Nationwide Study of Idiopathic Thrombocytopenic Purpura in Pregnant Women and the Clinical Influence on Neonates

Abstract

Idiopathic thrombocytopenic purpura (ITP) occurs more commonly in young women during the reproductive years. To obtain information for management of ITP in pregnancy, we performed a nationwide retrospective survey. Findings from a total of 284 pregnant women with ITP and their 286 newborn infants were available for analysis. The bleeding tendency at delivery was managed chiefly with corticosteroid, intravenous high-dose gamma-globulin, and platelet transfusion. Maternal complications occurred in 77 cases (27.1%) and were frequently seen in cases with poor control of ITP. Neonatal abnormalities, which were not influenced by the clinical state of the mother, occurred at a frequency of 17.8%. Thrombocytopenia in neonates occurred in 48 cases (22.4%), and bleeding tendency was found in 16 cases (6.3%) without severe bleeding. Prediction of thrombocytopenia in neonates was difficult. However, infants from splenectomized mothers with well-controlled ITP showed thrombocytopenia more frequently than those from nonsplenectomized mothers. Mothers treated with steroids at doses greater than 15 mg/day showed a high frequency of maternal complications and fetal abnormal body weight. These observations will be useful in the management of pregnant women with ITP and their infants.

A novel recombinant human thrombopoietin therapy for the management of immune thrombocytopenia in pregnancy

“…12,26,44 Pregnancy-associated autoimmune neonatal thrombocytopenia is a self-limited disease with a platelet nadir at postnatal days 4 and 5, after which most counts will rise to normal levels within 1 month. 25 In our study, neonatal thrombocytopenia was noted in 9 neonates. Considering they were all asymptomatic with platelet count above 50 3 10 9 /L, we did not give them any treatment.…”

“…The former may experience exacerbation or relapse during their pregnancy. 24,25 The managements of these Adverse events recorded in all 31 patients who take at least 1 dose of rhTPO and in their infants.…”

Fetal-maternal complications and their association with gestational thrombocytopenia

“…Gernsheimer et al [21], recommend the use of corticosteroids or IVIG if platelet count falls below 20--30 × 10 9 /L. Some studies consider the following as important predictors of an increased risk of neonatal thrombocytopenia: maternal history of splenectomy, maternal platelet count of < 50 × 10 9 /L at some point during the pregnancy, and a previous pregnancy complicated with neonatal thrombocytopenia [23][24][25][26]. Noris et al [27], performed a multicenter, retrospective study evaluating 339 pregnancies in 181 women.…”

Immune (Idiopathic) Thrombocytopenic Purpura Diagnosed in Pregnancy: A Case Report and Review of Management

“…The risk of fetal thrombocytopenia has been reviewed in a metaanalysis by Burrows et al, which showed that 10.1% of infants born to mothers with ITP had platelet counts below 50 × 10 9 /L and 4.2% below 20 × 10 9 /L [19]. Fujimura et al noted that the risk of intracranial hemorrhage in the offspring of patients with ITP is very low (< 1%) [20]. Various studies have also shown no correlation between maternal ITP status, platelet counts and the development of intracranial hemorrhage.…”