Analysis of 339 pregnancies in 181 women with 13 different forms of inherited thrombocytopenia.
Pregnancy in women with inherited thrombocytopenias is a major matter of concern as both the mothers and the newborns are potentially at risk of bleeding. However, medical management of this condition cannot be based on evidence because of the lack of consistent information in the literature. To advance knowledge on this matter, we performed a multicentric, retrospective study evaluating 339 pregnancies in 181 women with 13 different forms of inherited thrombocytopenia. Neither the degree of thrombocytopenia nor the severity of bleeding tendency worsened during pregnancy and the course of pregnancy did not differ from that of healthy subjects in terms of miscarriages, fetal bleeding and pre-term births. The degree of thrombocytopenia in the babies was similar to that in the mother. Only 7 of 156 affected newborns had delivery-related bleeding, but 2 of them died of cerebral hemorrhage. The frequency of delivery-related maternal bleeding ranged from 6.8% to 14.2% depending on the definition of abnormal blood loss, suggesting that the risk of abnormal blood loss was increased with respect to the general population. However, no mother died or had to undergo hysterectomy to arrest bleeding. The search for parameters predicting delivery-related bleeding in the mother suggested that hemorrhages requiring blood transfusion were more frequent in women with history of severe bleedings before pregnancy and with platelet count at delivery below 50 × 10(9)/L.
Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation, Italy.
Patrizia
P
Noris
National Reference Centre on Inherited Platelet Disorders and Service d'Hématologie Biologique, CHU Robert Debré and Paris 7 Denis Diderot University, Paris, France.
Nicole
N
Schlegel
Service of Biometry and Statistics, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
Catherine
C
Klersy
Institute of Medical Research Alfredo Lanari, University of Buenos Aires, Argentina.
Paula G
PG
Heller
Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation, Italy.
Elisa
E
Civaschi
Universitat Autònoma de Barcelona, Institut de Recerca Biomèdica Sant Pau, Spain.
Nuria
N
Pujol-Moix
Department of Medicine-DIMED, University of Padova Medical School, Italy.
Fabrizio
F
Fabris
AP-HP, Armand Trousseau Children's Hospital, Haematological Laboratory, French Reference Center for Inherited Platelet disorders, Paris, France Inserm UMR1009, Villejuif, France.
Remi
R
Favier
Department of Internal Medicine, University of Perugia, Italy.
Paolo
P
Gresele
Centre de Compétence Nord-Est des Pathologies Plaquettaires from the frame of the Reference French Centre, France Service d'Hématologie Biologique, Centre Hospitalo-Universitaire, Nancy, France.
Véronique
V
Latger-Cannard
Department of Medicine and Department of Pathology & Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Adam
A
Cuker
Plateforme Technologique et d'Innovation Biomédicale, Hôpital Xavier Arnozan, Pessac, France.
Paquita
P
Nurden
Institut für Immunologie und Transfusionsmedizin, Greifswald, Germany.
Andreas
A
Greinacher
Medicina III, Ospedale San Paolo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy.
Marco
M
Cattaneo
Servizio Malattie Emorragiche e Trombotiche, Istituto di Medicina Interna e Geriatria, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy.
Erica
E
De Candia
Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation, Italy.
Alessandro
A
Pecci
National Reference Centre on Inherited Platelet Disorders and Service d'Hématologie Biologique, CHU Robert Debré and Paris 7 Denis Diderot University, Paris, France.
Marie-Françoise
MF
Hurtaud-Roux
Institute of Medical Research Alfredo Lanari, University of Buenos Aires, Argentina.
Ana C
AC
Glembotsky
Immunohematology Department, Banc de Sang i Teixits de Catalunya, Barcelona, Spain.
Eduardo
E
Muñiz-Diaz
Department of Medicine-DIMED, University of Padova Medical School, Italy.
Maria Luigia
ML
Randi
Institut d'Hématologie-Transfusion, Pôle Biologie Pathologie Génétique, CHRU, Lille, France.
Nathalie
N
Trillot
Department of Internal Medicine, University of Perugia, Italy.
Loredana
L
Bury
Département des Spécialités de Médecine, Service d'Hématologie, Hôpitaux Universitaires de Genève, Suisse Université de Genève, Faculté de Médecine, Suisse.
Thomas
T
Lecompte
Genetica Medica, Dipartimento di Scienze Mediche Chirurgiche, Policlinico Sant'Orsola-Malpighi, University of Bologna, Italy.
Caterina
C
Marconi
Department of Medical Sciences, University of Trieste, Italy Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.
Anna
A
Savoia
Department of Internal Medicine, University of Pavia-IRCCS Policlinico San Matteo Foundation, Italy c.balduini@smatteo.pv.it.
Carlo L
CL
Balduini
Service d'Hémostase Bio-Clinique, Centre Régional de traitement des maladies hémorragiques de Rennes-Bretagne, CHU de Rennes, Rennes, France.
Sophie
S
Bayart
Institut d'Hématologie-Transfusion, Pôle Biologie Pathologie Génétique, CHRU Lille, France.
Anne
A
Bauters
Université Mohamed V Rabat, Faculté de Médecine et de Pharmacie, Hôpital Avicenne, Rabat, Morocco.
Schéhérazade
S
Benabdallah-Guedira
Division of Angiology and Haemostasis, Department of Medical Specialisations, Faculty of Medicine and University Hospitals of Geneva, Geneva, Switzerland Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Françoise
F
Boehlen
CHU Charles Nicolle, Unité Hémostase-Hématologie, Rouen, France.
Jeanne-Yvonne
JY
Borg
Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy.
Roberta
R
Bottega
Weill Medical College of Cornell University, New York, NY, USA.
James
J
Bussel
Department of Medical Sciences, University of Trieste, Trieste, Italy.
Daniela
D
De Rocco
Service d'hématologie Biologie, Centre Hospitalo-Universitaire Dijon, France.
Emmanuel
E
de Maistre
Department of Medical Sciences, University of Trieste, Trieste, Italy.
Michela
M
Faleschini
Department of Internal Medicine, University of Perugia, Perugia, Italy.
Emanuela
E
Falcinelli
Department of Medicine-DIMED; University of Padova Medical School, Padova, Italy.
Silvia
S
Ferrari
Unité d'Hémato-Oncologie pédiatrique, Hôpital Universitaire des Enfants Reine Fabiola, Bruxelles, Belgique.
Alina
A
Ferster
Department of Internal Medicine, University of Perugia, Perugia, Italy.
Tiziana
T
Fierro
Service de Néphrologie, CH Valenciennes, Valenciennes, France.
Dominique
D
Fleury
Division of Angiology and Haemostasis, Department of Medical Specialisations, Faculty of Medicine and University Hospitals of Geneva, Geneva, Switzerland Geneva Platelet Group, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Pierre
P
Fontana
Laboratoire d'Hématologie and National Reference Centre on Inherited Platelet Disorders, CHU Haut Lévêque, Pessac, France.
Chloé
C
James
INSERM UMR-S949/EFS-Alsace, Strasbourg, France.
Francois
F
Lanza
CHU Charles Nicolle, Unité Hémostase-Hématologie, Rouen, France.
Véronique
V
Le Cam Duchez
Department of Oncology, Azienda Santobono-Pausilipon, Pausilipon Hospital, Napoli, Italy.
Giuseppe
G
Loffredo
Genetica Medica, Dipartimento di Scienze Mediche Chirurgiche, Policlinico Sant'Orsola-Malpighi - University of Bologna, Bologna, Italy.
Pamela
P
Magini
Laboratoire de Génétique, CH Le Mans, France.
Dominique
D
Martin-Coignard
Centre Hospitalier de la côte basque, Bayonne, France.
Fanny
F
Menard
Service de Génétique Clinique, Centre de Référence Anomalies du Développement du Grand Ouest, CHU Rennes-Hôpital Sud, Rennes, France.
Sandra
S
Mercier
Department of Internal Medicine, University of Perugia, Perugia, Italy.
Annamaria
A
Mezzasoma
Department of Medicine and Haematology, University Hospital of Verona, Verona, Italy.
Pietro
P
Minuz
Department of Cell Therapy and Hematology, San Bortolo Hospital, Vicenza, Italy.
Ilaria
I
Nichele
Department of Pediatrics, University of Brescia, Brescia, Italy.
Lucia D
LD
Notarangelo
Genetica Medica, Dipartimento di Scienze Mediche Chirurgiche, Policlinico Sant'Orsola-Malpighi - University of Bologna, Bologna, Italy.
Tommaso
T
Pippucci
Medicina III, Ospedale San Paolo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Italy.
Gian Marco
GM
Podda
Laboratoire d'Hématologie and National Reference Centre on Inherited Platelet Disorders, CHU La Timone, Marseille, France.
Catherine
C
Pouymayou
AP-HP, Armand Trousseau children Hospital, Department of Anesthesiology, Paris, France.
Agnes
A
Rigouzzo
Hématologie clinique et thérapie cellulaire, CHU Amiens, France.
Bruno
B
Royer
Laboratoire d'Hématologie and National Reference Centre of Inherited Platelet Disorders, CHU Rangueil, Toulouse, France.
Pierre
P
Sie
Service d' Hématologie Biologique, CHU Hôpital Européen Georges Pompidou, Paris, France.
Virginie
V
Siguret
Service de Biologie Clinique Secteur Hématologie, CH Victor Dupouy, Argenteuil, France.
Catherine
C
Trichet
Hematology Unit, Spedali Civili Hospital and University of Brescia, Brescia, Italy.
Alessandra
A
Tucci
National Reference Centre on Inherited Platelet Disorders and Service d'Hématologie Biologique, CHU Robert Debré and Paris 7 Denis Diderot University, Paris, France.
Béatrice
B
Saposnik
Department of Medicine and Haematology, University Hospital of Verona, Verona, Italy.
Dino
D
Veneri
D000328:Adult; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000175:diagnosis* / Q000453:epidemiology* / Q000235:genetics; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000175:diagnosis* / Q000453:epidemiology* / Q000235:genetics; D055815:Young Adult