PREGNANCY | Study Results Indicate AIHA in Pregnant Women Is Manageable

Relapsed or de novo autoimmune hemolytic anaemia (AIHA) does not preclude the possibility of safely carrying a baby to term, according to research published in Blood

Among these patients, however, close monitoring, the administration of therapy when needed, and the awareness of potential complications, both for the mother and fetus, are essential for maximizing the odds of a safe delivery.

Although approximately 1 in 50,000 pregnant women develop anti-erythrocyte autoantibodies, not all such cases result in AIHA, which remains poorly understood, especially de novo or relapsed AIHA during pregnancy or puerperium.

Owing to its rarity, the optimal management and outcome trends of AIHA during pregnancy or puerperium are not well established. For this international, multi-center trial, researchers aimed to characterize disease severity, need for treatment, and impact on maternal and fetal outcomes among patients with relapsed or de novo AIHA in the pregnancy or puerperium settings.

Overall, of 546 female patients included, 45 (8%) had a pregnancy and 23 had AIHA relapse. Furthermore, although 48,615 pregnancies were observed in the study centers, 13 (0.03%) cases of de novo AIHA were noted. Data were contrasted against 32 controls also included.

Analysis showed that of 24 haemolytic events in the patient cohort, anaemia was severe, with median haemoglobin levels of 6.4 g/dL (range, 3.1-8.7). All cases of anaemia also required treatment, which included steroids with or without intravenous immunoglobulin (96%). Complete responses were noted in 65% of patients. Eight patients (33%) received antithrombotic prophylaxis.

Maternal complications, which included premature rupture of membranes, placental detachment, and preeclampsia, occurred in 15% of patients, while early miscarriages occurred in 13%.

More than 1 in 5 (22%) cases showed adverse fetal events, which included respiratory distress, fetal growth restriction, preterm birth, AIHA of the newborn, and perinatal death, which occurred in 2 cases.

“Data suggest that the occurrence of AIHA does not preclude the ability to carry a healthy pregnancy, provided that close monitoring and prompt therapy are ensured, and with awareness of potential maternal and fetal complications,” the authors wrote in their report.

Source: Autoimmune hemolytic anemia during pregnancy and puerperium: an international multicenter experience. Blood. 2023;141(16):2016-2021. doi:10.1182/blood.2022018890

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