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Rates of childbirth amongst women with myeloproliferative neoplasms

By Jennifer Reilly

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Apr 17, 2024

Learning objective: After reading this article, learners will be able to cite a new clinical development in myeloproliferative neoplasms.


Pregnancies in patients with myeloproliferative neoplasms (MPN) are often associated with poorer outcomes, including an increased risk of pre-eclampsia, as well as maternal and fetal morbidity. However, there are limited data on childbearing and birthrates amongst patients with MPN compared with the general population.1

Here, we summarize a retrospective analysis by Landtblom et al.1 published in Leukemia on the childbirth rates in women with MPN.

Study design1

  • Women with an MPN diagnosis, aged between 15 and 44 years, were selected from healthcare registers in Sweden.
  • Patients were age-matched in a ratio of 1:4 with controls from the general population.
  • The main outcome was time to first live childbirth post-MPN diagnosis.
    • Subgroup analyses were performed by age and MPN subtype.
  • Secondary outcomes were miscarriage rate, and stillbirth pre- and post-MPN diagnosis.

Key findings1

  • A total of 1,141 patients with MPN and 4,564 control participants were included in this study.
  • A 22% decreased childbirth rate was observed amongst the patients with MPN, compared with the control cohort (Figure 1).
    • Essential thrombocythemia was the only subtype with similar childbirth rates to the control group.
    • Childbirth rates were significantly reduced in all other MPN subtypes.
    • Women aged 15–25 years were observed to have significantly reduced birthrates compared with the control group.
    • No significant differences in birthrates were observed in any other age category.
  • At the time of diagnosis, 61% of women with MPN had given birth to at least one child, compared with 67.3% in the age-matched controls (p < 0.001).
  • With mean follow-up of 5 years, the risk of miscarriage was not significantly increased amongst patients with MPN compared with the control group; hazard ratio 1.25 (95% confidence interval [CI], 0.89–1.76).
    • However, women with MPN were more likely to have experienced a previous stillbirth, with fewer children in total.

Figure 1. Hazard ratio of live births per MPN subtype and age at diagnosis* 

CI, confidence interval; ET, essential thrombocythemia; MPN-U, myeloproliferative neoplasms-unclassified; PMF, primary myelofibrosis; PV, polycythemia vera.
*Data from Landtblom, et al.1

Key learnings

  • Overall, childbirth rates were lower amongst all subtypes of MPN compared with the general population, with the exception of essential thrombocythemia.
  • Women with MPN also had fewer children than age-matched controls and were more likely to have had stillbirths prior to MPN diagnosis.
  • The risk of miscarriage before or after diagnosis of MPN was similar to the general population group.
  • Optimizing MPN management before and during pregnancy is crucial to improve birthrates and minimize the risk of complications and necessitates continued international collaboration on treatment guidelines.

References

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