How Joan, Hobbs Gabriela
Division of Hematology, Brigham and Women's Hospital, Boston, MA.
Division of Oncology, Massachusetts General Hospital, Boston, MA.
Hematology Am Soc Hematol Educ Program. 2024 Dec 6;2024(1):541-546. doi: 10.1182/hematology.2024000578.
The aging obstetric population, combined with more frequent myeloproliferative neoplasm (MPN) diagnoses in younger patients, will result in hematologic providers increasingly caring for MPN patients in pregnancy. There are special considerations that pertain to management of pregnancy in MPN patients. This includes increased risks of thrombosis and hemorrhage as well as pregnancy complications that are likely related to placental dysfunction associated with an MPN diagnosis, including preeclampsia, preterm delivery, and intrauterine growth restriction. Complicating these outcomes is the uncertainty of the safety of many commonly used drugs in MPNs in pregnancy and breastfeeding. Given the overall low incidence of pregnancy in MPNs, many guidelines are based on expert opinions and extrapolation from other high-risk pregnancy populations. In this case-based review, we summarize the literature on MPN pregnancy outcomes and synthesize recommendations to provide guidance on the antepartum and postpartum management of MPN patients. Special attention is also made to issues relevant to preconception, including fertility and the use of assisted reproductive technology.
老年产科人群，再加上年轻患者中骨髓增殖性肿瘤（MPN）的诊断越来越频繁，将导致血液科医生越来越多地照顾孕期的MPN患者。对于MPN患者的妊娠管理有一些特殊的考虑因素。这包括血栓形成和出血风险增加，以及可能与MPN诊断相关的胎盘功能障碍有关的妊娠并发症，包括先兆子痫、早产和宫内生长受限。使这些结果更加复杂的是，许多常用药物在MPN患者妊娠和哺乳期的安全性存在不确定性。鉴于MPN患者妊娠的总体发生率较低，许多指南基于专家意见以及从其他高危妊娠人群推断而来。在本病例回顾中，我们总结了关于MPN妊娠结局的文献，并综合建议，为MPN患者的产前和产后管理提供指导。还特别关注与孕前相关的问题，包括生育能力和辅助生殖技术的使用。
