Understanding hemophilia A and pregnancy: Navigating challenges and ensuring safety

Pregnancy can be challenging for women with hemophilia A, bringing unique risks to both the mother and her unborn baby. Women who are carriers of hemophilia or have hemophilia themselves face higher risks of bleeding complications during pregnancy due to hormonal changes, increased blood volume, and lower Factor VIII activity levels compared with women without hemophilia. By proactively addressing these challenges with effective management strategies, women with hemophilia can have a safer pregnancy experience for both themselves and their babies. This information is for educational purposes only, and you should always talk to your doctor if you have any concerns about your hemophilia.

All women experience increased factor levels during pregnancy, including those without hemophilia, women who are carriers of hemophilia (typically possessing one healthy X chromosome), and those with 2 affected X chromosomes, resulting in them having hemophilia itself. Factor VIII levels usually increase in the second trimester, which may temporarily reduce bleeding risk in women with hemophilia A. However, Factor VIII levels drop again after delivery, resulting in an increased risk of bleeding complications such as postpartum hemorrhage in women with hemophilia. Understanding how hemophilia affects pregnancy is crucial for proper management.

Women with hemophilia or carriers may need to work closely with their healthcare team to manage their condition during pregnancy, including regular monitoring of clotting factors and potential changes in treatment to maintain adequate levels of Factor VIII. An obstetrician-gynecologist (OB/GYN) is an important part of this healthcare team and can support women with hemophilia or carriers. Treatment for low Factor VIII levels may be needed during pregnancy and may include Factor VIII replacement therapy. It is crucial to always talk to your doctor if you have any concerns about your own or your child’s hemophilia. Hemophilia testing during pregnancy can help in assessing the risks and planning appropriate care.

If there are concerns that a newborn may have inherited hemophilia from a parent—such as a baby who was born to a family with a history of hemophilia, a baby whose mother carries the hemophilia gene, or a baby who had bleeding symptoms at birth—he or she may be tested. To do this, blood from the umbilical cord (which connects the mother and baby before birth) may be collected and tested for clotting factor levels. To make or to confirm the diagnosis, this test would be performed again when the baby is 6 months old. The baby should be closely monitored for any signs of bleeding, including bruising, swelling, and bleeding at the sites of heel pokes and injections.

The mother should work with her doctor to ensure there is a plan in place for a safe delivery. It is important to monitor and maintain factor levels after delivery, as carriers are at increased risk of primary and secondary postpartum bleeding. Factor replacement therapy, antifibrinolytics, and hormonal therapy are the first-line therapies for its management. Prophylactic hormonal therapy may be started immediately after delivery and continued for one month in selected carriers who are at higher risk of bleeding. It is important that hemoglobin levels in carriers at risk of late postpartum bleeding are checked before being discharged from the hospital, and follow-up appointments to monitor bleeding for around 1–2 months after birth are recommended. The effects on the mother during hemophilia pregnancy require close attention to ensure her safety.

Navigating pregnancy with hemophilia A can be challenging, but with proactive management and close collaboration with healthcare providers, women with hemophilia can ensure a safer experience for themselves and their babies. Regular monitoring, individualized birth plans, and post-delivery care are essential components of managing hemophilia during pregnancy. This article is solely for informational purposes, and you should speak to your doctor to learn more about hemophilia and pregnancy.