Family planning and pregnancy
Carriers should receive genetic counselling about the risks of having an affected child well in advance of a planned pregnancy, and should be seen by an obstetrician as soon as they suspect they are pregnant. The obstetrician should work closely with the staff of a haemophilia treatment centre to provide the best care during pregnancy and childbirth, and to minimize potential complications for both the mother and the newborn.
Most carriers have normal pregnancies without any bleeding complications. Levels of factor VIII increase significantly in pregnancy, which reduces the risk of bleeding in carriers of haemophilia A. Levels of factor IX, however, do not usually change significantly. There does not appear to be a higher risk of miscarriage in carriers of haemophilia.
Factor levels should be tested in the third trimester of pregnancy, when they are at their highest. If levels are low, precautions should be taken during labour to reduce the risk of excessive bleeding.
Before getting pregnant, carriers need clear and accurate information about:
- the chance of transmitting haemophilia to the child. Carriers of haemophilia have a 50 per cent chance of passing the disorder on to their children;
- the consequences, to both a female and a male child, of inheriting haemophilia;
- how haemophilia is treated, what care is available at a local level, and at what cost;
- how pregnancy, labour, and delivery should be managed to reduce risks to both mother and child;
- the options available for conception, prenatal diagnosis, and fetal sex determination.