PO02 | Pregnancy and delivery in women with hemophilia and carriers are still challenging: a ten years analysis from The Italian Association of Hemophilia Centers (AICE)

M. Napolitano¹, M. Mattana², C. Cammarata¹, M. Leotta³, S. Linari⁴, M.E. Mancuso⁵, G. F. Rivolta⁶, C. Santoro⁷, L. Valdrè⁸, R.C. Santoro³, S. Siragusa¹ | ¹Department of Health Promotion, Mother and Child Care, Internal Medicine and Med, Palermo; University of Palermo, Italy; ²Department of Precision Medicine in Medical, Surgical and Critical Care “Me. Pre. Cc”, University of Palermo; ³Hemostasis and Thrombosis Unit, Azienda Ospedaliera Universitaria Dulbecco, Catanzaro; ⁴Center for Bleeding Disorders, Careggi University Hospital, Firenze; ⁵Center for Thrombosis and Hemorrhagic Diseases, IRCCS Humanitas Research Hospital, Rozzano, Milan; ⁶Regional Reference Center for the Treatment of Congenital Hemorrhagic Diseases, Parma University Hospital, Parma; ⁷Hematology, University Hospital Policlinico Umberto I, Roma; ⁸Inherited Bleeding Disorders Unit, IRCCS AOUBO, Bologna, Italy

Background: Women carriers of hemophilia A and B (HC-A, HC-B) or affected by hemophilia A and B (HW-A, HW-B) are often asymptomatic, they may however bleed during pregnancy and delivery. This study investigated pregnancy and childbirth outcomes in HC and HW managed in Italy. The primary aim was to define the frequency and severity of bleeding complications during pregnancy, delivery, and postpartum and evaluate their correlation with FVIII/FIX levels. We examined delivery approaches and treatment needs.

Methods: This retrospective multicenter study was conducted on behalf of the Italian Association of Hemophilia Centers (AICE). Following IRBs approval, HC and HW were enrolled between January 2022 and December 2024. Collected data, referring to any pregnancy and delivery managed between December 2011 and December 2021, included: age, ISTH-BAT score, genetic diagnosis, CBC, FVIII:c/FIX:c levels, prenatal diagnosis, pregnancy history, mode of delivery, postpartum bleeding, transfusional or pharmacological support.

Results: Overall 94 women were recruited: 48 HC-A, 27 HW-A,11 HC-B, 4 HW-B; median age at haemophilia diagnosis was 27 years (2-45); median ISTH-BAT score was 1,74 (0-11). Data from 174 pregnancies were analyzed: 95 vaginal births, 59 cesarean sections,10 miscarriages. Prenatal diagnosis was performed in 99 pregnancies (56,8%). Twelve bleeding episodes during pregnancy (6,7%) and 20 postpartum bleedings (12,9%) were record. At delivery, 31 women (20%) received treatment. Five patients (3,2%) required treatment postpartum. Overall 3 women required blood and one also plasma transfusion. There was no correlation between bleeding episodes and treatment (p=0,297) or factor levels (p=1,2). An inverse correlation between ISTH-BAT score and factor levels was observed (p=0,08) (Table 1).

Conclusions: Bleeding risk in carriers of haemophilia is not only determined by factor levels, other concomitant risk factors play a role. Specific protocols are needed to ensure a safer multidisciplinary approach. Table 1.