Pregnancy outcomes after recovery from thrombotic thrombocytopenic purpura-hemolytic uremic syndrome.
BACKGROUND
Recurrent thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP-HUS) during a subsequent pregnancy is an important concern because pregnancy may increase the risk for relapse.


METHODS
Outcomes of all pregnancies after recovery from TTP-HUS in the Oklahoma TTP-HUS Registry, a cohort of 301 consecutive patients during the period of 1989 through 2003, were assessed and compared to the total published experience.


RESULTS
In the Oklahoma Registry, 3 of 7 (43%) women with idiopathic TTP-HUS, 2 of 11 (18%) women who were pregnant/postpartum, and 0 of 1 (0%) woman with a bloody diarrhea prodrome at their initial presentation were diagnosed with TTP-HUS during a subsequent pregnancy; all 5 women recovered. In published reports, 10 of 11 (91%) women with idiopathic TTP-HUS and 11 of 18 (61%) women who were pregnant/postpartum at their initial presentation, and all 11 (100%) women with congenital TTP-HUS were diagnosed with TTP-HUS during a subsequent pregnancy. Rates of recurrence in the Oklahoma Registry may be less because of case report bias for exceptional patients. Recurrent TTP-HUS was difficult to diagnose because other pregnancy-related complications were frequent.


CONCLUSIONS
Although pregnancies in these women were often complicated, a future pregnancy may be a safe and appropriate decision for women who have recovered from TTP-HUS.
Vesely
Sara K
SK
Hematology-Oncology Section, Department of Medicine, College of Medicine, The University of Oklahoma Health Science Center, Oklahoma City, Oklahoma.
Li
Xiaoning
X
McMinn
J R
JR
Terrell
Deirdra R
DR
George
James N
JN
D015331:Cohort Studies; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000150:complications*; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic; D011256:Pregnancy Outcome; D011446:Prospective Studies; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications*; D012008:Recurrence