Immune thrombocytopenia and pregnancy: an exposed/nonexposed cohort study

Abstract

The risk of immune thrombocytopenia (ITP) worsening during pregnancy and neonatal ITP (NITP) have never been prospectively studied. We included 180 pregnant and 168 non-pregnant ITP women in a prospective, multicenter, observational cohort study. 131 pregnant ITP women were matched to 131 non-pregnant ITP women by history of splenectomy, ITP status (no response, response, complete response) and duration. Groups were followed for 15 months. The primary outcome was the first occurrence of ITP worsening defined by a composite endpoint including bleeding events and/or severe thrombocytopenia (<30x109/L) and/or ITP treatment modification. We also studied the recurrence of ITP worsening and incidence of NITP and risk factors. The first occurrence of ITP worsening did not differ between pregnant and non-pregnant ITP women (53.4 per 100 person-years [95%CI, 40.8-69.9] vs. 37.1 [27.5-50.0]; hazard ratio [HR], 1.35 [95%CI, 0.89-2.03], p=0.16). Pregnant ITP women were more likely to have recurrence of severe thrombocytopenia and treatment modification (HR, 2.71 [95%CI, 1.41-5.23], p=0.003; HR, 2.01 [95%CI, 1.14-3.57], p=0.017, respectively). However, recurrence of severe bleeding events was not different between groups (p=0.4). Nineteen (14%) neonates showed NITP <50´109/L. By multivariable analysis, NITP was associated with a previous offspring with NITP and maternal platelet count <50´109/L within 3 months before delivery (adjusted odds ratio, 5.55 [95%CI, 1.72-17.89], p=0.004 and 4.07 [1.41-11.73], p=0.009). To conclude, ITP women do not increase their risk of severe bleeding during pregnancy. NITP is associated with NITP history and the severity of maternal ITP during pregnancy. These results will be useful for counseling ITP women.

Risk‐based and individualised management of bleeding and thrombotic events in adults with primary immune thrombocytopenia (ITP)

“…The majority of patients responded, rhTPO treatment was well‐tolerated and no TEEs or safety concerns were detected 67 . A recent prospective study in pregnant/non‐pregnant matched cohorts showed that ITP treatments administered during pregnancy were almost exclusively corticosteroids and IVIg, with only one patient receiving romiplostim 68 . This supports the idea that in most cases, ITP can be managed using steroids and IVIg during pregnancy and that TPO‐RAs should only be dedicated to complex cases and in late pregnancy.…”

Burden of immune thrombocytopenia (ITP): Special considerations for refractory ITP

“…Two neonates experienced bleeding events: one neonate died from intracranial haemorrhage, one neonate received intravenous immune globulin (IVIg) and platelet transfusions and recovered. 21 Risk factors for having an infant born with severe thrombocytopenia have been reported to be having a previous child born with severe thrombocytopenia. 22 Additional risk factors that have been suggested include a maternal history of splenectomy and maternal disease severity.…”

“…Of the 171 neonates, there were platelet counts available for 136 neonates and approximately 27% of the babies were born with neonatal ITP. Two neonates experienced bleeding events: one neonate died from intracranial haemorrhage, one neonate received intravenous immune globulin (IVIg) and platelet transfusions and recovered 21 . Risk factors for having an infant born with severe thrombocytopenia have been reported to be having a previous child born with severe thrombocytopenia 22 .…”

Expertenreport Immunthrombozytopenie – Aktuelle Diagnostik und Therapie

“…Das Risiko liegt bei ca. 5-14% [130]. Intrazerebrale Blutungen treten bei <1,5% auf und die neonatale Mortalität beträgt <1%.…”