Hemophilia affects pregnancies in individuals who are genetic carriers of hemophilia or who have the condition. It can lead to unusual bleeding and be passed on to the baby. Prenatal care is essential for individuals with hemophilia.

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Hemophilia is a rare genetic bleeding disorder that affects your blood’s ability to clot, leading to excessive bleeding. Certain clotting proteins, or clotting factors, are low or absent in this condition. There are different types of hemophilia and levels of severity.

Most often, hemophilia happens in people assigned male at birth due to a recessive mutation on the X chromosome. People assigned female at birth who have mild hemophilia symptoms usually have one healthy X chromosome, making them carriers. On rare occasions, they can have two affected X chromosomes and have hemophilia. It is unknown what percentage of people assigned female at birth have hemophilia.

Several types of bleeding disorders, such as von Willebrand disease, thrombocytopenia, and different types of hemophilia, can affect an individual during pregnancy. It is essential to know which condition you have so you can get the correct treatment.

Learn more about hemophilia.

It is important to have a healthcare team in place if you have hemophilia or are a carrier and are pregnant. Your team may include:

If you have hemophilia, you have a higher chance of bleeding complications during pregnancy. Your doctors will monitor your clotting factors through blood draws.

Your anesthesiologist may not recommend an epidural for labor pain management because of the chance of bleeding around the injection site. Be ready for different pain management options. The level of your clotting factors will help your healthcare professional determine if an epidural is safe for you.

The most significant effect hemophilia has on your pregnancy is after delivery. Parents who carry the gene are at high risk for heavy bleeding after delivery. Once you deliver, the higher levels of clotting factors during pregnancy fall back to lower levels.

Excessive bleeding after giving birth is called postpartum hemorrhage and requires emergency treatment. Hemorrhage can happen right after you give birth or several weeks later.

If you are a carrier for hemophilia, your ability to clot is usually enough to prevent bleeding symptoms during pregnancy. If you have the rare condition of having two affected X chromosomes, you will most likely have more severe symptoms.

Symptoms of hemophilia during pregnancy are similar to the symptoms you have when you’re not pregnant:

Parents can pass on the hemophilia gene to their babies. It is most likely to affect male children as they only have one X chromosome. You can find out if you are having a male baby through ultrasound or even earlier through noninvasive prenatal testing (NIPT)

You can have special testing for hemophilia in your fetus through amniocentesis, chorionic villus sampling (CVS), or fetal cord blood sampling during pregnancy.

If you are a carrier for hemophilia, your XY baby has a 50% chance of having hemophilia. Your XX baby has a 50% chance of being a carrier. It is a much more severe condition for children assigned male at birth than those assigned female.

Your doctor will take special precautions when you give birth if you have hemophilia or are a carrier and have a male baby. They will try to avoid using forceps or a vacuum to assist with delivering your baby. These devices can cause bleeding in your baby’s brain if they have hemophilia.

If you are having an XY baby, your doctor will also try to avoid using a fetal scalp electrode to monitor your baby’s heart rate. This device can cause bleeding from the scalp in a baby with hemophilia.

You may need treatment for low clotting factors from hemophilia during pregnancy and after delivery. Treatment includes:

  • Recombinant factor concentrates: Recombinant factor concentrates are concentrated blood clotting factors that help your blood clot and help manage bleeding.
  • Antifibrinolytic agents: Antifibrinolytic agents are medications that work by slowing down the process that breaks down blood clots. An example is Tranexamic Acid (TXA).
  • Desmopressin Acetate (DDAVP): DDAVP is a medication similar to a hormone that occurs in your body. This medication helps you to release one of the clotting factors stored in your tissues and helps reduce bleeding.

Your treatment plan depends on the severity of your hemophilia. Treatment also involves managing any bleeding events. A delivery plan must include where you deliver and medications to give to prevent postpartum hemorrhage.

The outlook for pregnant people with hemophilia has improved significantly over the past few decades. There have been advances in medical knowledge and treatment options.

You can have a healthy pregnancy and delivery with proper medical care and close monitoring. It is essential to follow the instructions of your healthcare team.

Can I have a vaginal delivery if I have hemophilia?

Vaginal delivery is often possible for individuals with hemophilia. It will depend on your specific circumstances. It may be a good idea to communicate closely with your healthcare team to determine the safest way to deliver your baby.

As a carrier for hemophilia, am I at increased risk for miscarriage?

You are not usually considered at increased risk for miscarriage unless you have low levels of fibrinogen of factor XIII. This is one reason why it’s important for a healthcare professional to monitor your clotting factors.

Can my baby be circumcised if I have hemophilia?

If you plan to circumcise your baby, it is best to first find out if they have hemophilia. Circumcision is the number one cause of bleeding for babies with hemophilia. If your baby does have the condition, it is best to avoid circumcision.

Having hemophilia or being a carrier during pregnancy requires working with your healthcare team. Special care must be taken if you are having a baby with XY chromosomes.

You can have a safe pregnancy and delivery with proper medical care, close monitoring, and following your treatment plan.