Hi tinkerbellaneesa,
Our member, Narendra has compiled a list of threads here relating to thal minor and pregnancy. You can see these links in the post as
http://www.thalassemiapatientsandfriends.com/index.php/topic,3041.0.htmlStudies have concluded that thal minor has no effect on pregnancy. You've had three miscarriages. I have heard from literally hundreds of thal minor women who have had miscarriages and many reporting multiple miscarriages, just like you. It is also well accepted that in thalassemia major and intermedia, the hypercoagulable state exists. What this means in practical terms is blood clotting is much more common in major and intermedia than it is in non-thals. It is also well known that this hypercoagulable state can result in miscarriage in these conditions. I have talked about this repeatedly in posts, so I will not go into depth about the mechanics of what happens, but I will say that in major and intermedia, it is known that this clotting issue can cause a loss of blood flow between the placenta and uterus. This can result in partial to full detachment of the placenta from the uterus, causing a miscarriage. However, none of this is accepted by the professionals when it comes to thal minor.
I am not a doctor. In some ways, this gives me an advantage because it leaves me able to believe what I see with my own eyes and hear with my own ears, rather than rely on studies that studied THE WRONG THING. Most thal minors are asymptomatic, which usually means they have no idea they carry thal because it does not significantly impact their health, but a significant number of thal minors are indeed symptomatic, regardless of any text any doctor may have read to the contrary. (No, doctors are not gods in my eyes and deserve respect only when earned and no lazy doctor will ever earn that respect. I do however, hold some doctors in the thal community in very high regard, but in no way do these people represent doctors in general. Most doctors will go no further than their text books and articles to find out what life in the real world is like, so when it comes to thal minor, the best course is often to ignore your doctor's advice unless that doctor is willing to listen and learn). Anyway, when you take the whole thal minor population and analyze them, you are dismissing those who do have problems, because for the most part, the right people were not studied. Study symptomatic minors and the results will turn out completely different. I have probably discussed the issue of miscarriage in thal minor with women more than any other human on earth over the past 8 years and I have absolutely no doubt that thal minor does contribute to miscarriages, because for 8 years that is exactly what I have observed in case after case after case. Your particular reports tell me that you have had a very low blood flow between the placenta and uterus early during the miscarriage pregnancies, resulting in slow growth and finally miscarriage.
Folic acid is absolutely essential for all women trying to get pregnant or are already pregnant. Any doctor not informing a woman of this most important fact should lose his or her license in my opinion. Low folic acid is the most common cause of birth defects. Thals have a special need for folic acid because it is necessary for building red blood cells (RBC's) and an adequate supply of folate is ALWAYS necessary. I recommend 2-5 mg during pregnancy for thal women, with 5 mg being definitely favored. I believe this should be a lifelong supplement for any symptomatic thal. If you do get pregnant again, talk to your doctor about being tested for any signs of thrombosis during the pregnancy. Not all doctors will cooperate and order this test because your miscarriages are "just one of those things". Sometimes, the complete lack of science in what doctors say is astounding. I would rather that the doctor say he has no idea if that's the case than give you platitudes. How very frustrating! If a doctor does agree to test you and does report some signs of clotting, he may prescribe a baby aspirin daily. This will help thin the blood and help to prevent clots. However, this can be of some help but does not address the whole situation. It addresses an after the fact situation. I believe in being proactive and trying to prevent it in the first place or at least minimize it. There are some problems caused by the nature of thal blood. Small pale and ineffective RBC's are produced that "clutter" the blood. Hemoglobin is made from alpha and beta globin in equal amounts. In beta minor, there is a deficiency of beta globin, leading to a surplus of alpha globin. These alpha chains form tetramers among themselves, which presents even more "clutter" in the blood. In addition, both of these things cause oxidation, creating hydroxyl radicals that cause damage throughout the body. This "clutter" can reduce the normal blood flow between the uterus and placenta and if significant enough, can cause miscarriage. To help prevent this, there are some things you can easily do. A diet high in antioxidants is important for all thals. In addition, I recommend taking at least 400 IU natural vitamin E complex daily. The complex is a mix of the tocopherols present in naturally occurring vitamin E and it works best when the complex is used. E is a powerful antioxidant and a mild blood thinner. Both of these properties are essential for thal minor pregnancy. Take a good B-complex tablet daily. I suggest a B-100 that contains at least 100 mg of essential B vitamins. B2 has recently come into the spotlight for its ability to lengthen the lives of RBC's, which will reduce some of the 'clutter". Magnesium is also necessary to prolong the life of the RBC, so a calcium/magnesium supplement, along with vitamin D is also recommended. I don't think calcium should ever be taken without magnesium and vitamin D. They work together and should be taken together, as taking calcium alone, makes it much harder to be absorbed and do you any good. I also must comment on vitamin D. Emerging evidence shows that vitamin D is the most common vitamin deficiency in humans with one half to two thirds of the world population deficient. I would suggest getting this level tested before getting pregnant. It should be at least 30. My own doctor is now up to 35. If honesty ever prevails, we will hear that for optimal health, the vitamin D level in the body should be at least 50. What I am observing in thal minors is that they are commonly deficient. It is now fully accepted that almost all thal majors are deficient in D unless it has been corrected, so maybe some day we will get an admission that thal minors also fall into that category.
Nothing I said is difficult to do. No one can guarantee a healthy pregnancy for mom and baby, but by following a good diet with lots of fruit and veggies and taking a few supplements, you can give yourself a much better chance at a successful pregnancy.