Maternal Coagulation Profiles in Pregnant Women with Thalassemia: A Retrospective Observational Study in South China

Chaoxuan Dong, Xin Chen, Li Zhang, Huimin Zhou, Meiqi Lin Department of Anesthesiology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, People’s Republic of ChinaCorrespondence: Chaoxuan Dong, Department of Anesthesiology, The First Affiliated Hospital of Jinan University, China 613 W. Huangpu Avenue, Guangzhou, Guangdong, 510630, People’s Republic of China, Tel +86 13354712423, Email [email protected]: Normal coagulation is essential for maternal safety during pregnancy and delivery. Thalassemia may influence coagulation parameters, however, its effects during pregnancy remain incompletely characterized. This study aimed to evaluate maternal coagulation profiles in pregnant women with thalassemia in South China.Patients and Methods: This retrospective observational study included 53 pregnant women with thalassemia and 352 pregnant women without thalassemia who delivered at a tertiary medical center in South China. Singleton pregnancies with gestational age of ≥ 37 weeks were analyzed. Women with other hematological disorders, pregnancy complications affecting coagulation, or abnormal cardiac, liver, or renal function were excluded. Primary outcomes were maternal coagulation indices - activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen (FIB), international normalized ratio (INR), and platelet count (PLT) - and were assessed in early and late pregnancy. Perinatal outcomes were also evaluated as secondary outcomes.Results: Women with thalassemia had lower TT in early pregnancy (P = 0.007) and higher PLT in both early and late pregnancy (P < 0.001) compared with women without thalassemia. From early to late pregnancy, APTT, PT, and INR decreased whereas TT and FIB increased in both groups (P < 0.01). PLT decreased only in the non-thalassemia group (P < 0.001). Changes in APTT (P = 0.02) and FIB (P = 0.025) were modestly more pronounced in the thalassemia group. Maternal anemia was more frequent among women with thalassemia (P < 0.001), while other perinatal outcomes were comparable between groups.Conclusion: Pregnancy in women with thalassemia is associated with modest differences in coagulation parameters compared with women without thalassemia. Importantly, these variations remained within clinically acceptable ranges and were not associated with adverse perinatal outcomes. The findings provide reassuring information and contribute to a better understanding of physiological coagulation adaptation in pregnant women with thalassemia.Plain Language Summary: Blood clotting helps prevent excessive bleeding during pregnancy and childbirth. Thalassemia is a common inherited blood disorder in South China and may influence blood clotting during pregnancy. This study compared routine blood clotting tests in pregnant women with and without thalassemia. Some clotting measurements differed between the two groups, but most values remained within normal ranges. Overall, the results provide reassuring information about blood clotting changes in pregnant women with thalassemia and help improve understanding of normal physiological adaptation during pregnancy.Keywords: pregnancy, anemia, bleeding disorders & coagulopathies, anesthesia in obstetrics, observational study