Dear Editor-in-Chief

The recent report on “The Adverse Effects of Pregnancies Complicated by Hemoglobin H (HBH) Disease” is very interesting (1). Rabiee et al. reported a pregnant case complicated with HBH disease. Indeed, this problem might not common in the Middle East but it is very common in Southeast Asia. The authors hereby would like to share the experience on this topic. In the recent report by Tongsong et al. (2), the maternal outcomes of normal mothers and those with HBH disease were not different. The common identified problems are fetal growth restriction, preterm birth and low birth weight (2). In fact, the mother with HBH disease might have only anemia without other symptoms and cannot be diagnosed if there is no good maternal screening (3, 4). According to a recent report on hydrop fetalis in Thailand by Taweevisit and Thorner, 3.8% were related to HBH disease (5). It is no doubt that hydrop fetalis can be the outcome of pregnancy of mother with HBH disease (2, 4). Although mothers with HBH disease might pose fetal abnormalities, most of them can complete pregnancy without complication and have normal infants (3, 4). Maternal with HBH disease regardless of additional hemoglobin disorder can have safe complete term pregnancy without need for any blood transfusion (6). Based on the experience from Thailand, HBH disease in pregnancy can be seen and required good care, especially for management of anemia. However, there is no serious problem of pregnancy and there is no indication for termination of pregnancy.

Acknowledgements

The authors declare that there is no conflict of interests.