Prepartum acquired hemophilia A: managing a double challenge for mother and child

Acquired hemophilia A during pregnancy is exceptionally rare and poses significant risks to both mother and fetus, including maternal hemorrhage and neonatal bleeding due to transplacental transfer of factor (F)VIII inhibitors. We report four cases of antenatally diagnosed acquired hemophilia A to provide insights into management and outcomes. All patients received corticosteroids during pregnancy, with individualized peripartum hemostatic strategies using bypassing agents when indicated. Transplacental FVIII inhibitor transfer occurred in three neonates, leading to transient low FVIII levels; only one mild bleeding event was observed, and all infants achieved spontaneous remission within weeks. Postpartum escalation of immunosuppressive therapy, including rituximab, was required in selected mothers to achieve remission. Our series highlights the critical importance of prepartum diagnosis, allowing optimized maternal hemostatic management, avoidance of traumatic delivery, and structured neonatal surveillance to prevent severe bleeding complications.