Pregnancy, delivery, and neonatal outcomes among women with beta-thalassemia major: A population-based study of a large US database

Purpose: We explored the effect of beta-thalassemia major on pregnancy and delivery outcomes in non-endemic area, utilizing USA population database. Methods: This is a retrospective study utilizing data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. A cohort of all deliveries between 2011 and 2014 was created using ICD-9 codes. Patients with beta-thalassemia major were identified and matched to patients without beta-thalassemia based on age, race, income quartile and type of health insurance at a ratio of 1:20. Baseline characteristics were compared between the groups using Chi-square and Fischer's exact tests, as appropriate. Univariate and multivariate analyses were conducted for pregnancy, delivery and neonatal outcomes to estimate the unadjusted and adjusted odds ratio, respectively. Results: Out of 3,070,656 pregnancies over the study period, beta-thalassemia major complicated 445 pregnancies. Patients with beta-thalassemia were more likely to have thyroid disorders and previous C-section (p-value < 0.05). There were no differences in pregnancy outcomes such as gestational hypertension, preeclampsia, gestational diabetes, and placenta previa. C-section was 30% more likely to be the method of birth (aOR 1.30, 95%CI 1.03–1.63) and there was more than three-fold increased in rate of blood transfusion (aOR 4.69, 95% CI 3.02–7.28) among participants with beta-thalassemia major. Mothers with Beta-thalassemia, almost, were 70% more likely to have a neonate small for gestational age (aOR 1.68, 95%CI 1.07–2.62). Conclusions: Women with beta-thalassemia major are more likely to give birth by C-section, require blood transfusion and have small for gestational age neonates. Counseling patients with beta-thalassemia about these risks and increased antenatal surveillance is advised.