Estimation of the Risk of Thrombocytopenia in the Offspring of Pregnant Women With Presumed Immune Thrombocytopenic Purpura

Samuels, Philip; Bussel, James B.; Braitman, Leonard E.; Tomaski, Anne; Druzin, Maurice L.; Mennuti, Michael T.; Cines, Douglas B.

doi:10.1097/00132582-199101000-00006

Cited by 49 publications

(115 citation statements)

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“…Additionally, searching for reliable predictors of NITP, we conducted a review of a total of 22 reported cases of fetal or neonatal ICH with NITP secondary to maternal ITP published from 1960 to 2010 [4,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. The result was summarized in Table IV.…”

Section: Resultsmentioning

confidence: 99%

“…In contrast, Payne et al reported that maternal history of splenectomy was significantly correlated with severe NITP (odds ratio: 5.63, confidence interval 2.2-14.3) [4] and this conclusion was also derived from a larger retrospective study including 284 pregnancies with ITP and 286 neonates by Fujimura et al [33]. According to the review of cases of fetal or neonatal ICH secondary to maternal ITP (Table IV) [4,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], it is reasonable to consider that maternal ITP refractory to splenectomy may have a potential risk to induce more serious NITP and increase the incidence of fetal or neonatal ICH. This new insight has never been pointed out before, but is interesting and noteworthy.…”

Section: Maternal Itp Refractory To Splenectomymentioning

confidence: 88%

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Reliable predictors of neonatal immune thrombocytopenia in pregnant women with idiopathic thrombocytopenic purpura

et al. 2011

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Of infants born to women with idiopathic thrombocytopenic purpura (ITP), about 10-15% have transient neonatal immune thrombocytopenic purpura (NITP). Of concern is the lack of a reliable predictor for NITP. We conducted a retrospective study of all pregnancies with ITP at Osaka University Hospital over the past 16 years analyzing a total of 127 pregnancies in 88 women with ITP to assess the predictive value of various clinical factors regarding neonatal platelet count in the current pregnancy. We also reviewed the literature concerning ITP in pregnancy and NITP prediction. Neonatal platelet counts were less than 100 3 10 9 /L in 20 of 130 neonates (15.4%), less than 50 3 10 9 /L in 11 neonates (8.5%), and less than 20 3 10 9 /L in three neonates (2.3%). There was a strong correlation between the first and second sibling regarding the occurrence and the severity of NITP with Spearman correlation coefficient of 0.55 (P 5 0.001) at birth and 0.63 (P < 0.0001) at nadir after birth. A maternal platelet count less than 100 3 10 9 /L at delivery showed a statistical trend for an association with the occurrence of NITP (P 5 0.043). Moreover, maternal ITP refractory to splenectomy correlated with a higher risk for fetal or neonatal ICH according to the review of the literature. In conclusion, pregnant women who have had a previous offspring with NITP or who have ITP refractory to splenectomy may be at particular risk of delivering an offspring with significant NITP. Management decisions, including mode of delivery, may be altered by the degree of risk for potentially severe NITP. Am. J. Hematol. 87:15-21, 2012. V

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Section: Resultsmentioning

confidence: 99%

Section: Maternal Itp Refractory To Splenectomymentioning

confidence: 88%

Reliable predictors of neonatal immune thrombocytopenia in pregnant women with idiopathic thrombocytopenic purpura

et al. 2011

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“…It is an important issue, as the choice of the mode of delivery is apparently strongly influenced once the diagnosis of ITP is made. 4 Platelet survival is known to be shorter in normal pregnancy. 5 All these findings are consistent with the findings of Gerbasiet al, who suggested an increased platelet turnover, clot formation and fibrinolysis in normal pregnancies.…”

Section: Gestational Thrombocytopeniamentioning

confidence: 99%

“…2,4 The presence of circulating platelet antibodies may indicate increased risk of neonatal problems due to transplacental passage of these antibodies. 4 Another interesting observation is that the presence of such antibodies was detected in 10/11 nonthrombocytopenic mothers of infants born with severe transient nonalloimmune thrombocytopenia. The mothers had shortened platelet survival and increased turnover of their thrombocytes when studied postpartum.…”

Section: Idiopathic Thrombocytopenic Purpura (Itp)mentioning

confidence: 99%

“…8 There are, however, reports that circulating platelet antibodies may predict fetal thrombocytopenia. 4 This should be examined carefully in the light of findings that dizygotic twins born to mothers with ITP are found to have discordant platelet counts. 9 This could be explained by variation in the affinity of maternal antibodies for fetal platelets, or in the maturity of the fetal reticuloendothelial system, or in the ability of the fetal bone marrow to compensate for the increased platelet destruction.…”

Section: Idiopathic Thrombocytopenic Purpura (Itp)mentioning

confidence: 99%

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Thrombocytopenia During Pregnancy

Gari-Bai¹

1998

Ann Saudi Med

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Romiplostim use in pregnant women with immune thrombocytopenia

et al. 2022

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Treatment for immune thrombocytopenia (ITP) in pregnancy is hampered by the lack of fetal safety evidence of maternally‐administered medications. The Pregnancy Surveillance Program (PSP) collected patient information from 2017–2020 for pregnancy, birth outcomes, and adverse events (AEs) for 186 women exposed to romiplostim from 20 days before pregnancy to the end of pregnancy. Timing of exposure was available in 128 women. Seventy‐one mothers (38%) had prepregnancy exposure to romiplostim; intrapartum exposure was known for the first (for many mothers when they discovered their pregnancy), second, and third trimesters for 74 (40%), 22 (12%), and 44 (24%) mothers, respectively, with 15 mothers exposed during >1 trimester. Among the 86 mothers with known pregnancy outcomes, 46 (53%) had at least one pregnancy‐related serious AE (SAE); approximately 2/3 of SAEs were due to underlying ITP. Of 92 mothers with known birth outcomes, 60 (65%) had a normal pregnancy and 16 (17%) had complications, with both categories including term and preterm births; there were 12 (14%) spontaneous miscarriages/stillbirths, 3 (3%) ectopic pregnancies, and 1 (1%) molar pregnancy. Most abnormal births resulted from abnormal pregnancies. There were five neonatal/postnatal AEs of note: inguinal hernia, cytomegalovirus infection, trisomy 8 (third trimester single‐dose romiplostim exposure), single umbilical artery without known anomalies, and development of autism at age 2 years. Seven of 12 infants with neonatal thrombocytopenia had resolution of thrombocytopenia before discharge; all 12 were discharged. Review of pregnancies in women exposed to romiplostim did not reveal any specific safety concerns for mothers, fetuses, or infants.

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Estimation of the Risk of Thrombocytopenia in the Offspring of Pregnant Women With Presumed Immune Thrombocytopenic Purpura

Cited by 49 publications

References 0 publications

Reliable predictors of neonatal immune thrombocytopenia in pregnant women with idiopathic thrombocytopenic purpura

Reliable predictors of neonatal immune thrombocytopenia in pregnant women with idiopathic thrombocytopenic purpura

Thrombocytopenia During Pregnancy

Romiplostim use in pregnant women with immune thrombocytopenia

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