Practice recommendations for MPN patients from the preconception to postpartum period
| Preconception |
| • Detailed obstetric history and risk assessment • Avoid estrogen-containing contraceptives, discussion of cytoreductive agents and fertility • Stop hydroxyurea 3 months prior to conception • IVF and infertility: consider optimization of blood counts, LMWH prophylaxis for IVF |
| Pregnancy |
| • Low-dose aspirin • Consider LMWH prophylaxis if additional thrombotic risk factor present • Target Hct goals adjusted to gestational age • Cytoreduction in high-risk pregnancies* • Increased monitoring and consideration of cytoreduction in persistently high blood counts • High-risk obstetrics/maternal fetal medicine for increased fetal monitoring |
| Postpartum |
| • LMWH prophylaxis +/- aspirin for 6 weeks postpartum • Breastfeeding: LMWH, aspirin, and IFN preferred agents |
| Preconception |
| • Detailed obstetric history and risk assessment • Avoid estrogen-containing contraceptives, discussion of cytoreductive agents and fertility • Stop hydroxyurea 3 months prior to conception • IVF and infertility: consider optimization of blood counts, LMWH prophylaxis for IVF |
| Pregnancy |
| • Low-dose aspirin • Consider LMWH prophylaxis if additional thrombotic risk factor present • Target Hct goals adjusted to gestational age • Cytoreduction in high-risk pregnancies* • Increased monitoring and consideration of cytoreduction in persistently high blood counts • High-risk obstetrics/maternal fetal medicine for increased fetal monitoring |
| Postpartum |
| • LMWH prophylaxis +/- aspirin for 6 weeks postpartum • Breastfeeding: LMWH, aspirin, and IFN preferred agents |
See Table 3.
Hct, hematocrit; IFN, interferon.