Pregnancy outcomes in mothers of offspring with inherited bone marrow failure syndromes

Pediatr Blood Cancer. 2018 Jan;65(1):10.1002/pbc.26757. doi: 10.1002/pbc.26757. Epub 2017 Aug 12.

Abstract

Background: Children with inherited bone marrow failure syndromes (IBMFSs) may be symptomatic in utero, resulting in maternal and fetal problems during the pregnancy. Subsequent pregnancies by their mothers should be considered "high risk".

Methods: We retrospectively analyzed outcomes of 575 pregnancies in 165 unaffected mothers of offspring with Fanconi anemia (FA), dyskeratosis congenita (DC), Diamond-Blackfan anemia (DBA), and Shwachman-Diamond syndrome (SDS) for events noted during pregnancy, labor, and delivery. We compared outcomes of pregnancies with affected and unaffected offspring within each group of mothers and with the general population.

Results: The rates of miscarriage (12-20%), elective abortion (5-10%), and live birth (68-78%) among mothers of all IBMFS groups were similar and comparable with general population rates but recurrent miscarriages (≥2) were significantly more common in mothers of offspring with DBA and SDS. Offspring with FA were more frequently born small for gestational age (SGA) than unaffected babies (39% vs. 4%) and had fetal malformations (46%) with 18% having three or more, often necessitating early delivery and surgery; offspring with DC had higher rates of SGA (39% vs. 8%) and fetal distress (26% vs. 3%); and offspring with DBA had fetal hypoxia (19% vs. 1%) leading to preterm and emergency cesarean deliveries (26% vs. 6%). Offspring with early-onset severe phenotypes had the most prenatal and peripartum adverse events.

Conclusion: We identified the high-risk nature of pregnancies in mothers with IBMFS-affected fetuses, suggesting the need for prepregnancy counseling and monitoring of subsequent pregnancies by high-risk fetal-maternal specialists.

Keywords: fetal distress; inherited bone marrow failure syndromes; perinatal complications; preterm; small for gestation.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Abortion, Spontaneous*
  • Adolescent
  • Adult
  • Anemia, Aplastic*
  • Bone Marrow Diseases*
  • Bone Marrow Failure Disorders
  • Female
  • Hemoglobinuria, Paroxysmal*
  • Humans
  • Infant, Newborn
  • Infant, Small for Gestational Age*
  • Live Birth*
  • Middle Aged
  • Peripartum Period*
  • Pregnancy
  • Premature Birth / epidemiology*

Supplementary concepts

  • Bone Marrow failure syndromes