I am pregnant

A coordinated care plan between your haematologist and your obstetrician helps ensure the health of you and your unborn child.

Some people are diagnosed with a myeloproliferative neoplasm (MPN) in their twenties and thirties, a time in life when you may be thinking about starting a family. The good news is that having an MPN doesn’t have to prevent you from having children. If possible, you will want to plan ahead with your health care team before becoming pregnant.  And if you’re already pregnant, your haematologist can help protect your health and that of your unborn child. Here are ten tips for pregnancy with an MPN. You can find more detailed medical information in our pregnancy section.

Tips for pregnancy with an MPN

Talk with your doctors
If you (or your partner) are thinking about becoming pregnant or if you are already pregnant, it’s important to talk with your haematologist, GP and obstetrician as early as possible. They can assist you in making treatment decisions and advise you about your care as you go through your pregnancy.

Reconsider your medications
Some medications for MPNs are not compatible with pregnancy. Optimally you should stop treatment with certain drugs, such as hydroxycarbamide or anagrelide, three to six months before trying to become pregnant or before fathering a child. These drugs are dangerous for a developing fetus. Your haematologist can assist you with choosing a safe medication and adjusting to any new medications before pregnancy if needed.

Know your risks
Women with MPNs do have a higher rate of miscarriage than women in the general population. A recent survey in the UK was performed to highlight MPNs to obstetric teams and investigate the best way to care for women with MPNs through their pregnancies, to ensure the optimal outcome for both mother and baby. Until we learn more, the best way to care for yourself and your unborn child is to coordinate your care closely with a haematologist and an obstetrician who can monitor you carefully throughout your pregnancy.

Talk with your family
It can be helpful to bring others in your life into the picture. Help them to understand what you are going through, and ask for help and support – both emotional and physical – as you go through your pregnancy.  This is especially important if you have suffered a miscarriage.  Learn more in our pregnancy section.

Consider your options
There are several treatments that are safe and effective to take during pregnancy.

Low-dose aspirin is not harmful to a developing fetus and works to block the action of platelets in your bloodstream, helping to prevent clots. 

Interferon alpha is a drug derived from naturally occurring substances. Interferon acts to reduce the number of platelets or red cells in your bloodstream, which in turn helps to prevent clots. It is safe to take during pregnancy, although it has side effects and you may need time to adjust to treatment.

Heparin is a blood-thinner given by injection. This drug helps to prevent clots from forming.

Phlebotomy If you have polycythemia vera (PV), you can continue to have phlebotomies during pregnancy to reduce your heamatocrit. You may find that you need fewer phlebotomies while pregnant because of the increased blood volume during pregnancy.

Talk with your doctor and explore our  treatments section for more information on these treatments.

If you’ve suffered a miscarriage
Miscarriage can be a traumatic and lonely experience. If you have suffered a miscarriage or a stillborn child, the Miscarriage Association (UK) can provide much-needed support and understanding.

Plan ahead for delivery
Women with MPNs need careful monitoring throughout their pregnancy, especially for pre-eclampsia.  Pre-eclampsia is a common risk for pregnant women with MPNs and can be dangerous for both mother and unborn child.  If you develop pre-eclampsia, you may be induced so that your baby is born a little early in order to protect your health and that of your baby.  Your haematologist and obstetrician may recommend that you deliver your baby in a hospital rather than at home.  This can sometimes feel disappointing but it is often the safest choice if your risks are higher than normal.

After delivery
Your blood volume will decrease quickly immediately after delivery or after a miscarriage, and this puts mothers with MPNs at higher than usual risk of suffering clots. Your haematologist will recommend heparin injections for a period of several weeks after delivery to reduce any risks. Whether your baby is delivered vaginally or by caesarian section, you may also be at higher risk of bleeding after delivery, especially if you are taking heparin. Your incision may take a number of weeks to close if you have had a caesarian section. It can be helpful to plan ahead by involving friends and family members early and asking for help, especially if you are very fatigued and are unable to drive for a time while on medication.

Breastfeeding
If your blood counts are high, your haematologist may recommend that you begin treatment with a cytoreductive drug such as hydroxycarbamide or anagrelide shortly after delivery. These drugs are not safe for newborns and can be passed through the breast milk to your baby. If you require this treatment it will not be safe for you to breastfeed your baby. The safety of interferon is also uncertain but many doctors would say it is probably safe to breastfeed while taking this drug. Talk with your haematologist for more information about breastfeeding and treatment options.

Talk to someone who’s been there
Many women with MPNs have gone through a miscarriage or have grappled with the problems of having an MPN throughout their pregnancy. If you would like to speak to someone who’s been there, please contact us or click here to learn more about peer support.