Clinical outcomes of pregnant women with mastocytosis

Mastocytosis and Skin Cancer: The Current State of Knowledge

Mastocytosis is a heterogeneous group of diseases associated with excessive proliferation and accumulation of mast cells in different organs. Recent studies have demonstrated that patients suffering from mastocytosis face an increased risk of melanoma and non-melanoma skin cancer. The cause of this has not yet been clearly identified. In the literature, the potential influence of several factors has been suggested, including genetic background, the role of cytokines produced by mast cells, iatrogenic and hormonal factors. The article summarizes the current state of knowledge regarding the epidemiology, pathogenesis, diagnosis, and management of skin neoplasia in mastocytosis patients.

Mastocytosis: Fertility and Pregnancy Management in a Rare Disease

Mastocytosis encompasses a subset of rare diseases, characterized by the presence and accumulation of abnormal neoplastic MC in various organ systems, including skin, bone marrow, spleen and gastrointestinal tract. Clinical manifestations are highly heterogeneous, as they result from both MC mediator release and MC organ infiltration. Both pregnancy, a lifetime dominated by huge physiological changes, and labor can provide triggers that could induce worsening of mastocytosis symptoms. On the other hand, mastocytosis has relevant implications in obstetric management and prenatal care during all the pregnancy. In this review article, current knowledge about the impact of mastocytosis on fertility and pregnancy outcome will be reviewed and discussed, with the aim to provide clinical practice guidance for the evaluation and management of pregnancy and delivery in patients with cutaneous and systemic mastocytosis.

Pregnancy and Delivery in Patients with Mastocytosis Treated at the Polish Center of the European Competence Network on Mastocytosis (ECNM)

OBJECTIVE

To present current guidelines regarding treatment of mastocytosis in pregnancy on the example of observed patients.

DESIGN

Case control national study.

SETTING

Polish Center of the European Competence Network on Mastocytosis (ECNM).

POPULATION OR SAMPLE

23 singleton spontaneous pregnancies in 17 women diagnosed with mastocytosis in years 1999-2014, before becoming pregnant.

METHODS

Prospective analysis outcomes of pregnancies and deliveries.

MAIN OUTCOME MEASURES

Survey developed in cooperation with the Spanish Instituto de Estudios de Mastocitosis de Castilla-La Mancha (CLMast), Hospital Virgen del Valle, Toledo, Red Espańola de Mastocitosis (REMA), Spain.

RESULTS

All 23 pregnancies resulted from natural conception. Obstetrical complications recorded in the first trimester included spontaneous miscarriage (5 pregnancies). Four patients delivered preterm, including one delivery due to preeclampsia at 26 weeks which resulted with neonate death due to extreme prematurity. Five women delivered via cesarean: four due to obstetrical indications and one due to mastocytosis, during which no anesthesia related complications were recorded. Of patients delivering vaginally, two received extradural anesthesia, three required oxytocin infusion due to uterine hypotonia. No labor complications were recorded. In one woman with pregnancy-induced hypertension, early puerperium was complicated by the presence of persistent arterial hypertension. One neonate was born with the signs of cutaneous mastocytosis. Another neonate was diagnosed with Patau syndrome. Four women were treated for mastocytosis prior to conception and continued therapy after becoming pregnant. One patient was put on medications in the first trimester due to worsening of her symptoms. Pregnancy exerted only a slight effect on the intensity and frequency of mastocytosis-related symptoms observed. Worsening of the disease-related symptoms was documented in only four patients (23%). None of the patients showed the signs of anaphylaxis, either before becoming pregnant, or during pregnancy and puerperium.

CONCLUSIONS

There is no contraindication to pregnancy when mastocystosis-related pathologies are under appropriate medical control.

[Mastocytosis and pregnancy]

Mastocytosis is a rare disorder characterized by an accumulation of mastocytes in cutaneous and visceral tissues. In the presence of stimuli such as stress, pain, drug administration and cutaneous compression, it can ultimately lead to cardiovascular collapse. In women with mastocytosis, pregnancy monitoring and pain management in the peripartum period can be challenging and should involve a multidisciplinary approach. In this article, we discuss our ante partum care and intra partum management, as illustrated by three recent cases.

Mastocytosis in pregnancy

OBJECTIVE

Mastocytosis is a rare disorder characterized by abnormal accumulation of mast cells in various organs. Clinical complaints include pruritus, cutaneous flushing, dyspepsia, and episodes of anaphylaxis, and are usually the result of local and systemic mast cell mediator release. The triggers include a variety of factors including drugs, exercise, stress, anxiety, and temperature extremes.

CASE REPORT

A 26-year-old primigravida at 40 weeks' gestation with urticaria pigmentosa presented to our hospital. She was diagnosed with cutaneous mastocytosis based on pathologic examination of her skin biopsy. There were no complications during pregnancy, except for cutaneous manifestations with pruritus and premature uterine contractions at 27 weeks' gestation. After admission, antihistamine agents were administered during labor to treat the above symptoms, and antibiotic agents were given for prophylaxis of chorioamnionitis. Labor pain was successfully managed with warm showers, frequent position changes and massage, and therefore, epidural analgesia was not carried out. After 6 hours of labor, the patient gave birth to a healthy female infant via normal spontaneous vaginal delivery with right mediolateral episiotomy. Neither local anesthetic agents nor antibiotic agents caused any reaction. The postpartum period was uneventful.

CONCLUSION

Pregnant women with mastocytosis should be treated symptomatically and should avoid factors that may exacerbate symptoms of disease. Clinicians should be aware of preterm labor during pregnancy. As a preventive measure, resuscitation equipment should be available during the labor, delivery and postpartum period to treat unanticipated hypotension and shock.