ET and pregnancy

Women with ET can have healthy babies, but they should be
aware of complications, risks, and whom to contact in the event
of an unplanned pregnancy.

While the typical ET patient is 50-70 years old, about 20 percent of women with ET are younger than 40, that is, within child-bearing age. Women with ET can have healthy babies, but ET does pose elevated risks for both mothers and fetuses that fertile women should know about and discuss with both their hematologists and gynecologists.

A link between ET and early miscarriage has been known for many years. A 2007 report in the Orphanet Journal of Rare Diseases, and a 2017 article specifically on ET and pregnancy in the Obstetrical and Gynecological Report offers this info:

Maternal clot risk
Pregnancy increases clot risks for all women. This risk may be greater for pregnant women with ET, but researchers can't say for sure.

Miscarriage and pregnancy complications
A first-trimester miscarriage occurs in about one in three pregnancies among women with ET, though this rate might be lower among women being treated for the disease.

After the first trimester, pregnant women with ET often see a spontaneous reduction in their platelet counts. This may be the reason that the chances for later-term miscarriage drop significantly after the first trimester in women with ET. In fact, women with ET experience a more marked platelet drop than other pregnant women, which may bring platelet levels into normal range.

Later-term miscarriages among women with ET occur about 5 to 9 percent of the time. However, that rate is higher than the later-term miscarriage rate among the general population, which is only 0.5 percent.

Low-dose aspirin may decrease the chance of miscarriage in women with ET, though a cause-and-effect has not yet been established. Low-dose aspirin might also help prevent a blockage in the flow of blood from the placenta to the baby.

Pregnancy complications that are more common among women with ET than the general population include premature delivery (5 to 8 percent), babies that do no grow at a normal rate in the womb (4 to 5 percent), and tearing of the placenta from the uterine wall (2.8 percent).

Chemotherapy and pregnancy
Hydroxyurea is a known teratogenic drug. That means it can cause birth defects or spontaneous abortions. Anagrelide may also cause pregnancy complications. However, incidence of pregnancy problems among women with ET on these chemotherapies is unknown.

Women who are using these drugs and who want to become pregnant should discuss this with their hematologists and gynecologists. Be sure to ask about the risks of stopping chemo, and how long it is advisable to be off chemo before trying to become pregnant.

Women who have unplanned pregnancies on HU and anagrelide are usually told to stop these drugs and immediately contact their gynecologists and hematologists to determine the best course of treatment.

The effect of Jakafi on pregnancy is unknown, but breastfeeding women should not take this drug or other chemotherapies.

Interferons and pregnancy
Interferon-based therapies are considered the safest to use in pregnancy. Again, it's best to discuss this therapy with a hemo in consult with a gynecologist. Women with unplanned pregnancies on interferon-based therapies are usually told to contact their hematologists and gynecologists immediately.

Be well!

Related: ET in younger patients

Related: Taking chemo? Use a condom

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