Background:
Blood disorders including hemophilia, thrombosis, sickle cell disease and thalassemia pose important problems for reproductive-age women because of the relationship of these disorders to adverse pregnancy outcomes. These chronic conditions and their genetic carrier states elevate or often unmask the risk for an array of adverse pregnancy outcomes for women and their infants. For instance, the presence of a thrombophilia predisposes pregnant women to an increased risk of maternal and fetal adverse pregnancy outcomes including recurrent miscarriage, unexplained fetal death, placental thrombosis, infarcts, and abruptions, intrauterine growth retardation, preeclampsia and maternal cerebrovascular ischemic events or stroke. It is estimated that 50% of maternal thromboembolic events can be attributed to an inherited or acquired thrombophilia. Similarly, pregnancy has been associated with exacerbation of disorders such as sickle cell disease, and may place women, especially those with sickle cell anemia at an increased risk of some obstetrical complications. Thus, preconception and interconception care for women with blood disorders or who carry risk genes for blood disorders is critical for ensuring optimal health of the mother and her child.

Objectives:
This special session will provide an overview of the role of preconception care for reducing risk for adverse pregnancy outcomes among women with blood disorders with an emphasis on hereditary blood disorders. Presentations will address 1) the role and guidelines for preconception genetic counseling for women with blood disorders such as Thalassemia, Sickle Cell Anemia, Hemophilia and Thrombosis, 2) the evidence and current guidelines regarding preconception care for women with thrombophilia, and 3) the potential impact of preconception care on maternal and fetal complications for women with sickle cell disease.

Methods:
Review of literature, guidelines and current practice

Results:
Evidence suggests that preconception genetic screening and counseling can be an important tool for the provision of appropriate preconception care and education of women with known or suspected genetic disorders in order to decrease the morbidity and mortality for the women during a future pregnancy, and to lessen the risk for avoidable complications in the mother and the infant. Preconception diagnosis of a thrombophilia may significantly reduce the risk of adverse pregnancy outcomes through thromboprophylaxis, early treatment or other risk reduction strategies. However who to screen for inherited and acquired thrombophilia remains controversial. Additionally, reported results for maternal and fetal complications of pregnancy in women with sickle cell disease and sickle vary considerably depending on the source of data. Conclusion and implications for practice: Management of blood disorders requires providers and patients to tailor treatment and management in to minimize complications for the mother while simultaneously minimizing risks for the infant. Similar to other women with other chronic conditions, because of their high risk for adverse pregnancy outcomes, women with blood disorders should be a targeted population for preconception and interconception care.

Conclusion and implications for practice: