Pregnancy and Birth Outcomes among Women with Idiopathic Thrombocytopenic Purpura

Wyszynski, Diego F.; Carman, Wendy J.; Cantor, Alan B.; Graham, John M.; Kunz, Liza; Slavotinek, Anne; Kirby, Russell S.; Seeger, John D.

doi:10.1155/2016/8297407

Cited by 28 publications

(28 citation statements)

References 20 publications

(21 reference statements)

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“…90 A higher incidence of premature birth has also been reported. 90,91 Therapy does not appear to affect the neonatal risk of thrombocytopenia, and therefore, treatment is directed toward maintaining a safe platelet count in the mother, generally considered 30 3 10 9 /L, until closer to term when delivery must be anticipated. First-line therapy recommended by both ASH 3 and IWG 4 guidelines is with either intravenous immunoglobulin (IVIg) or corticosteroids, and they appear to be similarly efficacious in increasing platelet counts.…”

Section: Itp In Pregnancymentioning

confidence: 99%

“…In 1 study of 235 ITP pregnancies, less than half of the patients required therapy. 91 Of 91 pregnancies requiring treatment, 47 patients were treated with IVIg and 51 with corticosteroids. There were no differences between treatment groups with regard to platelet count at delivery, antepartum or postpartum hemorrhage, or need for predelivery platelet transfusion; women who were treated had higher platelet count at delivery and less need for platelet transfusion compared with untreated women.…”

Section: Itp In Pregnancymentioning

confidence: 99%

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Clinical updates in adult immune thrombocytopenia

Lambert

Gernsheimer

2017

Blood

349

319

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Immune thrombocytopenia (ITP) occurs in 2 to 4/100 000 adults and results in variable bleeding symptoms and thrombocytopenia. In the last decade, changes in our understanding of the pathophysiology of the disorder have led to the publication of new guidelines for the diagnosis and management of ITP and standards for terminology. Current evidence supports alternatives to splenectomy for second-line management of patients with persistently low platelet counts and bleeding. Long-term follow-up data suggest both efficacy and safety, in particular, for the thrombopoietin receptor agonists and the occurrence of late remissions. Follow-up of patients who have undergone splenectomy for ITP reveals significant potential risks that should be discussed with patients and may influence clinician and patient choice of second-line therapy. Novel therapeutics are in development to address ongoing treatment gaps.

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Section: Itp In Pregnancymentioning

confidence: 99%

Section: Itp In Pregnancymentioning

confidence: 99%

Clinical updates in adult immune thrombocytopenia

Lambert

Gernsheimer

2017

Blood

349

319

View full text Add to dashboard Cite

show abstract

“…Thrombocytopenia, which is defined as a platelet count being less than 150x10 3 /μL, occurs in approximately 7% of pregnant women (1). Various etiologies can cause thrombocytopenia during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

“…Gestational thrombocytopenia, which usually occurs in the midsecond to third trimester and which is a mild form with platelet counts more than 70x10 3 /μL, constitutes 70-80% of cases (1,5). ITP, which is an autoimmune disease with autoantibodies against the platelet membrane causing platelet destruction in the reticuloendothelial system, must be considered in the differential diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Pregnancy of patients with idiopathic thrombocytopenic purpura: maternal and neonatal outcomes

Kalaycı¹,

Durdağ²,

Baran³

et al. 2020

J Turkish German Gynecol Assoc

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Objective: Thrombocytopenia occurs in 7% of pregnant women. Along with other causes, idiopathic thrombocytopenic purpura (ITP), which is an autoimmune disease with autoantibodies causing platelet destruction, must be considered in the differential diagnosis. Antiplatelet antibodies can cross the placenta and cause thrombocytopenia in the newborn. The aim of our study was to assess the management of ITP in pregnancy, and to investigate neonatal outcomes. Material and Methods: This retrospective study was conducted in a tertiary center including 89 pregnant patients with ITP followed between October 2011 and January 2018. Patients were evaluated in two groups according to diagnoses of ITP and chronic ITP. Age, obstetric history, ITP diagnosis, and follow-up period, presence of splenectomy, platelet count during pregnancy and after birth, treatment during pregnancy, route of delivery, weight and platelet count of newborn, sign of hemorrhage, and fetal congenital anomaly were assessed. Results: Considering the ITP and chronic ITP groups, no significant difference was seen with respect to parity, timing of delivery, preoperative and postoperative platelet counts, and hemoglobin values. Route of delivery, birth weight, APGAR scores, newborn platelet count, and congenital anomaly rates were also similar. The timing of treatment was different because patients whose diagnoses were established during pregnancy were mostly treated for preparation of delivery. Treatment modalities were similar. Conclusion: Probability of severe thrombocytopenia at delivery is higher in patients with ITP who are diagnosed during pregnancy when compared with patients who received prepregnancy diagnoses. ITP is an important disease for both the mother and newborn. Patients should be followed closely in cooperation with the hematology department.

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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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Pregnancy and Birth Outcomes among Women with Idiopathic Thrombocytopenic Purpura

Cited by 28 publications

References 20 publications

Clinical updates in adult immune thrombocytopenia

Clinical updates in adult immune thrombocytopenia

Pregnancy of patients with idiopathic thrombocytopenic purpura: maternal and neonatal outcomes

Romiplostim use in pregnant women with immune thrombocytopenia

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