A new study from Australia and New Zealand provides delivery guidelines for pregnant women with epidermolysis bullosa (EB) or women whose unborn babies have EB. The guidelines suggest that a normal vaginal delivery (NVD) is considered safe for most of these women.
The study titled, “Retrospective evidence on outcomes and experiences of pregnancy and childbirth in epidermolysis bullosa in Australia and New Zealand,” was published in the International Journal of Women’s Dermatology.
While most research of EB focuses on the molecular basis of the disease and its various levels of classification, knowledge about pregnancy and childbirth in this patient population is generally lacking.
A handful of case reports from Europe and Australia have cited healthy NVDs and cesarean sections in women with EB of various severities.
When delivering babies with EB, several factors should be considered, including the use of anesthesia and nonadhesive tape and padding, as these might pose additional risks to the mother or the baby.
To better understand delivery practices and successful deliveries, the researchers surveyed obstetricians, women with EB, and those who gave birth to babies with the condition.
Of 1,346 obstetricians surveyed in Australia, 195 responded. Of these, only 7% had experienced deliveries involving EB patients.
Although some obstetricians said they had searched for literature to learn more about the disease, most were unable to find articles relating to pregnancy and EB. Less than half consulted with a dermatologist during the pregnancy.
All of the obstetricians recommended NVD and emphasized that more literature is needed on the topic.
In total, 75 unaffected women who delivered EB babies responded to the survey. Most had NVDs instead of C-sections. Although these women experienced more significant complications with EB deliveries, most were unaware that they were giving birth to babies with this condition.
Like obstetricians, these mothers emphasized the need for more literature about EB.
Additionally, some women, particularly those with children affected by severe EB, recommended prenatal screening to help them make informed decisions.
Of the surveys sent to women with EB who gave birth, most responded (44 out of 55). Of the babies born, about half were unaffected by EB. Most women had an NVD, and most reported stable conditions during pregnancy.
In this group of women, some suggested prenatal screening to detect more severe cases of EB. Most women, however, reported that “the joy of having children was worth the discomfort and pain.”
In general, NVD is safe and effective for most women affected by EB or for unaffected women giving birth to children with EB, the study found.
Awareness about the condition and how it relates to pregnancy is recommended for all obstetricians.
Full guidelines can be found at this link.