top of page

MPN in pregnancy - All you need to know!

Updated: Jun 26, 2023

Myeloproliferative neoplasms (MPNs) can increase the risks in pregnancy, but planning makes a difference.



Content guide



 


MPN in Pregnancy


Many people may be diagnosed with an MPN in their twenties and thirties, the time in life when many of us are establishing careers and starting families. It can come as an unwelcome surprise to learn not only that you have an MPN, but that this disorder may affect your ability to start a family. You might have learned you had an MPN when you had your first blood test after becoming pregnant. Understandably, this news may have come as a shock.



MPN in Pregnancy is real and achievable


If you have a myeloproliferative neoplasm (MPN), you may wonder how it will affect your pregnancy and your baby. MPNs are rare blood disorders that cause bone marrow to make too many blood cells. They can increase your risk of blood clots, bleeding, and other complications during pregnancy. But don't worry, there is good news!


The good news is that having an MPN doesn't have to stop you from having a healthy pregnancy and baby. Many women with MPNs have successful pregnancies and deliveries.


The key is to plan and work closely with your health care team. Your hematologist (a doctor specializing in blood disorders) and your GP (general practitioner) can help you manage your condition and monitor your health before, during, and after pregnancy. They can also advise you on the best treatment options for your MPN and pregnancy.


Some of the things you and your health care team may need to consider are:

  • The type and severity of your MPN

  • Your age and general health

  • Your personal and family history of blood clots or bleeding

  • The medications you are taking or may need to take for your MPN

  • The potential risks and benefits of different treatments for you and your baby

  • The timing and frequency of blood tests and scans

  • The mode and timing of delivery

  • The need for extra care or support after delivery

By planning and working together with your health care team, you can reduce the risks of complications and enjoy a happy and healthy pregnancy. Remember, having an MPN doesn't mean you can't have children. It just means you need to be more careful and prepared.




Risks and Treatments


Myeloproliferative neoplasms (MPNs) are a group of blood disorders that affect the production of red blood cells, white blood cells, and platelets. MPNs can cause various complications during pregnancy, such as miscarriage, pre-eclampsia, thrombosis, and bleeding.


MPNs can increase the risk of miscarriage both early and late in pregnancy. MPNs can also increase the risk of the mother developing pre-eclampsia, a dangerous condition in which a woman develops high blood pressure during pregnancy. Pre-eclampsia can lead to severe problems for both the mother and the baby, such as seizures, stroke, organ damage, and growth restriction.


MPNs can also increase the risk of blood clots (thrombosis) and bleeding (hemorrhage) in pregnant women. Thrombosis can occur in the veins or arteries and can cause life-threatening complications such as pulmonary embolism or stroke. Bleeding can occur due to low platelet count or abnormal platelet function and can cause heavy menstrual bleeding, nosebleeds, bruising, or postpartum hemorrhage.


The treatment of MPNs during pregnancy depends on several factors, such as the type and severity of MPN, the presence of symptoms or complications, the risk of thrombosis or bleeding, and the potential effects on the fetus. The main goals of treatment are to prevent thrombosis and bleeding, to control symptoms such as itching or fatigue, and to avoid fetal harm.



Some of the treatments may be used for MPNs during pregnancy are:


  • Aspirin: a low dose of aspirin may be prescribed to reduce the risk of thrombosis and improve placental blood flow. Aspirin is generally safe for both the mother and the baby, but it may increase the risk of bleeding should be stopped before delivery.

  • Heparin: a type of anticoagulant that prevents blood clots. Heparin may be given to women with a high risk of thrombosis or a history of thrombosis. Heparin does not cross the placenta and does not affect the fetus, but it may increase the risk of bleeding and osteoporosis.

  • Interferon: a medication that reduces blood cell production and modulates the immune system. Interferon may be used for women with severe MPN symptoms or complications not controlled by other treatments. Interferon is considered safe for both the mother and the baby, but it may cause side effects such as flu-like symptoms, depression, or liver problems.

  • Phlebotomy: a procedure that involves removing some blood from a vein to reduce the red blood cell count. Phlebotomy may be performed for women with polycythemia vera (PV), a type of MPN that causes a high red blood cell count. Phlebotomy can lower the risk of thrombosis and improve symptoms such as headache or dizziness. Phlebotomy does not affect the fetus but may cause iron deficiency or anemia.


Pregnant women with MPNs must be carefully monitored by their healthcare team, including their hematologist, obstetrician, and midwife, to watch for and manage any problems that may develop. They should also follow general recommendations such as staying hydrated, avoiding smoking and alcohol, wearing compression stockings if advised, and reporting signs of thrombosis or bleeding.


MPNs can pose some challenges during pregnancy, but with proper planning and treatment, most women with MPNs can have a successful pregnancy and a healthy baby.



What to expect during pregnancy


If you have an MPN or are planning to become pregnant, you should expect more frequent blood tests and appointments with your healthcare team than a woman without an MPN.


Check your blood counts, monitor your symptoms, and adjust your treatment if needed. You may also need to take medication such as aspirin or heparin to prevent blood clots, which are more common in people with MPNs and can cause severe complications in pregnancy. Your healthcare team will advise you on the best medication and dosage.


You should also be aware of the signs and symptoms of pre-eclampsia, such as headaches, blurred vision, swelling of the hands and feet, and abdominal pain.


Contact your health care team immediately if you experience any of these symptoms.



How will an MPN affect my baby?


Most babies born to mothers with MPNs are healthy and do not inherit the disorder. However, there is a slight chance (less than 10%) that your baby may have a low platelet count or an enlarged spleen at birth. These conditions usually resolve on their own or with treatment and do not cause any long-term problems for your baby.


Some women with MPNs may need to deliver their baby earlier than expected, either by induction or cesarean section. This is usually done to reduce the risk of complications for the mother or the baby. Your healthcare team will discuss the best timing and mode of delivery for you and your baby.



What to Expect After Delivery If You Have an MPN

If you have a myeloproliferative neoplasm (MPN), you may have some concerns about how your condition will affect your pregnancy and delivery. MPNs are a group of rare blood cancers that cause the body to produce too many or too few blood cells. The most common types of MPNs are polycythemia vera (PV), essential thrombocythemia (ET) and myelofibrosis (MF).


Having an MPN can increase your risk of complications during pregnancy and delivery, such as high blood pressure, bleeding, blood clots and fetal growth problems. However, with proper care and monitoring, most women with MPNs can have a healthy pregnancy and delivery.


After you give birth, you will need to continue to have regular blood tests and follow-up appointments with your health care team. Your blood counts may change after delivery and you may need to adjust your medication accordingly. You should also watch out for any signs of infection, bleeding or thrombosis (blood clots) and seek medical attention if you notice any.


Here are some tips to help you cope with your MPN after delivery:

  • Stay hydrated. Drinking plenty of fluids can help prevent dehydration, which can worsen your symptoms and increase your risk of blood clots.

  • Eat a balanced diet. Eating foods rich in iron, folate, and vitamin B12 can help support your blood production and prevent anemia.

  • Get enough rest. Sleep is important for your physical and mental health, especially after giving birth. Try to nap when your baby sleeps and ask for help from your partner, family, or friends when you need it.

  • Exercise moderately. Physical activity can help improve your circulation, mood and energy levels. However, avoid strenuous or high-impact exercises that could cause injury or bleeding. Talk to your doctor before starting any exercise program.

  • Seek support. Having an MPN can be stressful and overwhelming, especially after having a baby. You may experience anxiety, depression or isolation. It is important to talk to someone you trust about how you feel and seek professional help if needed. You can also join a support group or online community for people with MPNs or new mothers.

Having an MPN does not mean you cannot enjoy motherhood. With proper care and support, you can manage your condition and take care of yourself and your baby.


If you are planning to breastfeed your baby, you should discuss this with your hematologist before you start. Some medications used to treat MPNs may pass into breast milk and affect your baby. Your hematologist will advise you on whether it is safe to breastfeed while taking your medication or if you need to switch to a different medication or formula feed your baby.



Breastfeeding in MPN patient


Some new mothers may not be able to breastfeed their baby if they need to take medication after delivery. In this blog post, we will explore some of the benefits and challenges of breastfeeding for mothers with MPN, as well as some tips and resources to help you make an informed decision.


Challenges of breastfeeding


Breastfeeding can also pose some challenges for mothers with MPN, especially if they need to take medication that is not compatible with breastfeeding. Some of the drugs used to treat MPN, such as hydroxycarbamide and anagrelide, can pass into breast milk and harm the baby.


Therefore, mothers who need these drugs should not breastfeed their baby or should stop breastfeeding before starting treatment. The safety of interferon during breastfeeding is less clear, and some studies suggest that it may be safe in low doses. However, it is important to consult with your doctor before breastfeeding while on interferon, as there may be individual factors that affect the risk-benefit balance.


Another challenge of breastfeeding for mothers with MPN is coping with the emotional impact of not being able to breastfeed if they wanted to. Breastfeeding is often seen as a natural and desirable way of feeding a baby, and some mothers may feel guilty, disappointed, or inadequate if they cannot breastfeed. They may also face pressure or criticism from others who do not understand their situation or who have different opinions about breastfeeding. These feelings can affect their self-esteem, mood, and relationship with their baby.


Tips and resources


If you are a mother with MPN who wants to breastfeed or is currently breastfeeding, here are some tips and resources that may help you:

  • Talk to your doctor about your treatment options and how they affect your ability to breastfeed. Ask about the risks and benefits of different drugs, and whether there are any alternatives that are safe for breastfeeding.

  • Seek support from your midwife, lactation consultant, nurse or other health professional who can help you with breastfeeding techniques, problems, and advice. They can also help you monitor your baby's growth and development, and check for any signs of adverse effects from medication.

  • Join a support group or online community for mothers with MPN or similar conditions. You can share your experiences, feelings and questions with other mothers who understand what you are going through. You can also find a buddy who can offer emotional support and practical help.

  • Educate yourself and others about MPN and breastfeeding. Learn as much as you can about your condition and how it affects your health and parenting choices. You can also educate your family, friends and others who may have questions or concerns about your decision to breastfeed or not. You can use reliable sources of information such as websites, books or leaflets from reputable organizations.

  • Be kind to yourself and do what is best for you and your baby. Remember that there is no right or wrong way to feed.


How can I manage fatigue after delivery?


Fatigue is a common symptom of MPN that can affect your physical and mental well-being. Fatigue can also be worsened by pregnancy and delivery, especially if you have lost blood or have other complications. Here are some tips to help you manage fatigue after delivery:

  • Rest as much as possible. Try to nap when your baby sleeps, even if it is only for a short time. Avoid doing too much housework or other chores that can wait.

  • Eat well and drink plenty of fluids. Choose nutritious foods that give you energy, such as fruits, vegetables, whole grains, lean protein, and dairy products. Avoid caffeine, alcohol and sugary drinks that can dehydrate you or make you feel jittery.

  • Exercise moderately. Physical activity can help you feel more alert and improve your mood. Aim for at least 150 minutes of moderate exercise per week, such as walking or swimming. Start slowly and gradually increase your intensity and duration. Listen to your body and stop if you feel unwell or in pain.

  • Seek support from others. Don't be afraid to ask for help from your partner, family members, friends, or neighbors. They can assist you with childcare, household tasks, shopping, or cooking. You can also join a support group for women with MPN or new mothers to share your experiences and feelings with others who understand.

  • Talk to your doctor. If your fatigue is severe or persistent, it may be a sign of an underlying problem, such as anemia, infection, or depression. Your doctor can check your blood counts, prescribe medication, or refer you to a specialist if needed.

Fatigue after delivery is normal and expected, but it can be more challenging for women with MPN. By following these tips, you can cope better with fatigue and enjoy your new baby.



Planning for pregnancy with a myeloproliferative neoplasm


A myeloproliferative neoplasm (MPN) is a type of blood cancer that causes your bone marrow to make too many blood cells. This can lead to problems such as blood clots, bleeding, infections, and an enlarged spleen. MPNs are chronic conditions that require lifelong treatment and monitoring.


If you have been diagnosed with an MPN and want to start a family, it’s important to plan with your hematologist. Your hematologist is a doctor who specializes in blood disorders and can help you manage your condition and prepare for pregnancy.

In this blog post, we will discuss some of the things you need to consider before and during pregnancy if you have an MPN.


If possible, it is best to plan with your hematologist and GP or obstetrician BEFORE becoming pregnant.


Pregnancy can affect your MPN in different ways. For some people, pregnancy may improve their symptoms and blood counts. For others, pregnancy may worsen their condition and increase the risk of complications such as blood clots or bleeding. Your hematologist can assess your individual situation and advise you on the best time to conceive and the safest way to manage your MPN during pregnancy.


Another reason to plan is that some of the medications used to treat MPNs are not safe for pregnancy. These include hydroxycarbamide and anagrelide, which are drugs that reduce the number of blood cells in your body. These drugs can harm the development of your baby and should be avoided if you are planning to become pregnant or father a child.


If you have been taking aspirin only, or you are being treated with aspirin together with phlebotomy, you can usually stay on this same treatment plan while you are trying for a child, this applies to both men and women.


Aspirin is a drug that prevents blood clots by making your platelets less sticky. Platelets are small blood cells that help your blood clot when you have an injury. Aspirin is often used to treat MPNs because it reduces the risk of blood clots, which can be life-threatening.


Phlebotomy is a procedure that removes some of your blood from your body. This lowers the number of red blood cells in your body, which carry oxygen around your body. Phlebotomy is often used to treat polycythemia vera (PV), which is a type of MPN that causes your bone marrow to make too many red blood cells. This can make your blood thick and slow down its flow.


Aspirin and phlebotomy are generally safe for pregnancy and do not affect your fertility or the development of your baby. However, you should always consult your hematologist before taking any medication or having any procedure.


Cytoreductive drugs and pregnancy: what you need to know.


If you have a myeloproliferative neoplasm (MPN), a type of blood cancer that causes your bone marrow to produce too many blood cells, you may be taking cytoreductive drugs to lower your blood counts and reduce your risk of complications. However, these drugs can have harmful effects on your fertility and your unborn child. In this blog post, we will explain why you should avoid cytoreductive drugs such as hydroxycarbamide or anagrelide if you are planning to become pregnant, and what alternatives you have.


Cytoreductive drugs work by interfering with the DNA synthesis of your blood cells, which slows down their production and growth. However, this also means that they can damage the DNA of your eggs, which can cause birth defects or miscarriage in your baby. Therefore, if you are taking cytoreductive drugs such as hydroxycarbamide or anagrelide to control your MPN, we recommend that you ask your hematologist for a different treatment plan and that you discuss whether you should stop taking these drugs for at least six months before becoming pregnant.


There are other options for managing your MPN that are safer for your pregnancy. For example, you may be able to switch to a different type of drug called interferon, which stimulates your immune system to fight the abnormal blood cells. Interferon has been shown to be effective and safe for women who want to have children. Another option is to have a procedure called phlebotomy, which involves removing some of your blood to lower your red blood cell count. This can be done regularly during your pregnancy under close monitoring.


If you have been taking cytoreductive drugs such as hydroxycarbamide or anagrelide to control your MPN, we recommend that you ask your hematologist for a different treatment plan and that you discuss whether you should stop taking these drugs for at least six months before becoming pregnant. It is important to plan and allow your body to adjust, without rushing. You may not need medication because your blood volume will increase during pregnancy. Your hematologist can advise you on the best choices for you.











44 views0 comments

Recent Posts

See All

Comments

Rated 0 out of 5 stars.
No ratings yet

Add a rating
bottom of page