Pregnancy outcomes and iron status in β-thalassemia major and intermedia: a systematic review and meta-analysis

source extracted confidence: high 2026-04-09
#humans #infant-newborn #pregnancy #female #beta-thalassemia

Pregnancy outcomes and iron status in β-thalassemia major and intermedia: a systematic review and meta-analysis

Vlachodimitropoulou et al., 2024 | Blood Adv | Meta Analysis

Citation

Vlachodimitropoulou Evangelia, Mogharbel Hussain, ... Malinowski Ann Kinga. Pregnancy outcomes and iron status in β-thalassemia major and intermedia: a systematic review and meta-analysis. Blood Adv. 2024-Feb-13;8(3):746-757. doi:10.1182/bloodadvances.2023011636

Abstract

Advancements in orally bioavailable iron chelators and MRI methods have improved life expectancy and reproductive potential in thalassemia major (TM) and thalassemia intermedia (TI). Pregnancy is associated with adverse maternal and neonatal outcomes, frequency of which has not been well delineated. This systematic review aims to provide risk estimates of maternal and fetal outcomes in TM and TI and explore pregnancy's impact on iron homeostasis. Fifteen studies (429 participants, 684 pregnancies) were included. Meta-analysis revealed a higher thrombosis risk in TI (3.7%) compared to TM (0.92%), unchanged from prepregnancy. Heart failure risks in the earlier years appeared similar (TM 1.6% vs TI 1.1%), and maternal mortality in TM was 3.7%, but with current management, these risks are rare. Gestational diabetes and pre-eclampsia occurred in 3.9% and 11.3% of TM pregnancies, respectively. Caesarean section rates were 83.9% in TM and 67% in TI. No significant difference in stillbirth, small for gestational age neonates, or preterm birth incidence between TM and TI was observed. In TM pregnancies, red cell requirements significantly increased (from 102 to 139 ml/kg/year, P = 0.001), and 70% of TI pregnancies required blood transfusions. As expected, increased transfusion alongside chelation cessation led to a significant increase in serum ferritin during pregnancy (TM by 1005 ng/mL; TI by 332 ng/mL, P < 0.0001). Deterioration in iron status was further reflected by an increase in liver iron concentration (from 4.6 to 11.9 mg/g dry weight, P < 0.0001), and myocardial T2-star (T2∗) magnetic resonance imaging decreased (from 36.2 ± 2.5 ms to 31.1 ms) during pregnancy. These findings emphasize the elevated maternal risk of iron-related cardiomyopathy during pregnancy and labor, stressing the importance of cardiac monitoring and postpartum chelation therapy resumption.

Key Findings

These findings emphasize the elevated maternal risk of iron-related cardiomyopathy during pregnancy and labor, stressing the importance of cardiac monitoring and postpartum chelation therapy resumption.

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 429
Age Range See abstract
Condition stress

MeSH Terms

  • Humans
  • Infant, Newborn
  • Pregnancy
  • Female
  • beta-Thalassemia
  • Iron
  • Pregnancy Outcome
  • Cesarean Section
  • Premature Birth

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Meta-Analysis, Systematic Review, Journal Article
  • Vertical: iron

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09