Category: Medical/Surgical/Diseases/Complications
Poster Session II
The objective is to provide risk estimates of the maternal/neonatal outcomes in Thalassemia Major (TM) and Thalassemia Intermedia (TI), and explore the impact of pregnancy on iron status.
Study Design:
The study was registered on PROSPERO (CRD42020182475). Risk of bias was assessed by the Newcastle-Ottawa Scale and JBI Checklist.
Results:
Fifteen studies, 429 participants and 684 pregnancies were included. Studies had a moderate/high risk of bias. Meta-analysis demonstrated an increased risk of thrombosis of 3.7% (95% CI 1.2-75) in βTI compared to βTM (0.9% (95% CI 0.1-2.6)). The risk of heart failure was similar for βTM and βTI [1.6% (95% CI 0.4-3.7) vs. 1.1% (95% CI 0.4-3.7), respectively]. The proportion of patients who developed gestational diabetes (GDM) and pre-eclampsia in βTM was 3.9% (95% CI 1.3-8.0) and 11.3% (95% CI 6.2-15.3), and maternal mortality was 3.7% (95% CI 0.78-8.6). Cesarean delivery rate was 83.9% (95% CI 65.2-96.2) in TM and 67% (95%CI 66-77.2) in TI. There were no significant differences in the rate of stillbirth/small for gestational age neonates/preterm birth. For βTM, there was a significant increase in RBC requirements during pregnancy, increasing from 102 to 139ml of RBC/kg/year. (p= 0.001; I2 91%,P < 0.0001). In pregnancies with βTI, 70% (95% CI 57.7-81.3) required a red cell transfusion during pregnancy. Overall, the pooled mean serum ferritin concentration was significantly increased in βTM (1005 ng/mL) vs βTI (332 ng/mL)(P < 0.0001) (Figure 1). There was a significant increase in liver iron concentration from 4.6 (±2.7) to 11.9 (±3.2) mg/g dry weight (p < 0.0001) and a significant decrease in myocardial T2* (36.2±2.5 ms to 31.1 ms±3.4) during pregnancy.
Conclusion:
While pregnancy outcomes are favourable, there is a doubling of the risk of stillbirth and increased risk of GDM, pre-eclampsia, preterm birth, and Caesarean section. In βTM, there is an escalation of iron loading during pregnancy, as reflected by a rise in serum ferritin, increase in liver iron concentration and decrease in myocardial MRI T2*, which may translate to an increased risk of cardiac complications.
Evangelia Vlachodimitropoulou, BSc, MBBS, PhD
Mount Sinai Hospital
Toronto, Ontario, Canada
Hussain Mogharbel, MD
Mount Sinai Hospital
winnipeg, Ontario, Canada
Kevin Kuo, MD, MSc
Toronto General Hospital
Toronto, Ontario, Canada
Michelle Ryu, BSc
Mount Sinai Hospital
Toronto, Ontario, Canada
Nadine Shehata, MD, MSc
Mount Sinai Hospital
Toronto, Ontario, Canada
Ann Malinowski, MD, MSc
Mount Sinai Hospital
Toronto, Ontario, Canada