Document Type : Original articles

Authors

1 Department of Gynecology and Obstetrics, College of Medicine, University of kirkuk

2 Department of pediatrics, College of Medicine, University of Kirkuk, Kirkuk, Iraq

Abstract

Background: Maternal beta-thalassemia minor may increase the risk of adverse obstetrical outcomes like restricted fetal growth, reduced birth weight, and preterm delivery.
Objective: To determine maternal and neonatal outcomes in pregnant women with beta-thalassemia minor in Kirkuk province, Iraq.
Materials and Methods: A case-control study was conducted and enrolled 95 pregnant women with beta-thalassemia minor and 100 control pregnant women without beta-thalassemia minor. A comparison between the two groups was performed regarding the general characteristics of the pregnant women, obstetrical complications, and neonatal outcomes.
Results: The mean hemoglobin (Hb), gestational age, and birth weight were significantly lower in the cases compared to the control group, with a P-value < 0.001, 0.002, and 0.004, respectively. Blood transfusion, emergency caesarean section (CS), postpartum hemorrhage, preterm labor, small for gestational age (SGA), and admission to the neonatal care unit (NCU) in cases were significantly higher compared to the control group. Admission to NCU was higher with low maternal Hb, lower gestational age at the time of delivery, pregnancies complicated by diabetes mellitus, oligohydramnios, meconium-stained liquor, preterm labor, pregnant women who delivered by CS, neonates with SGA , and those with a low APGAR (A= appearance, P = pulse rate, G = grimace, A = activity, and R = respiration) score.
Conclusion: Beta-thalassemia minor may adversely affect pregnancy outcomes and increase the frequency of neonatal admission to NCU.

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Main Subjects

 [1]     C. Shen et al., “Evaluation of indices in differentiation between iron deficiency anemia and β-thalassemia trait for Chinese children,” J. Pediatr. Hematol. Oncol., vol. 32, no. 6, pp. e218–e222, 2010.
[2]      R. Galanello and R. Origa, “Beta-thalassemia,” Orphanet J. Rare Dis., vol. 5, pp. 1–15, 2010.
[3]      H. Al-Nood, “Thalassemia trait in outpatient clinics of Sana’a City, Yemen,” Hemoglobin, vol. 33, no. 3–4, pp. 242–246, 2009.
[4]      Y. Aydinok, “Thalassemia,” Hematology, vol. 17, no. sup1, pp. s28–s31, 2012.
[5]      E. M. S. Ismael and M. Y. Shamdeen, “The pregnancy outcome in patients with minor β-thalassemia,” Med. J. Babylon, vol. 16, no. 3, pp. 229–233, 2019.
[6]      L. C. Garfunkel, J. Kaczorowski, and C. Christy, Pediatric clinical advisor E-book: instant diagnosis and treatment. Elsevier Health Sciences, 2007.
[7]      S. Luewan, K. Srisupundit, and T. Tongsong, “Outcomes of pregnancies complicated by beta-thalassemia/hemoglobin E disease,” Int. J. Gynecol. Obstet., vol. 104, no. 3, pp. 203–205, 2009.
[8]      A. H. Nassar, M. Naja, C. Cesaretti, B. Eprassi, M. D. Cappellini, and A. Taher, “Pregnancy outcome in patients with β-thalassemia intermedia at two tertiary care centers, in Beirut and Milan,” Haematologica, vol. 93, no. 10, pp. 1586–1587, 2008.
[9]      H. I. Yahya, “Thalassaemia genes in Baghdad, Iraq,” EMHJ-Eastern Mediterr. Heal. Journal, 2 (2), 315-319, 1996, 1996.
[10]    K. J. Khaleel, A. H. Hameed, A. M. Fadhel, and N. Y. Yaseen, “Prevalence of thalassemia genes in Mosul,” Iraqi J. Sci., vol. 50, pp. 8–10, 2009.
[11]    M. K. Hassan, J. Y. Taha, L. M. Al Naama, N. M. Widad, and S. N. Jasim, “Frequency of haemoglobinopathies and glucose-6-phosphate dehydrogenase deficiency in Basra,” EMHJ-Eastern Mediterr. Heal. Journal, 9 (1-2), 45-54, 2003, 2003.
[12]    N. A. Al-Allawi, A. H. Faraj, and N. H. Ahmed, “Prevalence of haemoglobinopathies in Sulaimani-Iraq,” Duhok Med J, vol. 2, pp. 71–79, 2008.
[13]    C. Charoenboon, P. Jatavan, K. Traisrisilp, and T. Tongsong, “Pregnancy outcomes among women with beta-thalassemia trait,” Arch. Gynecol. Obstet., vol. 293, pp. 771–774, 2016.
[14]    H. Vafaei, S. Karimi, M. Akbarzadeh Jahromi, N. Asadi, and M. Kasraeian, “The effect of mother’s β-thalassemia minor on placental histology and neonatal outcomes,” J. Matern. Neonatal Med., vol. 35, no. 10, pp. 1907–1914, 2022.
[15]    P. Ruangvutilert, C. Phatihattakorn, C. Yaiyiam, and T. Panchalee, “Pregnancy outcomes among women affected with thalassemia traits,” Arch. Gynecol. Obstet., vol. 307, no. 2, pp. 431–438, 2023.
[16]    A. Adler, T. Wainstock, and E. Sheiner, “Prenatal exposure to maternal β-thalassemia minor and the risk for long-term hematologic morbidity in the offspring: A population-based cohort study,” Early Hum. Dev., vol. 158, p. 105397, 2021.
[17]    V. Falcone et al., “Gestational diabetes mellitus in pregnant women with beta-thalassemia minor: A matched case-control study,” J. Clin. Med., vol. 11, no. 7, p. 2050, 2022.
[18]    S. Amooee, A. Samsami, J. Jahanbakhsh, and M. Karimi, “The pregnancy outcome in patients with minor β-thalassemia,” Iran. J. Reprod. Med., vol. 9, no. 1, p. 9, 2011.
[19]    T. Hanprasertpong et al., “Pregnancy outcomes amongst thalassemia traits,” Arch. Gynecol. Obstet., vol. 288, pp. 1051–1054, 2013.
[20]    X. Wang, S. Xiao, L. Li, and M. Yang, “Effect of different Hb concentrations on the risk of gestational diabetes mellitus in women with thalassemia minor,” 2023, 10.21203/rs.3.rs-2614397/v1.
[21]    Y. Wu et al., “Effects of thalassemia on pregnancy outcomes of women with gestational diabetes mellitus,” J. Obstet. Gynaecol. Res., vol. 48, no. 5, pp. 1132–1140, 2022.
[22]    E. Vlachodimtropoulou Koumoutsea, H. Mogharbel, K. H. M. Kuo, M. Ryu, N. Shehata, and A. K. Malinowski, “Pregnancy Outcomes and Iron Status in the Context of Beta Thalassemia Major and Intermedia: A Systematic Review and Meta-Analysis,” Blood, vol. 140, no. Supplement 1, pp. 2580–2581, 2022.
[23]    D. Yordanova, A. Nikolov, A. Museva, and V. Karamiseva, “The pregnancy outcome in patients WITH β-thalassemia minor,” Akush. Ginekol. (Sofiia)., vol. 53, pp. 20–24, 2014.
[24]    H. Al-Wassia and M. Saber, “Admission of term infants to the neonatal intensive care unit in a Saudi tertiary teaching hospital: cumulative incidence and risk factors,” Ann. Saudi Med., vol. 37, no. 6, pp. 420–424, 2017.