassemia major, the use of intensive transfusion regimens and
careful iron chelation, together with appropriate use of ovulation induction
therapy, have made pregnancy a practical possibility (Suzan, 2005).
Pregnancy checks up in
thalassemia major:
·
Assess cardiac
function;
·
Check liver
functions;
·
Check status of viral
infection;
·
Optimize diabetic
control;
·
Optimize thyroid
replacement;
·
Review medication;
·
Ascertain
hemoglobinopathy status of male partners;
·
Determine red cell
antibodies;
·
Provide Rubella
immunity;
·
Optimize life style
issues (e.g., smoking cessation).
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