Esssential thrombocythaemia and pregnancy-A need for prospective study and a consensus on its management

MPN are rare diseases, however young women with ET are increasingly being recognised. Management during pregnancy is often a recognised issue with no clear guidelines for management. Pregnancy is associated with considerable risk of complications and therefore warrants a multidisciplinary approach and early identification of high-risk pregnancies. Robust data is limited and therefore we advocate for more prospective (cohort and registry), multicentre, collaborative efforts to gather meaningful information about risk, and risk-adapted therapy, to guide management. The commentary reviews the study by How et al and compares the observations to other studies around the world. It recognises that previous pregnancies with complications increase the risk of further complications during future pregnancies. It is important to recognise the high-risk pregnancies and have a risk adapted approach to the same. The use of low dose aspirin is recommended throughout the pregnancy. The use of LMWH prophylaxis antepartum should be individualised to the thrombotic risk status and applied post-partum for at least 6 weeks. Interferon a remains the safest and effective approach for cytoreductive therapy. Collaborative expert efforts world-wide, as well as larger prospective trials and registry data, will enhance our knowledge to formulate standard guidelines for these group of patients.