Maternal Bleeding Complications in Pregnant Women with Immune Thrombocytopenic Purpura: A Retrospective National Study
Authors: Araji Ghada , Mustafa Ahmad , Khamis Zaid , Chowdhry Varun , Sarkis Tyler , Wu Kevin , Wei Chapman , Khan Salman , Niazi Muhammad Raphay 
Published: December 2024

Background: Immune Thrombocytopenic Purpura (ITP) is a hematological disorder characterized by low platelet counts that commonly affects women of reproductive age. Numerous studies have examined the outcomes of infants born to mothers with ITP, while fewer studies have discussed the morbidity of obstetric patients with ITP. ITP's clinical course can be unpredictable, with patients experiencing fluctuating platelet count, posing unique challenges during pregnancy, particularly concerning bleeding risks during and after delivery. Our study aimed to investigate if pregnant patients with ITP are at higher risk of bleeding complications during and after delivery to improve clinical practices and maternal outcomes.

Methods: We utilized the National Inpatient Sample (NIS) Database to identify pregnant patients admitted for delivery from 2016 to 2018. Baseline demographics and comorbidities were collected using ICD-10 codes. Patients were stratified into two cohorts: those with ITP and those without ITP. Greedy propensity matching using R was performed to match the two cohorts in a 1:1 ratio based on age, race, antiplatelet use, anticoagulant use, and steroid use. Univariate analysis pre-match along with multivariate logistic regression post-match were used to evaluate outcomes including intrapartum bleeding, postpartum bleeding, and mortality.

Results: Out of a total of 207,511 pregnant patients, 215 were identified with ITP. The incidence of intrapartum bleeding was higher in the ITP cohort compared to the non-ITP cohort, though not statistically significant (0.9% vs. 0.3%; p = 0.107). However, postpartum bleeding rates were significantly higher in patients with ITP (10.2% vs. 4.4%; p&lt;0.001). After propensity score matching, multivariate logistic regression post-match again reaffirmed the findings: intrapartum bleeding was higher in ITP patients but did not achieve statistical significance (OR 2.9; 95% CI: 0.726-11.864; p = 0.131), whereas postpartum bleeding remained significantly higher in ITP patients (OR 2.491; 95% CI: 1.6-3.879; p &lt;0.001). There was no difference in mortality rates between the two cohorts.

Conclusion: This study highlights the significantly higher risk of postpartum bleeding in pregnant patients with ITP, emphasizing the need for vigilant monitoring and proactive management strategies. Although intrapartum bleeding was more frequent in the ITP cohort, it did not reach statistical significance, suggesting that current obstetric practices may be effective in managing this risk. The absence of a difference in mortality rates is reassuring, indicating that with appropriate care, pregnant patients with ITP can have outcomes comparable to those without the condition. Clinicians should maintain heightened awareness and preparedness for postpartum bleeding in ITP patients, considering interventions such as preemptive platelet transfusions, close postpartum monitoring, and individualized care plans. Future research should focus on refining management protocols and exploring the long-term impacts of ITP on maternal and neonatal health to further enhance clinical guidelines and patient care.