ORIGINAL ARTICLE Pregnancy in beta-thalassemia intermedia: 20-year experience of a Greek thalassemia center Ersi Voskaridou 1 , Angeliki Balassopoulou 1 , Effrossyni Boutou 1 , Veroniki Komninaka 1 , Dimitrios Christoulas 2 , Maria Dimopoulou 1 , Evangelia-Eleni Delaki 1 , Dimitris Loukopoulos 3 , Evangelos Terpos 4 1 Thalassemia Centre, ‘Laiko’ University General Hospital of Athens, Athens; 2 Department of Hematology, 251 General Air Force Hospital, Athens; 3 Hematology Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens; 4 Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece Abstract Objective: Progress in the management of patients with thalassemia intermedia (TI) enabled increasing rates of pregnancies among TI women worldwide. Nevertheless, information regarding TI pregnancy management and outcome is quite limited in the literature. The aim of this study was to report our experience regarding the maternal and fetal outcome of TI patients, as well as to depict the complexity of the disease and the need for multidisciplinary and personalized management as shown by the description of two interesting pregnancy cases. Methods: We analyzed our data recorded from 60 pregnancies in 34 women over a 20-yr period. Results: Forty-nine patients achieved full-term pregnancies (mean maternal age SD: 27.4 6.5 yr) within 37 3 gestation weeks. Their mean hemoglobin value was 8.33 1.22 g/dL; 26.5% of patients were not transfused at all or they had been transfused only once during gestation. There were 11 abortions (18.3%). The spontaneous abortions (5/11) were related to high HbF levels. Six patients had more than two normal deliveries. Nineteen newborns (38.8%), which weighed 2–3 kg, required hospitalization to an intensive neonatal care unit for 1–3 wk. One patient presented with life-threatening complications (hemolytic anemia, thrombocytopenia, and enlargement of spleen) and another with spastic paraparesis due to extramedullary paravertebral masses. Conclusions: Although several complications can occur during a pregnancy in TI women, the careful and frequent monitoring by both hamatologists and obstetricians can lead to successful deliveries. Key words pregnancy; thalassemia intermedia; transfusion Correspondence Ersi Voskaridou, Thalassemia Center, Laiko University General Hospital, 16 Sevastoupoleos Street, GR 11526 Athens, Greece. Tel: +302132060940; Fax: +302107456138; e-mail: ersi_voskaridou@yahoo.com Accepted for publication 27 May 2014 doi:10.1111/ejh.12387 Thalassemia is the most commonly inherited disease worldwide. Thalassemia intermedia (TI) represents a phe- notype ranging from thalassemia major (TM) to thalasse- mia minor. Fetal hemoglobin (HbF), hemoglobin A, or a combination of both are produced in TI patients in vary- ing levels according to the underlying beta locus mutations (1). TI patients have with a milder clinical appearance than those with TM that varies from being completely asymptomatic and transfusion independent until adulthood, to requiring regular transfusions from early childhood (>2 yr old) with severe growth retardation and skeletal deformities (2). There is no adequate clinical definition of TI; it is a diagnosis that can be made only after a consid- erable period of observation and that often requires revi- sion. Individuals with thalassemia intermedia present later than thalassemia major, have milder anemia, and by definition do not require or only occasionally require transfusion. In contrast, the clinical presentation of thalas- semia major occurs between 6 and 24 months and requires regular red blood cell (RBC) transfusions to survive. The majority of patients with TI present with mild anemia (Hb: 7–10 g/dL) and splenomegaly, symptoms that are 492 © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd European Journal of Haematology 93 (492–499)