Effect of pregnancy on the course of immune thrombocytopenia: a retrospective study of 118 pregnancies in 82 women.

Abstract

In women with pre-existing immune thrombocytopenic purpura (ITP), the effect of pregnancy on the course of the disease is poorly known. We performed a dual-centre retrospective cohort study of 118 pregnancies in 82 women with primary ITP. In early pregnancy, the platelet count was <100 × 10(9) /l in 35·6% of pregnancies. During pregnancy the median platelet count nadir was 66 × 10(9) /l (25th-75th percentile: 42-117), with platelet count <30 × 10(9) /l for 26 pregnancies (22%). In 49% of pregnancies, a significant decrease of the platelet count required treatment at least transiently in preparation for delivery. At the time of delivery, the median platelet count was 110 × 10(9) /l (77-155). Compared to before pregnancy, at 3 months post-partum, only 11% of pregnancies [95% confidence interval (95% CI): 6·8-20·2] showed disease worsening. Previous splenectomy was the only factor significantly associated with ITP worsening after pregnancy (53·9% vs. 10·3%, P < 0·001). For 8·3% of the pregnancies (95% CI: 3·8-15·1), neonatal thrombocytopenia required treatment, especially in case of previous maternal splenectomy (adjusted odds ratio 16·7, 95% CI: 2·61-106). The overall risk of exacerbation of ITP and severe thrombocytopenia during pregnancy is acceptable.

• Authors: Valentine Loustau, Odile Debouverie, Florence Canoui-Poitrine, Lilia Baili, Mehdi Khellaf, Claudine Touboul, Laetitia Languille, Marine Loustau, Philippe Bierling, Bassam Haddad, Bertrand Godeau, Olivier Pourrat, Marc Michel
• Journal: British journal of haematology (Br J Haematol) Vol. 166 Issue 6 Pg. 929-35 (Sep 2014) ISSN: 1365-2141 [Electronic] England
• PMID: 24957165 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © 2014 John Wiley & Sons Ltd.

Topics

• Adult
• Delivery, Obstetric
• Female
• Humans
• Platelet Count
• Postpartum Hemorrhage (blood, etiology)
• Pregnancy
• Pregnancy Complications, Hematologic (blood, therapy)
• Pregnancy Outcome
• Prenatal Care
• Purpura, Thrombocytopenic, Idiopathic (blood, therapy)
• Retrospective Studies
• Thrombocytopenia, Neonatal Alloimmune (blood, etiology)
• Young Adult