Pregnancy, Delivery, and Neonatal Outcomes Among Women with Beta-thalassemia Major: a Population-based Study of a Large US Database

Overview

Journal Arch Gynecol Obstet

Date 2025 Jan 18

PMID 39825900

Authors

Juliette St-Georges

Abdullah Alnoman

Ahmad Badeghiesh

Haitham Baghlaf

Affiliations

Soon will be listed here.

Abstract

Purpose: We explored the effect of beta-thalassemia major on pregnancy and delivery outcomes in non-endemic area, utilizing USA population database.

Methods: This is a retrospective study utilizing data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. A cohort of all deliveries between 2011 and 2014 was created using ICD-9 codes. The patients with beta-thalassemia major were identified and matched to patients without beta-thalassemia based on age, race, income quartile, and type of health insurance at a ratio of 1:20. The baseline characteristics were compared between the groups using Chi-square and Fischer's exact tests, as appropriate. The univariate and multivariate analyses were conducted for pregnancy, delivery and neonatal outcomes to estimate the unadjusted and adjusted odds ratio, respectively.

Results: Out of 3,070,656 pregnancies over the study period, beta-thalassemia major complicated 445 pregnancies. The patients with beta-thalassemia were more likely to have thyroid disorders and previous C-section (p-value < 0.05). There were no differences in pregnancy outcomes such as gestational hypertension, preeclampsia, gestational diabetes, and placenta previa. C-section was 30% more likely to be the method of birth (aOR 1.30, 95%CI 1.03-1.63) and there was more than three-fold increase in rate of blood transfusion (aOR 4.69, 95% CI 3.02-7.28) among participants with beta-thalassemia major. Mothers with beta-thalassemia, almost, were 70% more likely to have a neonate small for gestational age (aOR 1.68, 95%CI 1.07-2.62).

Conclusions: Women with beta-thalassemia major are more likely to give birth by C-section, require blood transfusion and have small for gestational age neonates. Counseling patients with beta-thalassemia about these risks and increased antenatal surveillance is advised.

References

Taher A, Musallam K, Cappellini M . β-Thalassemias. Reply. N Engl J Med. 2021; 384(22):2166. DOI: 10.1056/NEJMc2105064. View

Savona-Ventura C, Bonello F . Beta-thalassemia syndromes and pregnancy. Obstet Gynecol Surv. 1994; 49(2):129-37. DOI: 10.1097/00006254-199402000-00025. View

Tirlapur S, Leung E, Ball E, Khan K, Clark T . Future research in gynaecological surgery. Best Pract Res Clin Obstet Gynaecol. 2013; 27(3):471-8. DOI: 10.1016/j.bpobgyn.2012.12.001. View

Zhao M, Ma H, Cheng P, Yang H, Zhao Y, Han Q . Apatinib combined with temozolomide treatment for pseudoprogression in glioblastoma: A case report. Medicine (Baltimore). 2023; 101(49):e32156. PMC: 9750629. DOI: 10.1097/MD.0000000000032156. View

Origa R, Piga A, Quarta G, Forni G, Longo F, Melpignano A . Pregnancy and beta-thalassemia: an Italian multicenter experience. Haematologica. 2009; 95(3):376-81. PMC: 2833066. DOI: 10.3324/haematol.2009.012393. View

Voskaridou E, Balassopoulou A, Boutou E, Komninaka V, Christoulas D, Dimopoulou M . Pregnancy in beta-thalassemia intermedia: 20-year experience of a Greek thalassemia center. Eur J Haematol. 2014; 93(6):492-9. DOI: 10.1111/ejh.12387. View

Ruangvutilert P, Phatihattakorn C, Yaiyiam C, Panchalee T . Pregnancy outcomes among women affected with thalassemia traits. Arch Gynecol Obstet. 2022; 307(2):431-438. PMC: 9918558. DOI: 10.1007/s00404-022-06519-y. View

Charoenboon C, Jatavan P, Traisrisilp K, Tongsong T . Pregnancy outcomes among women with beta-thalassemia trait. Arch Gynecol Obstet. 2015; 293(4):771-4. DOI: 10.1007/s00404-015-3908-6. View

Sheiner E, Levy A, Yerushalmi R, Katz M . Beta-thalassemia minor during pregnancy. Obstet Gynecol. 2004; 103(6):1273-7. DOI: 10.1097/01.AOG.0000126575.34482.fb. View

10.

Virot E, Thuret I, Jardel S, Herbrecht R, Lachenal F, Lionnet F . Pregnancy outcome in women with transfused beta-thalassemia in France. Ann Hematol. 2021; 101(2):289-296. DOI: 10.1007/s00277-021-04697-4. View

11.

Kattamis A, Forni G, Aydinok Y, Viprakasit V . Changing patterns in the epidemiology of β-thalassemia. Eur J Haematol. 2020; 105(6):692-703. PMC: 7692954. DOI: 10.1111/ejh.13512. View

12.

Kuhnl A, Peckitt C, Patel B, Ardeshna K, Macheta M, Radford J . R-GEM-Lenalidomide versus R-GEM-P as second-line treatment of diffuse large B-cell lymphoma: results of the UK NRCI phase II randomised LEGEND trial. Ann Hematol. 2019; 99(1):105-112. DOI: 10.1007/s00277-019-03842-4. View

13.

Sayani F, Kwiatkowski J . Increasing prevalence of thalassemia in America: Implications for primary care. Ann Med. 2015; 47(7):592-604. DOI: 10.3109/07853890.2015.1091942. View

14.

Nassar A, Usta I, Rechdan J, Koussa S, Inati A, Taher A . Pregnancy in patients with beta-thalassemia intermedia: outcome of mothers and newborns. Am J Hematol. 2006; 81(7):499-502. DOI: 10.1002/ajh.20654. View

15.

Nassar A, Naja M, Cesaretti C, Eprassi B, Cappellini M, Taher A . Pregnancy outcome in patients with beta-thalassemia intermedia at two tertiary care centers, in Beirut and Milan. Haematologica. 2008; 93(10):1586-7. DOI: 10.3324/haematol.13152. View

16.

Roumi J, Moukhadder H, Graziadei G, Pennisi M, Cappellini M, Taher A . Pregnancy in β-thalassemia intermedia at two tertiary care centers in Lebanon and Italy: A follow-up report on fetal and maternal outcomes. Am J Hematol. 2017; 92(6):E96-E99. DOI: 10.1002/ajh.24690. View

17.

Ansari S, Azarkeivan A, Kivan A, Tabaroki A . Pregnancy in patients treated for beta thalassemia major in two centers (Ali Asghar Children's Hospital and Thalassemia Clinic): outcome for mothers and newborn infants. Pediatr Hematol Oncol. 2005; 23(1):33-7. DOI: 10.1080/08880010500313306. View

18.

You Q, Jiang Q, Shani I, Lou Y, Huang S, Wang S . Miscarriage, stillbirth and the risk of diabetes in women: A systematic review and meta-analysis. Diabetes Res Clin Pract. 2022; 195:110224. DOI: 10.1016/j.diabres.2022.110224. View

19.

Naik R, Lanzkron S . Baby on board: what you need to know about pregnancy in the hemoglobinopathies. Hematology Am Soc Hematol Educ Program. 2012; 2012:208-14. DOI: 10.1182/asheducation-2012.1.208. View