title: Corticosteroids compared with intravenous immunoglobulin for the treatment of immune thrombocytopenia in pregnancy.
abstract: Treatment options for immune thrombocytopenia (ITP) in pregnancy are limited, and evidence to guide management decisions is lacking. This retrospective study of singleton pregnancies from 2 tertiary centers compared the effectiveness of intravenous immunoglobulin (IVIg) and corticosteroids in treatment of ITP. Data from 195 women who had 235 pregnancies were reviewed. Treatment was not required in 137 pregnancies (58%). Of the remaining 98 pregnancies in 91 women, 47 (48%) were treated with IVIg and 51 were treated with corticosteroids as the initial intervention. Mean maternal platelet count at birth did not differ between groups (IVIg 69 × 10(9)/L vs corticosteroids 77 × 10(9)/L; P = .71) nor did the proportion of mothers who achieved a platelet count response (IVIg 38% vs corticosteroids 39%; P = .85). There were no fatal or severe maternal, fetal, or neonatal hemorrhages. Of 203 neonates in whom platelet counts were available, 56 (28%) had a birth platelet count <150 × 10(9)/L and 18 (9%) had platelet counts <50 × 10(9)/L. Nadir platelet counts for most affected neonates occurred at birth, although for some neonates, nadir platelet counts occurred up to 6 days postnatally. Intracranial hemorrhage was noted in 2 neonates (nadir platelet counts were 135 and 18 × 10(9)/L). There were no neonatal deaths. The majority of pregnant women with a history of ITP did not require treatment, and neonatal outcomes were comparable for mothers who received IVIg or corticosteroids for treatment of maternal ITP.
authors.affiliation: Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada;
authors.forename: Dongmei
authors.initials: D
authors.lastname: Sun
authors.affiliation: Departments of Medicine, Laboratory Medicine, and Pathobiology, and Institute of Health Policy, Management, and Evaluation, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada; Canadian Blood Services, Toronto, ON, Canada;
authors.forename: Nadine
authors.initials: N
authors.lastname: Shehata
authors.affiliation: Maternal-Infant Care Research Centre, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada;
authors.forename: Xiang Y
authors.initials: XY
authors.lastname: Ye
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and.
authors.forename: Sandra
authors.initials: S
authors.lastname: Gregorovich
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and.
authors.forename: Bryon
authors.initials: B
authors.lastname: De France
authors.affiliation: Department of Medicine, McMaster University, Hamilton, ON, Canada; Canadian Blood Services, Hamilton, ON, Canada; and.
authors.forename: Donald M
authors.initials: DM
authors.lastname: Arnold
authors.affiliation: Department of Paediatrics and Institute of Health Policy, Management and Evaluation, and.
authors.forename: Prakesh S
authors.initials: PS
authors.lastname: Shah
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
authors.forename: Ann Kinga
authors.initials: AK
authors.lastname: Malinowski
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D005260:Female; D005315:Fetal Diseases / Q000188:drug therapy*; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007231:Infant, Newborn; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000188:drug therapy*; D011379:Prognosis; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000188:drug therapy*; D012189:Retrospective Studies; D054098:Thrombocytopenia, Neonatal Alloimmune / Q000188:drug therapy*
chemical_list: D000305:Adrenal Cortex Hormones; D016756:Immunoglobulins, Intravenous