Principles of pregnancy management in women with Ph-negative myeloproliferative neoplasms
Shmakov R.G., Polushkina E.S., Akhmedova A.I., Sokolova M.A., Vinogradova M.A.
Material and methods. Complications of pregnancy, delivery, and postpartum period and neonatal health status were evaluated in both groups.
Results. The creation of a program for pregnancy preparation and management in women with Ph-negative MPN led to a significant reduction in reproductive losses from 76.3% to 3.3% and to a downward trend in the number of pregnancy complications from 84,6% to 74.2%. The health status and frequency of malformations in children born to the mothers with MPN who had been treated during pregnancy did not differ from those in the healthy population.
Conclusion. Pregnant women with Ph-negative MPN belong to a high-risk group. The results of the investigation have shown that pregnancy has no impact on the course of myeloproliferative disease. The algorithm elaborated by the authors could substantially reduce reproductive losses and the number of pregnancy complications in women with MPN. The health status of the children does not differ from that in the general population.
- Table. Structure allocation of Ph-negative myeloproliferative neoplasms during pregnancy (n = 95)
- Figure. Pregnancy outcomes in women with Ph-negative myeloproliferative neoplasms (n = 167)
1. Alimam S., Bewley S., Chappell L.C., Knight M., Seed P., Gray G. et al. Pregnancy outcomes in myeloproliferative neoplasms: UK prospective cohort study. Br. J. Haematol. 2016; 175(1): 31-6.
2. Lavi N., Horowitz N.A., Brenner B. An update on the management of hematologic malignancies in pregnancy. Womens Health (Lond.). 2014; 10(3): 255-66.
3. Skeith L., Carrier M., Robinson S.E., Alimam S., Rodger M.A. Risk of venous thromboembolism in pregnant women with essential thrombocythemia: a systematic review and meta-analysis. Blood. 2017; 129(8): 934-9.
4. Barbui T., Finazzi G., Carobbio A., Thiele J., Passamonti F., Rumi E. et al. Development and validation of an International Prognostic Score of thrombosis in World Health Organization-essential thrombocythemia (IPSET-thrombosis). Blood. 2012; 120(26): 5128-33.
5. Rumi E., Bertozzi I., Casetti I.C., Roncoroni E., Cavalloni C., Bellini M. et al.; Associazione Italiana per la Ricerca sul Cancro Gruppo Italiano Malattie Mieloproliferative Investigators. Impact of mutational status on pregnancy outcome in patients with essential thrombocytemia. Haematologica. 2015; 100(11): e443-5.
6. El-Hemaidi I., Robinson S.E. Management of haematological malignancy in pregnancy. Best Pract. Res. Clin. Obstet. Gynaecol. 2012; 26(1): 149-60.
7. Health and Social Care Information Centre (HSCIC). NHS Maternity Statistics -England, 2010-2011.
8. Aviles A., Neri N., Nambo M.J. Hematological malignancies and pregnancy: treat or not treat during first trimester. Int. J. Cancer. 2012; 131(11): 2678-83.
9. Lavi N., Brenner B., Avivi I. Management of pregnant women with myeloproliferative neoplasms. Thromb. Res. 2013; 131(Suppl. 1): S11-3.
10. Umazume T., Yamada T., Akaishi R., Araki N., Nishida R., Morikawa M., Minakami H. Essential thrombocythemia as a risk factor for stillbirth. Thromb. Res. 2014; 133(2): 158-61.
11. Gerds A.T., Dao K.H. Polycythemia vera management and challenges in the community health setting. Oncology. 2017; 92(4): 179-89.
12. Horowitz N.A., Lavi N., Nadir Y., Brenner B. Haematological malignancies in pregnancy: An overview with an emphasis on thrombotic risks. Thromb. Haemost. 2016; 16(4): 613-7.
13. Pieri L., Guglielmelli P., Vannucchi A.M. Chronic myeloproliferative neoplasms: a collaborative approach. Mediterr. J. Hematol. Infect. Dis. 2010; 2(2):e2010017.
14. Gangat N., Wolanskyj A.P., Schwager S., Tefferi A. Predictors of pregnancy outcome in essential thrombocythemia: a single institution study of 63 pregnancies. Eur. J. Haematol. 2009; 82(5): 350-3.
15. Сухих Г.Т., Давыдов М.И., Савченко В.Г. Репродуктивное здоровье женщин с онкогематологическими заболеваниями. М.; 2012: 172-8. [Sukhikh G.T., Davydov M.I., Savchenko V.G. Reproductive health of women with oncohematological diseases. Moscow; 2012: 172-8. (in Russian)]
16. Amit O., Barzilai M., Avivi I. Management of hematologic malignancies: special considerations in pregnant women. Drugs. 2015; 75(15):1725-38.
17. Barbui T., Barosi G., Birgegard G., Cervantes F., Finazzi G., Griesshammer M. et al. Philadelphia-negative classical myeloproliferative neoplasms: critical concepts and management recommendations from European LeukaemiaNet. J. Clin. Oncol. 2011; 29(6): 761-70.
18. Yazdani Brojeni P., Matok I., Garcia Bournissen F., Koren G. A systematic review of the fetal safety of interferon alpha. Reprod. Toxicol. 2012; 33(3): 265-8.
About the AuthorsShmakov Roman Georgievich, MD, Ph.D, Chief medical officer, Research Centre of Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: firstname.lastname@example.org
Polushkina Evgenia Sergeevna, Ph.D, senior Research, Research Centre of Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: email@example.com
Akhmedova Aminat Isaevna, postgraduate student, Research Centre of Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: firstname.lastname@example.org
Sokolova Manana Alexsandrovna, Ph.D, senior Research, Hematology Research Center, Ministry of Health of Russia.
117997, Russia, Moscow, Novaya Zukovskaya str. 8. E-mail: email@example.com
Vinogradova Maria Alekseevna, Ph.D, head of the department of transfusiology and extracorporeal detoxication, Research Centre of Obstetrics,
Gynecology and Perinatology, Ministry of Healthcare of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. E-mail: firstname.lastname@example.org
For citations: Shmakov R.G., Polushkina E.S., Akhmedova A.I., Sokolova M.A., Vinogradova M.A. Principles of pregnancy management in women with Ph-negative myeloproliferative neoplasms. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (12): 46-51. (in Russian)