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| - Because of chronic anemia, hypogonadotropic hypogonadism and iron chelation, pregnancy in homozygous and heterozygous compound beta-thalassemia patients stays nowadays a challenge. We describe pregnancy outcome and beta-thalassemia management of transfused beta-thalassemia women, recorded in the French national register of thalassemia, who gave birth between 1995 and 2015. We compared them with healthy women and made a literature review about pregnancy in beta-thalassemia. Thirty-seven women had 79 pregnancies, including 16 early miscarriages. Fifty-six pregnancies were studied. Among them, there were 5 twin pregnancies. Assisted reproduction was used for 16%. Mean term at delivery was 37.7 amenorrhea weeks and mean birth weight was 2760g. There were 53.6% of cesarean sections. There were 6 thromboembolic events, 6 serious infections, 6 pregnancyinduced hypertensions (PIH), 6 intra-uterine growth retardations (IUGR), 3 alloimmunizations, 2 heart diseases (iron overload independent) and 1 preeclampsia. Iron chelation was stopped for each pregnancy except one. Women with TM received more transfusions during pregnancy. There was no complication in the post-partum period excepted 5 infections. Compared to the healthy group, the use of assisted reproduction and cesarean sections were more frequent. Birth weight was lower but delivery term was not different. Thromboembolic events, PIH, delivery hemorrhage and IUGR were more frequent. ln the post-partum period, global maternai complications were more frequent in the betathalassemia group. Pregnancy in transfused-beta-thalassemia patients is safe with a few obstetrical events and no cardiac complication. Women gave birth at full term but with a smaller birth weight than healthy women. Obstetrical and sickle cell disease (SCD)-related complications are regular during pregnancy in SCD women. The use of prophylactic erythrocyte exchange is discussed. We describe pregnancy outcome, SCD outcome and transfusion management, during pregnancy, in a monocentric cohort of SCD patients. We tried to determine the efficacy and tolerance of prophylactic erythrocyte exchanges during pregnancy. Results: Fifty-eight pregnancies were studied in 36 women (23 HbSS, 7 HbSβ, 5 HbSC and 1 HbCC women). Mean term at delivery was 35.4 amenorrhea weeks and 34.5% of pregnancies ended prematurely. Mean birth weight was 2336g. Cesarean section was chosen in 72% of pregnancies. There were 38% of SCD complications during pregnancy. There were 67% of obstetrical complications and among them: 13 intrauterine growth retardations, 12 abnormal fetal heart rates, 7 preeclampsia, 5 intrauterine fetal deaths, 4 pregnancy-induced hypertensions, 4 threatened premature labors, 4 premature rupture of membranes, 4 delivery hemorrhages, and 3 stillbirths. There were 10 infections, one case of alloimmunization, one pulmonary embolism but no maternai death. Hydroxycarbamide and iron chelator were stopped for each pregnancy. Prophylactic erythrocyte exchanges were performed for 26 pregnancies and prophylactic transfusions for 9 pregnancies, with a good tolerance. Whatever SCD management, pregnancy and SCD prognosis were the same. During the post-partum period, there were 21 SCD-related complications, and several neonatal complications (7 jaundices, 4 deaths, 4 acute respiratory distresses and 3 infections). Erythrocyte exchanges are well tolerated but do not change pregnancy outcome. Clinical trials are necessary to clarify their indications and their modalities
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