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CC BY 4.0 · TH Open 2021; 05(02): e183-e187
DOI: 10.1055/s-0041-1730036
Original Article

Women with Hemophilia: Case Series of Reproductive Choices and Review of Literature

Shadan Lalezari
1   National Hemophilia Center, Sheba Medical Center, Tel Hashomer, Israel
,
Assaf A. Barg
1   National Hemophilia Center, Sheba Medical Center, Tel Hashomer, Israel
2   Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
3   Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel
,
Rima Dardik
1   National Hemophilia Center, Sheba Medical Center, Tel Hashomer, Israel
,
Jacob Luboshitz
1   National Hemophilia Center, Sheba Medical Center, Tel Hashomer, Israel
,
Dalia Bashari
1   National Hemophilia Center, Sheba Medical Center, Tel Hashomer, Israel
,
Einat Avishai
1   National Hemophilia Center, Sheba Medical Center, Tel Hashomer, Israel
,
Gili Kenet
1   National Hemophilia Center, Sheba Medical Center, Tel Hashomer, Israel
2   Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
3   Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel
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Abstract

Aim Very little is known regarding reproductive choices, pregnancy, and delivery of women with moderate to severe hemophilia. Our aim was to describe our experience with three hemophiliac women and their journey to achieve motherhood.

Methods Medical charts of women with moderate to severe hemophilia A treated at our center were evaluated. Data regarding choices of conception, pregnancy course, mode of delivery, and pregnancy outcomes were obtained.

Results Three women are presented. Whereas patient 1 chose to adopt her first child and later had twins through egg donations and a surrogate mother, patient 2 underwent spontaneous pregnancy and delivered via cesarean section. Patient 3 preferred in vitro fertilization and preimplantation genetic diagnosis to avoid hemophilia and hemophilia carriership in her offspring.

Conclusion The appropriate means to achieve parenthood for women with moderate to severe hemophilia should be individualized and requires support of a comprehensive multidisciplinary team.

Keywords

hemophilia - carriers - women - pregnancy - childbirth - reproduction

Disclosures

All authors have no competing interests except for: Shadan Lalezari has received honoraria/consultation fees from Bayer, Pfizer, Teva, Takeda, Roche, and PI Healthcare.


Assaf A. Barg has received honoraria for lectures from ROCHE and a grant from Pfizer.


Gili Kenet receives grant and research support from Alnylam, Bayer, BPL, Opko Biologics, Pfizer, and Shire, and honoraria for consultancy/lectures from Alnylam, Bayer, CSL, Opko Biologics, Pfizer, Takeda, and ROCHE.


Author Contributions

All authors made substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data for the work. They drafted the work or revised it critically for important intellectual content. The authors approved the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved




Publication History

Received: 14 February 2021

Accepted: 06 April 2021

Article published online:
01 June 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Plug I, Mauser-Bunschoten EP, Bröcker-Vriends AH. et al. Bleeding in carriers of hemophilia. Blood 2006; 108 (01) 52-56
    CrossrefPubMedGoogle Scholar
  • 2 White II GC, Rosendaal F, Aledort LM, Lusher JM, Rothschild C, Ingerslev J. Factor VIII and Factor IX Subcommittee. Definitions in hemophilia. Recommendation of the scientific subcommittee on factor VIII and factor IX of the scientific and standardization committee of the International Society on Thrombosis and Haemostasis. Thromb Haemost 2001; 85 (03) 560
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Miesbach W, Alesci S, Geisen C, Oldenburg J. Association between phenotype and genotype in carriers of haemophilia A. Haemophilia 2011; 17 (02) 246-251
    CrossrefPubMedGoogle Scholar
  • 4 Paroskie A, Gailani D, DeBaun MR, Sidonio Jr RF. A cross-sectional study of bleeding phenotype in haemophilia A carriers. Br J Haematol 2015; 170 (02) 223-228
    CrossrefPubMedGoogle Scholar
  • 5 James AH. More than menorrhagia: a review of the obstetric and gynaecological manifestations of bleeding disorders. Haemophilia 2005; 11 (04) 295-307
    CrossrefPubMedGoogle Scholar
  • 6 Dhar P, Abramovitz S, DiMichele D, Gibb CB, Gadalla F. Management of pregnancy in a patient with severe haemophilia A. Br J Anaesth 2003; 91 (03) 432-435
    CrossrefPubMedGoogle Scholar
  • 7 Pavlova A, Brondke H, Müsebeck J, Pollmann H, Srivastava A, Oldenburg J. Molecular mechanisms underlying hemophilia A phenotype in seven females. J Thromb Haemost 2009; 7 (06) 976-982
    CrossrefPubMedGoogle Scholar
  • 8 Leuer M, Oldenburg J, Lavergne JM. et al. Somatic mosaicism in hemophilia A: a fairly common event. Am J Hum Genet 2001; 69 (01) 75-87
    CrossrefPubMedGoogle Scholar
  • 9 Oldenburg J, Rost S, El-Maarri O. et al. De novo factor VIII gene intron 22 inversion in a female carrier presents as a somatic mosaicism. Blood 2000; 96 (08) 2905-2906
    CrossrefPubMedGoogle Scholar
  • 10 Pena JE, Klein J, Thronton MH, Sauer MV. Providing reproductive care to male haemophiliacs infected with human immunodeficiency virus: preliminary experience. Blood 2000; 96: 2905-2906
    CrossrefPubMedGoogle Scholar
  • 11 Oyesiku JO, Turner CF. Reproductive choices for couples with haemophilia. Haemophilia 2002; 8 (03) 348-352
    CrossrefPubMedGoogle Scholar
  • 12 Kadir RA, Sabin CA, Goldman E, Pollard D, Economides DL, Lee CA. Reproductive choices of women in families with haemophilia. Haemophilia 2000; 6 (01) 33-40
    CrossrefPubMedGoogle Scholar
  • 13 Tedgård U, Ljung R, McNeil TF. Reproductive choices of haemophilia carriers. Br J Haematol 1999; 106 (02) 421-426
    CrossrefPubMedGoogle Scholar
  • 14 Belmont JW. Insights into lymphocyte development from X-linked immune deficiencies. Trends Genet 1995; 11 (03) 112-116
    CrossrefPubMedGoogle Scholar
  • 15 van den Berg HM. A cure for hemophilia within reach. N Engl J Med 2017; 377 (26) 2592-2593
    CrossrefPubMedGoogle Scholar
  • 16 Lusher JM, McMillan CW. Severe factor VIII and factor IX deficiency in females. Am J Med 1978; 65 (04) 637-648
    CrossrefPubMedGoogle Scholar
  • 17 Sharma V, Khalid A, Cohen AJ. Management of pregnancy in a patient with severe hemophilia type a. AJP Rep 2013; 3 (01) 29-32
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Bodrozic JN, Miljic PS, Lekovic DR. et al. Pregnancy and delivery in a woman with severe haemophilia A. Blood Coagul Fibrinolysis 2017; 28 (06) 496-499
    CrossrefPubMedGoogle Scholar
  • 19 Kadir RA, Economides DL, Braithwaite J, Goldman E, Lee CA. The obstetric experience of carriers of haemophilia. Br J Obstet Gynaecol 1997; 104 (07) 803-810
    CrossrefPubMedGoogle Scholar
  • 20 Chi C, Lee CA, Shiltagh N, Khan A, Pollard D, Kadir RA. Pregnancy in carriers of haemophilia. Haemophilia 2008; 14 (01) 56-64
    CrossrefPubMedGoogle Scholar
  • 21 Lee CA, Chi C, Pavord SR. et al; UK Haemophilia Centre Doctors' Organization. The obstetric and gynaecological management of women with inherited bleeding disorders--review with guidelines produced by a taskforce of UK Haemophilia Centre Doctors' Organization. Haemophilia 2006; 12 (04) 301-336
    CrossrefPubMedGoogle Scholar
  • 22 Davies J, Kadir RA. Mode of delivery and cranial bleeding in newborns with haemophilia: a systematic review and meta-analysis of the literature. Haemophilia 2016; 22 (01) 32-38
    CrossrefPubMedGoogle Scholar
  • 23 Andersson NG, Chalmers EA, Kenet G, Ljung R, Mäkipernaa A, Chambost H. PedNet Haemophilia Research Foundation. Mode of delivery in hemophilia: vaginal delivery and cesarean section carry similar risks for intracranial hemorrhages and other major bleeds. Haematologica 2019; 104 (10) 2100-2106
    CrossrefPubMedGoogle Scholar