title: Pregnancy outcomes following recovery from acquired thrombotic thrombocytopenic purpura.
abstract: Pregnancy may precipitate acute episodes of thrombotic thrombocytopenic purpura (TTP), but pregnancy outcomes in women who have recovered from acquired TTP are not well documented. We analyzed pregnancy outcomes following recovery from TTP associated with acquired, severe ADAMTS13 deficiency (ADAMTS13 activity <10%) in women enrolled in the Oklahoma TTP-HUS Registry from 1995 to 2012. We also systematically searched for published reports on outcomes of pregnancies following recovery from TTP associated with acquired, severe ADAMTS13 deficiency. Ten women in the Oklahoma Registry had 16 subsequent pregnancies from 1999 to 2013. Two women had recurrent TTP, which occurred 9 and 29 days postpartum. Five of 16 pregnancies (31%, 95% confidence interval, 11%-59%) in 3 women were complicated by preeclampsia, a frequency greater than US population estimates (2.1%-3.2%). Thirteen (81%) pregnancies resulted in normal children. The literature search identified 382 articles. Only 6 articles reported pregnancies in women who had recovered from TTP associated with acquired, severe ADAMTS13 deficiency, describing 10 pregnancies in 8 women. TTP recurred in 6 pregnancies.
  
  
  CONCLUSIONS
  With prospective complete follow-up, recurrent TTP complicating subsequent pregnancies in Oklahoma patients is uncommon, but the occurrence of preeclampsia may be increased. Most pregnancies following recovery from TTP in Oklahoma patients result in normal children.
authors.affiliation: Department of Biostatistics and Epidemiology, College of Public Health.
authors.forename: Yang
authors.initials: Y
authors.lastname: Jiang
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: McIntosh
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Reese
authors.forename: Cassandra C
authors.initials: CC
authors.lastname: Deford
authors.forename: Johanna A
authors.initials: JA
authors.lastname: Kremer Hovinga
authors.forename: Bernhard
authors.initials: B
authors.lastname: Lämmle
authors.forename: Deirdra R
authors.initials: DR
authors.lastname: Terrell
authors.forename: Sara K
authors.initials: SK
authors.lastname: Vesely
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Knudtson
authors.forename: James N
authors.initials: JN
authors.lastname: George
mesh_terms: D051722:ADAM Proteins / Q000097:blood / Q000172:deficiency*; D000071120:ADAMTS13 Protein; D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009825:Oklahoma / Q000453:epidemiology; D011225:Pre-Eclampsia / Q000503:physiopathology*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000453:epidemiology / Q000209:etiology*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D012008:Recurrence; D012042:Registries; D012196:Review Literature as Topic; D012307:Risk Factors; D055815:Young Adult
chemical_list: D051722:ADAM Proteins; D000071120:ADAMTS13 Protein; C099604:ADAMTS13 protein, human