Management of thalassemia in pregnancy: A retrospective study of 45 cases in a secondary maternity type 2B setting

Abstract

Background: Thalassemia, a hereditary hemoglobinopathy, increases maternal and fetal risks during pregnancy due to anemia and transfusion-related complications. Management in secondary maternity type 2B settings, with limited resources compared to tertiary centers, requires tailored strategies. Objective: To evaluate the clinical characteristics, management, and maternal-fetal outcomes of 45 pregnant women with thalassemia in a secondary maternity type 2B hospital. Methods: A retrospective study of 45 pregnant women with thalassemia (beta-thalassemia major, intermedia, or minor) managed between January 2020 and December 2024 at a secondary maternity type 2B facility. Data on demographics, thalassemia type, complications, interventions, and outcomes were extracted from medical records. Descriptive statistics summarized patient characteristics and outcomes, while logistic regression analyzed factors associated with adverse outcomes (preterm delivery, cesarean section, neonatal complications). Results: Of 45 patients (mean age: 27.8 years), 20 (44.4%) had beta-thalassemia major, 15 (33.3%) intermedia, and 10 (22.2%) minor. Common complications included severe anemia (51.1%), preeclampsia (17.8%), and intrauterine growth restriction (IUGR) (20.0%). Transfusions were required in 73.3% of cases. Cesarean delivery occurred in 48.9%, and preterm delivery in 24.4%. No maternal deaths occurred; neonatal complications affected 15.6% of cases. Multivariate analysis identified severe anemia (OR: 3.2, 95% CI: 1.1-9.3, p=0.03) and beta-thalassemia major (OR: 2.8, 95% CI: 1.0-7.8, p=0.05) as predictors of preterm delivery. Conclusion: Effective management of thalassemia in pregnancy is feasible in a type 2B setting with multidisciplinary care, achieving favorable maternal outcomes. However, severe anemia and beta-thalassemia major increase preterm delivery risk, underscoring the need for optimized transfusion protocols and fetal monitoring.