Pregnancy Outcomes in Women with Aplastic Anemia Treated with Immunosuppression

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The summary below is from the full report titled "Outcome of Pregnancy and Disease Course among Women with Aplastic Anemia Treated with Immunosuppression." It is in the 6 August 2002 issue of Annals of Internal Medicine (volume 137, pages 164-172). The authors are A Tichelli, G Socié, J Marsh, R Barge, N Frickhofen, S McCann, A Bacigalupo, J Hows, P Marin, D Nachbaur, A Symeonidis, J Passweg, and H Schrezenmeier, for the European Group for Blood and Marrow Transplantation Severe Aplastic Anaemia Working Party.

What is the problem and what is known about it so far?

Aplastic anemia is a failure of the bone marrow to make new blood cells of all types. Patients with aplastic anemia have too few red blood cells, white blood cells, and platelets. In addition to the problem of anemia, patients with aplastic anemia can have problems fighting infection and bleeding problems. Most patients who cannot be treated with bone marrow transplantation receive treatment with drugs that suppress the immune system. Aplastic anemia can develop during pregnancy and sometimes improves without treatment after pregnancy. Another situation is that women with aplastic anemia receive treatment with immunosuppressive drugs, get better, and later become pregnant. We know very little about how pregnancy affects the course of aplastic anemia and how the disease affects pregnancy.

Why did the researchers do this particular study?

To learn about the outcome of pregnancy and aplastic anemia in women who have the disease before they become pregnant.

Who was studied?

36 women with aplastic anemia who received treatment with immunosuppressive drugs and later became pregnant. All of the patients received care at one of 12 European medical centers.

How was the study done?

The researchers reviewed the medical records of the 36 women to collect information about the outcomes of their pregnancies. They also gathered information about the course of each woman's aplastic anemia.

What did the researchers find?

The 36 pregnancies led to 33 single births, 1 set of twins, 2 elective abortions, and 1 miscarriage. Of the 36 pregnancies, 22 were uneventful and 14 involved medical complications. In 7 of the pregnancies, the women experienced a relapse of aplastic anemia; 5 additional women needed blood transfusions during childbirth, 1 woman had a complication (eclampsia) during delivery, and 1 died after delivery of a stroke. Of the women who had relapses of aplastic anemia during pregnancy, 3 got better on their own, 3 got better after treatment, and 1 died.

What were the limitations of the study?

This study does not tell us anything about the chances a woman treated for aplastic anemia has of becoming pregnant and would not have included women who miscarried early in pregnancy.

What are the implications of the study?

Women with aplastic anemia can have uncomplicated pregnancies, but complications are frequent.