Maternal and Neonatal Outcomes in Pregnant Patients with Immune Thrombocytopenia: A Retrospective Study
Authors: Elkourashy Sarah , Magboul Hassan , Soliman Dina Sameh , Al Najjar Mohammed , Abdalla Elmustafa , Shawayli Hawra , Elsheikh Manar , Al mallahi Nayela , Mohamed Shehab 
Published: December 2024

Introduction

Autoimmune diseases are more prevalent in young women, particularly during their childbearing years. Immune thrombocytopenia (ITP) is one such autoimmune disorder that can affect women, including those who are pregnant. Managing ITP during pregnancy poses unique challenges. Despite the importance of understanding these challenges, data on ITP and its associated outcomes during pregnancy are rare, and existing reports often present conflicting results. In Qatar, this the first study to look at ITP and its outcomes during pregnancy. This retrospective study aims to assess maternal and neonatal outcomes in pregnant patients diagnosed with ITP in Qatar.

Methods

This five-year retrospective cross-sectional study was conducted between 2018 and 2023. 2023. Data were collected from electronic medical records at Hamad Medical Corporation (HMC). The study analyzed demographic data, platelet outcomes, maternal and neonatal complications, and treatment protocols. We defined chronic ITP for those who developed 12 months or more. Other groups were recently diagnosed less than 1 year before pregnancy or inside ( during ) the pregnancy .

Results

Seventy-seven pregnant patients diagnosed with ITP were included in the study. The majority of cases were of Middle Eastern origin (58.5%), followed by Asian origin (24.7%). Chronic ITP was identified in 19 patients; however, a total of 42 patients had ITP before pregnancy, while 34 developed ITP during pregnancy. Additionally, 28.5% of the patients had associated autoimmune diseases, including antiphospholipid syndrome, systemic lupus erythematosus, Sjogren's syndrome, and thyroid diseases.

Platelet counts at diagnosis had a median of 44 × 10^9/L. The median lowest platelet counts during pregnancy by trimester were 36 × 10^9/L, 44 × 10^9/L, and 46.5 × 10^9/L for the first, second, and third trimesters, respectively. The median platelet count before pregnancy was 97 × 10^9/L, dropping to 91 × 10^9/L after pregnancy and 41 × 10^9/L during pregnancy.

Majority of the patient had no maternal complications (78.38%), with premature rupture of membranes (PROM) being the most common complication (5.41%). Hemorrhage, either antepartum or postpartum, occurred in 2 patients with platelet counts below 34 × 10^9/L. Neonatal complications occurred in 20.27% of the cases, with preterm births (6.76%) and intrauterine growth restriction (IUGR) (4.05%) being the most common. Interestingly, 45% (19/42) of the patients who developed ITP before pregnancy had complications affecting either the mother, neonate, or both, whereas 64% of the patients who developed ITP during pregnancy had complications.

Just less than half of the patients (47.22%) required treatment during pregnancy. The most common treatment strategies were steroids and intravenous immunoglobulin (IVIG), used in 10 patients (13.89%), resulting in significant platelet count increment post-pregnancy (up to 337 × 10^9/L). Two patients were successfully treated with thrombopoietin (TPO) agonists.

Conclusion

Our ITP cases diagnosed either as chronic ITP, before pregnancy or during pregnancy. Median platelet counts during pregnancy were around the 40s, with no significant difference across the three trimesters. Approximately 80% of mothers and babies completed the pregnancy without significant complications, although some still faced different kind of complications. Effective management strategies, including the use of steroids, IVIG, and TPO agonists, can lead to significant improvements in platelet counts and favorable outcomes. There were more complications for those who developed ITP during pregnancy than those who had it before.