Pregnancy and Birth Outcomes among Women with Idiopathic Thrombocytopenic Purpura.

Diego F. Wyszynski,Russell S. Kirby,Liza H. Kunz,John M. Graham,Alan B. Cantor,John Seeger,Wendy J. Carman,Anne M. Slavotinek

doi:10.1155/2016/8297407

Abstract

Objective. To examine pregnancy and birth outcomes among women with idiopathic thrombocytopenic purpura (ITP) or chronic ITP (cITP) diagnosed before or during pregnancy. Methods. A linkage of mothers and babies within a large US health insurance database that combines enrollment data, pharmacy claims, and medical claims was carried out to identify pregnancies in women with ITP or cITP. Outcomes included preterm birth, elective and spontaneous loss, and major congenital anomalies. Results. Results suggest that women diagnosed with ITP or cITP prior to their estimated date of conception may be at higher risk for stillbirth, fetal loss, and premature delivery. Among 446 pregnancies in women with ITP, 346 resulted in live births. Women with cITP experienced more adverse outcomes than those with a pregnancy-related diagnosis of ITP. Although 7.8% of all live births had major congenital anomalies, the majority were isolated heart defects. Among deliveries in women with cITP, 15.2% of live births were preterm. Conclusions. The results of this study provide further evidence that cause and duration of maternal ITP are important determinants of the outcomes of pregnancy.

Highlights

Immune thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by persistent thrombocytopenia due to antibody binding to platelet antigen(s) and causing their premature destruction by the reticuloendothelial system, in the spleen
We identified 585 women with at least one claim of idiopathic thrombocytopenic purpura (ITP) and claims indicating pregnancy during the study period (January 1, 1994, through December 31, 2009)
Preterm birth was present in 16/58 (27.6%) infants born to mothers with ITP diagnosed prior to pregnancy and in 15/75 (20%) infants born to mothers with ITP diagnosed during pregnancy, with an overall prevalence of 23.3% [15]

Summary

Introduction

Immune (idiopathic) thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by persistent thrombocytopenia due to antibody binding to platelet antigen(s) and causing their premature destruction by the reticuloendothelial system, in the spleen. The American Society for Hematology guidelines [1] define ITP as “isolated thrombocytopenia with no clinically apparent associated conditions or other causes of thrombocytopenia.”. ITP is a condition generally diagnosed by exclusion of the numerous other causes of thrombocytopenia, such as infections, medications, hematological malignancies, disseminated intravascular coagulation, and other autoimmune conditions. In ITP, persistent thrombocytopenia is associated with an otherwise normal full blood count [2]. It is estimated that thrombocytopenia (defined as a platelet count less than 150 × 109/L) occurs in approximately 7% of pregnant women, with 74% of those with low platelet counts having incidental thrombocytopenia of pregnancy that can be managed routinely and in which the platelet

Methods

Results

Conclusion