Bleeding complications during pregnancy and delivery in haemophilia carriers and their neonates in Western France: An observational study

Alice Nau (1) , Benjamin Gillet (2) , Benoît Guillet (3, 4) , Philippe Beurrier (5) , Laurent Ardillon (6) , Vincent Cussac (7) , Sophie Guillou (8, 9) , Leela Raj (10) , Marc Trossaert (2) , Valérie Horvais (2) , Sophie Bayart (3) , Jérôme Potin (6) , Johann Rose (7) , Laurent Macchi (8, 9) , Francis Couturaud (10, 1) , Karine Lacut (10, 1) , Brigitte Pan-Petesch (10, 1)

1 CHRU Brest - Centre Hospitalier Régional Universitaire de Brest
2 CHU Nantes - Centre Hospitalier Universitaire de Nantes
3 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
4 Irset - Institut de recherche en santé, environnement et travail
5 CHU Angers - Centre Hospitalier Universitaire d'Angers
6 CHU Trousseau [Tours]
7 Centre Hospitalier Le Mans (CH Le Mans)
8 CHU de Poitiers - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
9 IRTOMIT - Ischémie Reperfusion en Transplantation d’Organes Mécanismes et Innovations Thérapeutiques
10 UBO - Université de Brest

Background: Pregnancy, delivery and the postpartum period expose haemophilia carriers, as well as their potentially affected neonates to a high risk of haemorrhagic complications.Objectives: To describe bleeding complications in haemophilia carriers and their newborns throughout pregnancy and postpartum and to identify potential factors increasing the risk of bleeding in this population.Patients/methods: The ECHANGE multicentre observational cohort study was conducted between January 2014 and February 2019 using the BERHLINGO database comprised of patients from seven French haemophilia centres.Results: During the 5 years study period, a total of 104 haemophilia carriers and 119 neonates were included, representing 124 pregnancies and 117 deliveries. Thirty-five (30%) bleeding events were observed, most of them (83%) occurred during the postpartum period, and 37% were reported during the secondary postpartum. Neuraxial anaesthesia was not complicated by spinal haematoma. Three (2.5%) neonates experienced cerebral bleeding. Caesarean section was associated with an increased risk of maternal bleeding in primary and secondary postpartum periods. Basal factor level <0.4 IU/mL was also found to be associated with an increased risk of bleeding during secondary postpartum.Conclusion: In our cohort, bleeding events occurred in more than a third of haemophilia carriers mainly in the postpartum period, and a significant portion of this bleeding occurred during the secondary postpartum. Haemophilia carriers warrant specific attention during primary and secondary postpartum, in particular in case of caesarean section and low basal factor level. The ECHANGE study is registered at clinicaltrials.gov identifier: NCT03360149.

Mots clés: Haemophilia carriers; haemophilia A; haemophilia B; newborns; postpartum; pregnancy

Domaines: Sciences du Vivant [q-bio]

Alice Nau, Benjamin Gillet, Benoît Guillet, Philippe Beurrier, Laurent Ardillon, et al.. Bleeding complications during pregnancy and delivery in haemophilia carriers and their neonates in Western France: An observational study. Haemophilia, 2020, 26 (6), pp.1046-1055. ⟨10.1111/hae.14117⟩. ⟨hal-02930160⟩