Reproductive choices and obstetrical experience in Dutch carriers of haemophilia A and B

Abstract

Reproductive choices, pregnancy and childbirth are influenced by culture and traditions. This probably also plays a role in carriers of haemophilia. The aim of the study is to evaluate the reproductive choices and obstetrical experiences in the current generation of carriers of haemophilia in our Haemophilia Centre in the north of the Netherlands, a largely secular country with liberal abortion laws and a unique tradition of home births. Retrospective survey among haemophilia carriers. We sent a questionnaire to 74 carriers, 65 were available, 75% responded. Median age was 41 (range 20-83) years. Of the 49 women, 46 had 120 pregnancies: 25 resulted in foetal loss, two in pregnancy termination (one for haemophilia) and 93 in live births. No woman had chosen not to start a family. Mean number of children was 2.0, 2.4 vs. 1.8 in women with and without sons with haemophilia (P = 0.008), respectively. Twenty women (20 of 46) were unaware of their carriership during 1st pregnancy; they were younger at 1st pregnancy than known carriers (25 vs. 29 years, P = 0.03). Twenty-three percentage reported bleeding complications during the first delivery. Overall, 10% vs. 3% of deliveries was complicated by a primary and secondary postpartum haemorrhage (PPH), respectively. In our Haemophilia Centre, carrier state has not influenced reproductive choices in the past, other than older age at first pregnancy. Carriers of haemophilia have an increased risk of primary PPH.