FERTILITY IN BETA-THALASSEMIA MAJOR - A REPORT OF 16 PREGNANCIES, PRECONCEPTUAL EVALUATION AND A REVIEW OF THE LITERATURE

Objectives To examine the pregnancies, mode of delivery and outcomes, review the literature on fertility and discuss preconceptual guidance for women with beta thalassaemia major. Design An observational study. Subjects Sixteen women with beta thalassaemia major. Setting Two collaborating London teaching hospitals. Main outcome measures Pre-pregnancy assessment, pregnancy course, mode of delivery, gestational age at delivery and birthweight. Results There were 16 pregnancies in 11 women. Three of these pregnancies were terminated. Of the 13 deliveries, there were two normal deliveries, one forceps delivery and 10 caesarean sections. The main findings in a further five women seeking fertility treatment were of hypogonadotrophic hypogonadism, diabetes and cardiomyopathy. Conclusions Pregnancy in women with beta thalassaemia major does not appear to have a deleterious effect on the course of the disease. No increased obstetric complications were encountered except for the high caesarean section rate, essentially due to cephalopelvic disproportion. A high incidence of cardiomyopathy and diabetes dictates a careful assessment before embarking on ovulation induction to treat the hypogonadotrophic hypogonadism which is common in these women.