Management of pregnant women with myeloproliferative neoplasms

Abstract

Myeloproliferative neoplasms (MPNs) are generally considered to be diseases of elderly population; however, 20% of subjects diagnosed with ET are younger than 40 years. Increase in gestational age in the Western world and improved diagnostic tools raise MPN incidence during pregnancy. MPNs are associated with a remarkable risk for thrombosis and the hypercoagulability milieu associated with pregnancy increases that risk even further. Pregnancies of women diagnosed with MPNs may be complicated with placental thrombosis, fetal growth restriction or loss, and increased risk for maternal thrombosis. The live birth rate in ET and PV is as low as 60 %, with first-trimester loss occurring in 20-30% of pregnancies and an increase in late placenta-mediated complications. Major maternal complications (thromboembolic events and bleeding) are more frequent in PV compared with ET. Therapeutic options range from no therapy, aspirin alone, low-molecular weight heparin (LMWH) to cytoreductive therapy, tailored according to patient-specific risk factors.