Though diagnosis of systemic mastocytosis (SM) usually occurs in adults ages 50 and over, there are some cases in women of child-bearing age. According to data available, pregnancy can potentially worsen systemic mastocytosis, and the growth and delivery of the baby may be affected.
The risk of spontaneous miscarriage is 25%-30%, and preterm deliveries are to be expected. Specialized maternal-fetal care from a multidisciplinary team is recommended to ensure the best outcomes.
What is SM?
SM is a rare white blood cell disorder that affects the mast cells, part of the body’s immune system. Present in the skin, internal organs and bones, normal mast cells protect the body from infection by releasing histamine and other chemicals into the bloodstream. In systemic mastocytosis, these cells mutate and multiply uncontrollably.
The production of excessive histamine causes symptoms such as flushing, skin inflammation and itching, headache, fatigue, gastrointestinal upsets including diarrhea and abdominal pain. Medication can help manage these symptoms, but there is no cure. In aggressive forms of the disease, multiorgan dysfunction and a shortened life span may occur.
Learn more about SM prognosis
Symptom monitoring during pregnancy
The symptoms of SM can be activated by a variety of triggers, including stress, sudden change in temperature, emotional or physical exertion, friction on the skin, infection, insect stings and a high-histamine diet. During pregnancy, avoiding triggers is essential to preventing a symptom burden that can be difficult to manage.
Antihistamines can be used to treat symptom flare-ups without harming the baby, but symptom deterioration during pregnancy has been documented.
A symptom log may be advised by the healthcare team to identify triggers and adjust treatment as required.
Reducing dietary, lifestyle and stress-related triggers are key to avoiding a buildup of histamine, which can cause an increase in symptoms. Adopting a low-histamine diet, eating home-cooked meals and practicing yoga and meditation can all contribute to a healthier lifestyle for patients. Nutritional supplements, such as multivitamins and Vitamin C can also help support a healthy pregnancy.
Potential risks during labor and delivery
The stress of labor can be dangerous for mother and baby, as it can trigger an extreme allergic reaction, leading to anaphylaxis. The delivery suite should be prepared with resuscitation equipment, just in case. Preterm labor can be triggered by elevated histamine levels. Preparing labor and delivery with a doula has been shown to be beneficial to outcomes.
In the case of a cesarean, the medical team will be aware that some anesthetics can also act as a trigger to systemic mastocytosis symptoms.
The postpartum period can also be marked by hypotension and shock, though this is rare.
