DP064 | PREGNANCY AND DELIVERY IN WOMEN WITH HAEMOPHILIA AND CARRIERS ARE STILL CHALLENGING: A TEN YEAR ANALYSIS FROM THE ITALIAN ASSOCIATION OF HEMOPHILIA CENTERS (AICE)

Background: Women who are carriers (HC) or affected (HW) by hemophilia A or B are often asymptomatic but may experience bleeding during pregnancy and childbirth. Aims: This study assessed pregnancy and delivery outcomes in HC and HW managed in Italy. The primary aim was to evaluate the frequency and severity of bleeding during pregnancy, delivery, and postpartum, and its correlation with FVIII/FIX levels. Delivery methods and treatment requirements were also examined. Methods: A retrospective multicenter study promoted by the Italian Association of Hemophilia Centers (AICE). After IRB approval, HC and HW were enrolled between Jan 2022 and Dec 2024. Data from pregnancies and deliveries managed from Dec 2011 to Dec 2021 were collected, including: age, ISTH-BAT score, genetic diagnosis, CBC, FVIII/FIX levels, prenatal diagnosis, obstetric history, delivery mode, postpartum bleeding, and need for treatment or transfusion. Results: Ninety-four women were included: 48 HC-A, 27 HW-A, 11 HC-B, 4 HW-B. Median age at diagnosis was 27 years (range 2–45); median ISTH-BAT score was 1.74 (range 0–11). Data from 174 pregnancies were analyzed: 95 vaginal, 59 cesarean deliveries, 10 miscarriages. Prenatal diagnosis was performed in 99 pregnancies (56.8%). Twelve bleeding episodes occurred during pregnancy (6.7%) and 20 postpartum (12.9%). At delivery, 31 women (20%) received treatment; 5 (3.2%) were treated postpartum. Three women required blood transfusion, one also plasma. No significant correlation was found between bleeding and treatment (p=0.297) or factor levels (p=1.2). An inverse correlation between ISTH-BAT and factor levels was observed (p=0.08). Conclusion: Bleeding risk in hemophilia carriers is not solely linked to factor levels; other risk factors contribute. Specific protocols and a multidisciplinary approach are essential for safer management.