Thalassemia > Pregnancy > Risks due to Medications

Risks Related to Medications

Genetic counseling is an important resource for information about the adverse effects of maternal medications on the developing fetus. It is important for any pregnant woman to consult her physician before using any type of medication. Potential risks to the fetus depend on the type of medication, the dosage, and the period in pregnancy in which exposure takes place. Certain medications may also be present in breast milk and may pose a risk to the newborn baby. A genetic counselor or perinatologist can offer information about any particular woman's risk.

The woman with thalassemia may be on one or more medications, including iron chelating agents or anti-viral drugs to manage previous infections. Known or theoretical risks of each of these medications should be considered in determining whether they should be continued in pregnancy or if their doses should be adjusted. Desferal is the most commonly used medication among these women because of its important role in reducing iron overload and its consequences. The possibility of adverse effects is suggested by animal studies in which skeletal anomalies are noted at doses comparable to human dosages. Less than 40 cases among pregnant women have been published describing the outcome of pregnancy for women on chronic Desferal treatment. Among the women who continued their pregnancies, none took Desferal beyond the first trimester. There was no evidence among these infants to suggest adverse effects of Desferal. Some additional cases have been reported in which Desferal therapy was initiated late in pregnancy following iron overdose. At least one of these infants was reported to have iron deficiency attributable to maternal Desferal therapy. Overall, the number of reported cases in women is insufficient to establish the safety of Desferal in pregnancy. Regarding the safety during breast-feeding, Desferal is unlikely to have a harmful effect given its poor absorption across the adult gut. However, there is no available information regarding Desferal treatment during breast-feeding. Therefore, the expected benefits and risks of continuing therapy during pregnancy or breast-feeding for any individual woman should be discussed with her physician. This is true for any additional medications given to the pregnant woman with thalassemia.