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CC BY 4.0 · TH Open 2022; 06(03): e230-e237
DOI: 10.1055/a-1837-7581
Original Article

Bleeding Complications Associated with Pregnancy with Primary Immune Thrombocytopenia: A Meta-Analysis

Jose Ramon Gonzalez-Porras 
1   Department of Hematology, Instituto de Investigación Biomédica de Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca (CAUSA), Universidad de Salamanca (USAL), Salamanca, Spain
,
Danylo Palomino
1   Department of Hematology, Instituto de Investigación Biomédica de Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca (CAUSA), Universidad de Salamanca (USAL), Salamanca, Spain
,
Luis Mario Vaquero-Roncero
2   Department of Anesthesiology, Reanimation and Pain Medicine, Instituto de Investigación Biomédica de Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca (CAUSA), Universidad de Salamanca (USAL), Salamanca, Spain
,
Jose María Bastida 
1   Department of Hematology, Instituto de Investigación Biomédica de Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca (CAUSA), Universidad de Salamanca (USAL), Salamanca, Spain
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Abstract

Introduction Immune thrombocytopenia (ITP) during pregnancy has received little attention from researchers. Reliable information about the outcome of mothers and newborns is required to properly counsel women who are pregnant or planning to become pregnant. Our primary outcomes were the frequency and severity of maternal and neonatal bleeding events in the setting of ITP in pregnancy. Mode of delivery, neonatal thrombocytopenia, and maternal/infant mortality were secondary outcomes.

Material and Methods We comprehensively reviewed the prospective studies that enrolled ≥20 pregnant women with primary ITP. Two reviewers, blinded to each other, searched Medline and Embase up to February 2021. Meta-analyses of the maternal and newborn outcomes were performed. Weighted proportions were estimated by a random-effects model.

Results From an initial screening of 163 articles, 15 were included, encompassing 1,043 pregnancies. The weighted event rate for bleeding during pregnancy was 0.181 (95% confidence interval [CI], 0.048–0.494). Most of these were nonsevere cases. The weighted event rates were 0.053 (95% CI, 0.020–0.134) for severe postpartum hemorrhage, 0.014 (95% CI, 0.008–0.025) for intracerebral hemorrhage, and 0.122 (0.095–0.157) for severe thrombocytopenia events in neonates (platelet count <50,000/μL). There were no reliable predictors of severe neonatal thrombocytopenia. The incidence of neonatal mortality was 1.06%. There were no maternal deaths.

Conclusion Primary ITP in pregnant women is rarely associated with poor outcomes.

Keywords

primary immune thrombocytopenia - pregnancy - platelet count - maternal thrombocytopenia - neonatal thrombocytopenia - maternal bleeding - postpartum hemorrhage - intracranial hemorrhage

Financial Activities Outside the Submitted Work

J.R.G.P. has received consultancy fees from Amgen, Novartis, SOBI, Grifols, and CSL Behring, and speaking honoraria from Novo Nordisk, Shire, SOBI, Roche, Daiichi Sankyo, Pfizer, Rovi, Amgen and Novartis. D.P., L.M.V.R., and J.M.B. declare that they have no competing interests.


Author Contributions

J.R.G.P. was responsible for conceptualization and original draft preparation; J.R.G.P. and D.P. for data curation; L.M.V.R. for formal analysis; and J.R.G.P., D.P., L.M.V.R., and J.M.B. for methodology, writing—review and editing, and final approval.


Supplementary Material



Publication History

Received: 09 July 2021

Accepted: 21 April 2022

Accepted Manuscript online:
27 April 2022

Article published online:
29 August 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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