The management, outcome, and postpartum disease course of 41 pregnancies in 20 women with polycythemia vera.

OBJECTIVES Pregnancies in women with polycythemia vera (PV) are associated with an increased risk of PV-related maternal complications and often result in miscarriage. Recommendations for the management of PV pregnancies are mainly based on studies with a small number of patients. A correlation between pregnancy outcome and postpartum course has been reported for essential thrombocythaemia, but corresponding data for PV are lacking so far. METHODS In 41 PV pregnancies, the pregnancy outcome, the use of PV-specific therapies (i.e. acetylsalicylic acid, low molecular weight heparin and/or interferon-alpha) and the postpartum PV course were investigated. RESULTS A live birth rate of 51.2 % (21/41 pregnancies) was observed. 43.9 % of pregnancies ended in spontaneous abortion and 4.9 % in stillbirth. A significantly increased live birth rate occurred in pregnancies with PV-specific therapies compared to standard antenatal care (69.0% vs. 8.3%; p<0.0019). The use of PV-specific therapy significantly increased the number of maternal hemorrhages (p=0.021) without increasing the risk of fetal complications. During the median postpartum follow-up period of 1.2 years (range 0.1-13.7), complicated postpartum PV occurred significantly more often after miscarriages (p=0.035). CONCLUSIONS According to our analysis, PV-specific therapy improved the live birth rate. Significantly more complicated postpartum PV courses were observed after miscarriages.