Managing Pregnancy with Thalassaemia

Different Types Of Thalassaemia

• Alpha Thalassaemia: Alpha thalassaemia is an inherited blood disorder in which the body does not produce enough alpha globin protein. This type of thalassaemia is common in people from Southeast Asia, China, Africa, and the Middle East.
• Beta Thalassaemia: This type of thalassaemia occurs when gene defects in the body affect the production of the beta-globin protein. This is common in the Mediterranean region but can also affect people of Chinese, African American or Asian origins.

• Thalassaemia minima: This is a type of beta thalassaemia that has few or no symptoms.
• Thalassaemia intermedia: This type of beta thalassaemia causes moderate to severe anaemia
• Nontransfusion-dependent beta thalassaemia: This type of thalassaemia presents symptoms that are less severe than thalassaemia major and the patient need not depend on transfusions. Symptoms include jaundice, fatigue, and a slow growth rate.

Impact of Thalassaemia on Pregnancy

• Causing pregnancy complications: Women who have thalassaemia have a higher risk of developing other pregnancy complications such as gestational diabetes, high blood pressure, placental abruption, kidney or gallbladder stones, or urinary tract infections
• Blood transfusions: A baby with a serious type of thalassaemia might need blood transfusions before birth to treat anaemia
• Foetal anaemia: In severe cases of thalassaemia, a foetus may develop anaemia which can cause heart failure
• Cardiac issues: Pregnant women with thalassaemia need to have their cardiac function closely monitored to make sure they do not face cardiac failure after giving birth
• Blood clots: Pregnancy can increase the risk of having blood clots and having thalassaemia can increase this risk even more

Basic Guidelines For Pregnant Women With Thalassaemia

1. Get regular prenatal checkups: Pregnant women with thalassaemia need to get frequent and regular prenatal checks done. This includes regular prenatal screening, blood tests, and checks for gestational diabetes. Regular blood tests will monitor your liver, heart, and thyroid functions.
2. Stay hydrated: Blood volume increases during pregnancy. Staying hydrated ensures that there is enough blood to carry nutrition to the foetus. Drinking more water will also prevent blood from thickening and causing clots, as clotting is extremely common during pregnancy.
3. Maintain your iron levels: Your doctor may recommend iron supplements and monitor your iron levels regularly. Additionally, you will also be monitored for iron overload. If your doctor is concerned about iron overload, you might need iron chelation therapy. Iron chelation therapy removes excessive iron from the body to prevent organ damage. The therapy involves medication that binds itself to iron in the blood and then removes it through urine or stool.
4. Take folic acid supplements: Folic acid supplements can help with mild anaemia associated with thalassaemia. People with mild symptoms do not usually need blood transfusions, which is where folic acid supplements come into play. Folic acid is a type of vitamin B that helps your body increase the number of red blood cells it produces. For people with moderate to severe forms of thalassaemia, a combination of folic acid and blood transfusions may be used for treatment.
5. Maintain a balanced diet: You must maintain a balanced diet focused on nutrition-rich foods. Try to incorporate foods rich in iron, calcium, folic acid, and vitamin D. It might also be a good idea to speak to a dietician for personalised recommendations for thalassaemia.
6. Manage stress levels and get adequate rest: Managing stress levels and maintaining a balanced mental state is very important, as your emotional health can directly impact your physical health. Pregnant women with thalassaemia should also make getting sufficient rest a priority.
7. Discuss blood transfusions with your doctor: Blood transfusions are often necessary for pregnant women with thalassaemia. For alpha thalassaemia major, intrauterine blood transfusions can be done as soon as 18- 25 weeks into a pregnancy. The goal of this is to provide the foetus with enough red blood cells to carry oxygen throughout the body. This is continued every few weeks till the woman delivers the baby. Typically, women who have thalassaemia major already have a blood transfusion regime in place, which continues during pregnancy as well.
8. Get all the required vaccinations: Make sure all your vaccinations are up-to-date to protect yourself from being exposed to and contracting infections. Speak to your doctor about getting all the required vaccines like the flu shot.

1. Avoid skipping medical appointments: If you have thalassaemia, you have to consistently get your prenatal checkups done. Ideally, you should not be skipping any of them, since thalassaemia can make your pregnancy a high-risk pregnancy, and regular prenatal appointments help your doctor monitor your health closely, so if there are any issues, they can be managed immediately.
2. Avoid strenuous physical activity: Getting regular exercise is a must when you are pregnant, however, this should be limited to mild forms of exercise like walking or stationary biking. Avoid any activity that puts too much strain on your body.
3. Avoid over-the-counter iron supplements: Only rely on your doctor for medications like iron supplements. Take them only if they are prescribed by the doctor. Over-the-counter supplements come with the risk of iron overload.
4. Avoid alcohol and smoking: Alcohol facilitates the oxidative damage of iron, and smoking reduces the HbCO (carboxyhemoglobin) percentage in blood by about 6 %. This is why you should avoid both of these activities if you are pregnant and have thalassaemia.
5. Do not ignore any symptoms: If you feel breathless, lightheaded, dizzy, and extremely tired, these could be symptoms of anaemia. Do not ignore these symptoms and call your doctor right away.
6. Do not underestimate the importance of mental health: Hormones during pregnancy can cause extreme mood swings, which come with stress, anxiety, and depression. If you find yourself unable to manage these moods, do not hesitate to seek out professional help
7. Do not self-medicate: A pregnancy with thalassaemia is considered a high-risk pregnancy, which makes it even more important for you to seek the doctor’s advice before taking any medicines.

Impact of Thalassaemia on a Baby

Postpartum Care

1. Anaemia Management: Women with thalassaemia, especially a severe form of it, have a higher risk of having anaemia after giving birth. Blood loss during childbirth can make this condition worse. After childbirth, it is important to monitor haemoglobin levels carefully and administer blood transfusions if the levels drop significantly.
2. Iron levels: Women with thalassaemia are at risk of iron overload due to blood transfusions. This is why iron levels need to be closely monitored and iron supplements should be avoided unless specifically prescribed by the doctor. To reduce iron overload, iron chelation therapy may be required. However, this is not recommended for breastfeeding mothers, as iron chelation medications can be passed on to the baby via breast milk.
3. Infection risk: Women with thalassaemia have an increased risk of infections in the postpartum period, like endometriosis, especially after a C-section. Careful monitoring of symptoms like pain, fever or any other signs of infection is required.
4. Increased risk of blood clots: Women with thalassaemia, especially ones who also have cardiac issues, are at a higher risk of developing blood clots (thromboembolism). Preventive measures like early ambulation and anticoagulants (blood thinners) may be recommended.
5. Cardiac risks: Women with thalassaemia have a higher risk of developing cardiac issues after giving birth. This happens due to frequent blood transfusions. Cardiac health must be monitored closely after childbirth for early detection of any cardiac issues. Consult your cardiologist for regular checkups.
6. Mental health support: Keeping a check on your mental health and wellness is extremely important in the postpartum period, especially since postpartum care for thalassaemia can be complicated. Speak to people you trust, about any emotions you may be having. They can be your friends or your family members. Do not hesitate when it comes to asking for help. If the feelings get overwhelming, reach out to a professional.

FAQs on Managing Pregnancy with Thalassaemia

1. Is it difficult to get pregnant if you have thalassaemia?
   Thalassaemia is a blood disorder that makes it challenging to manage a pregnancy but with proper care and guidance from your doctor, you should be able to have a successful pregnancy.
2. What are some symptoms that should not be ignored?
   What are some symptoms that should not be ignored?