Q: I am 31 years old and 6 months pregnant woman. I am a haemoglobin E trait patient and the doctor suggested me to take Livogen iron tablet. Can I take iron tablets during pregnancy? I am a thalassaemia carrier; some doctors have said that a carrier patient cannot take iron tablets during pregnancy. Please suggest.

A:You have not mentioned any clinical details or your complete blood count (haemoglobin value and red cell indices) in your query.

It appears that you are a double heterozygote for beta-thalassaemia / haemoglobin E (ß-thal/HbE) disease. The clinical symptoms of this condition are heterogeneous as they depend on several factors, especially gene mutations, and can be remarkably diverse ranging from milder form of the illness, which may be virtually asymptomatic in many patients to the extremely severe, characterised by profound anaemia requiring regular transfusions and sometimes even splenectomy. The patients are usually anaemic, with haemoglobin levels between 5 and 9 g/dL and at least some splenomegaly. The physiologic changes that occur during pregnancy further heighten the severity of anaemia in the mother, which could affect both clinical symptoms and pregnancy outcome. Anaemia in the mother can lead to problems both in the baby (growth restriction, low birth-weight) and the mother (pre-term labour). An effort is made to keep the haemoglobin value around 10 g/dl or higher and this may sometimes require blood transfusions too, even though it is not known whether a strict control of haemoglobin levels results in better pregnancy outcomes.

You should be guided by your treating doctor and must continue to take iron and folic acid tablets. Frequent monitoring may be necessary to check the baby's growth. It is best if you go to a centre where a team of haematologist, obstetrician and neonatologist are available.