Aplastic anemia is a rare and potentially fatal condition, affecting between 2 and 6/1,000,000 pregnancies in the United States. The primary objective of this review was to identify adverse maternal and fetal outcomes associated with aplastic anemia complicating pregnancy.METHODS:
We conducted a systematic review of published literature to identify all observational and randomized studies evaluating pregnancy outcomes in women diagnosed with aplastic anemia. A combination of keywords was used to identify the maximum number of relevant citations in MEDLINE, EMBASE, CINAHL and the Cochrane Database.RESULTS:
We identified 17 observational studies (70 women), which evaluated outcomes in pregnancies complicated by aplastic anemia. Overall, in 36 out of 70 (51.4%) cases at least one significant maternal complication was reported (Table 1). The most common maternal complications included antepartum and/or postpartum hemorrhage, which occurred in 11 (15.7%) cases, and postpartum relapse which developed in 13 (18.6%) cases. Three (4.3%) women experienced intracranial hemorrhage or thrombosis, while four (5.7%) women died within 1 year of pregnancy. Across these reported cases, pancytopenia was observed with a mean starting hemoglobin of 6.9g/dL, white blood cell count of 2.7x109/L and platelet count of 31x109/L. In 14 of 31 (45.2%) cases preterm birth ensued, with 20% of the women delivering prior to 34 weeks. Three cases of intrauterine fetal demise were also reported.CONCLUSION:
This review demonstrates the significant adverse maternal and fetal outcomes in pregnancies complicated with aplastic anemia. The findings from this review may aid in counselling and managing obstetric patients suffering from this rare condition.