Screening for Hemoglobinopathies in Pregnancy – The ACOG Approach
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. List population groups at high risk for hemoglobinopathies 2. Identify the appropriate test to order when seeking to clarify the presence of abnormal hemoglobin
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Hemoglobinopathies describe multiple disorders that affect the structure and function of hemoglobin. They are single gene disorders that have variable expressivity ranging from mild to severe. Identification of carriers allows patients to make informed reproductive planning decisions.
Test all patients for CBC and RBC indices as part of antepartum care
Add Hgb electrophoresis if
Increased risk based on ethnicity: African, Middle Eastern, Southeast Asian, West Indian and Mediterranean ancestry
MCV is low (<80 fL)
Indicates risk for one of the thalassemia traits
Serum ferritin levels recommended to check for possible iron deficiency anemia
If Hgb electrophoresis is normal, follow up is still required to rule out alpha-thalassemia
Abnormal Hgb electrophoresis identifies a carrier
Offer testing to partners of carriers to assess whether the fetus is at risk
Refer to genetic counseling if both members of a couple are carriers
Hemoglobinopathies, such as sickle cell disease, can affect the structure of hemoglobin, while mutations causing thalassemias result in reduced production of hemoglobin chains. These conditions are autosomal recessive so carriers will not necessarily be identified without screening. If a patient’s partner is also a hemoglobinopathy carrier, there is a significant risk of the offspring being affected and referral is advised. Hemoglobinopathy screening should be offered to high risk groups, which include those of African, Middle Eastern, Southeast Asian, West Indian and Mediterranean ancestry. Low risk individuals are those from Northern European, Japanese, Native American, Inuit and Korean background.
Hgb electrophoresis is the appropriate test to identify abnormal hemoglobins
Abnormal Hgb electrophoresis will identify abnormal hemoglobin, such as Hb AS, AC, SS, SC, A2
Beta-thalassemia is associated with elevated HbF and elevated HbA2
Hgb electrophoresis can be normal in alpha-thalassemia; therefore, further genetic testing will be required if patients of Southeast Asian descent have decreased MCV but normal Hgb electrophoresis
If both partners are carriers, prenatal diagnosis is available through either CVS or amniocentesis
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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