title: 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: APHP, Henri Mondor Hospital, Department of Internal Medicine, French National Referral Centre for Adult's Immune Cytopeniasl, Creteil, France; UPEC, Medicine Faculty, Creteil, France.
authors: Valentine
authors: V
authors: Loustau
authors: Odile
authors: O
authors: Debouverie
authors: Florence
authors: F
authors: Canoui-Poitrine
authors: Lilia
authors: L
authors: Baili
authors: Mehdi
authors: M
authors: Khellaf
authors: Claudine
authors: C
authors: Touboul
authors: Laetitia
authors: L
authors: Languille
authors: Marine
authors: M
authors: Loustau
authors: Philippe
authors: P
authors: Bierling
authors: Bassam
authors: B
authors: Haddad
authors: Bertrand
authors: B
authors: Godeau
authors: Olivier
authors: O
authors: Pourrat
authors: Marc
authors: M
authors: Michel
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D010976:Platelet Count; D006473:Postpartum Hemorrhage / Q000097:blood / Q000209:etiology; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000097:blood* / Q000628:therapy; D011256:Pregnancy Outcome; D011295:Prenatal Care; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood* / Q000628:therapy; D012189:Retrospective Studies; D054098:Thrombocytopenia, Neonatal Alloimmune / Q000097:blood / Q000209:etiology; D055815:Young Adult
keywords: immune thrombocytopenia; neonatal thrombocytopenia; pregnancy