Assessing Best Practices in Managing Pregnancy, Myeloproliferative Neuroplasms

As researchers noted in a critical review published in the American Journal of Hematology, MPNs pose unique fetal and maternal challenges, particularly risk of fetal loss. For ET, live birth rate is estimated at 70% with first trimester loss serving as the major complication in these populations, affecting 30%.

“Both pregnancy and MPN impart a hypercoagulable milieu, conferring a heightened risk for thrombosis,” said the authors. “In addition, bleeding diathesis may escalate at the time of delivery and in the postpartum phase, especially in the context of treatment with aspirin and/or low molecular weight heparin.”

With hematological and obstetrical challenges becoming increasingly prevalent for patients with MPNs during pregnancy, researchers sought to review these issues, as well as provide their systematic approach to management.

As they highlighted, it is now well established that patients with PV or ET experience a higher rate of both arterial and venous thrombotic events. However, current thrombotic risk stratification models in MPN have limited applicability in determining pregnancy complications, with risk suggested to be relatively low in those without prior thrombotic events and high if otherwise.

“In regards to thrombotic events, risk of venous thromboembolism is increased 4-fold to 6-fold during pregnancy, with the greatest risk in the post-partum phase,” they wrote.