Am J Perinatol 2011; 28(8): 597-604
DOI: 10.1055/s-0031-1276733
© Thieme Medical Publishers

Linking Maternal Platelet Counts with Neonatal Platelet Counts and Outcomes Using the Data Repositories of a Multihospital Health Care System

Jeff D. Jensen1 , Susan E. Wiedmeier2 , 4 , Erick Henry1 , 4 , Robert M. Silver3 , Robert D. Christensen4
  • 1The Institute for Healthcare Delivery Research, Salt Lake City, Utah
  • 2The Division of Neonatology, Department of Pediatrics, Salt Lake City, Utah
  • 3Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
  • 4Women and Newborns Clinical Program, Intermountain Healthcare, Salt Lake City, Utah
Further Information

Publication History

Publication Date:
03 May 2011 (online)

ABSTRACT

It is unclear whether neonates born to women with thrombocytopenia during pregnancy are themselves at increased risk for thrombocytopenia at birth. In the current retrospective study, platelet count reference ranges were developed for pregnant women according to trimester, and correlations were sought between the platelet counts of mothers at delivery and their neonates. During the study period, 92,518 platelet counts were recorded on 41,887 pregnant women. A progressive shift toward lower platelet counts in a similarly shaped histogram occurred during pregnancy, with the lower reference range (2.5 percentile) for platelets during the third trimester being 113 × 109/L. Among 11,797 maternal–neonatal pairs following delivery, no correlation was observed between maternal and neonatal counts. However, if the mother's lowest count was <50 × 109/L, the relative risk of any degree of thrombocytopenia in their neonate was 4.6 (95% confidence interval [CI], 1.8 to 33.3) and the relative risk of severe neonatal thrombocytopenia was 7.8 (95% CI, 1.8 to 33.3). The results of the current study demonstrate that platelet counts >75 × 109/L in pregnant women were not associated with an increased risk of neonatal thrombocytopenia, and maternal platelet counts of <50 × 109/L were accompanied by an almost fivefold risk increase of neonatal thrombocytopenia.

REFERENCES

  • 1 Burrows R F, Kelton J G. Incidentally detected thrombocytopenia in healthy mothers and their infants.  N Engl J Med. 1988;  319 142-145
  • 2 Matthews J H, Benjamin S, Gill D S, Smith N A. Pregnancy-associated thrombocytopenia: definition, incidence and natural history.  Acta Haematol. 1990;  84 24-29
  • 3 Burrows R F, Kelton J G. Thrombocytopenia at delivery: a prospective survey of 6715 deliveries.  Am J Obstet Gynecol. 1990;  162 731-734
  • 4 Burrows R F, Kelton J G. Fetal thrombocytopenia and its relation to maternal thrombocytopenia.  N Engl J Med. 1993;  329 1463-1466
  • 5 Shehata N, Burrows R, Kelton J G. Gestational thrombocytopenia.  Clin Obstet Gynecol. 1999;  42 327-334
  • 6 Anteby E, Shalev O. Clinical relevance of gestational thrombocytopenia of <100,000/microliters.  Am J Hematol. 1994;  47 118-122
  • 7 Boehlen F, Hohlfeld P, Extermann P, Perneger T V, de Moerloose P. Platelet count at term pregnancy: a reappraisal of the threshold.  Obstet Gynecol. 2000;  95 29-33
  • 8 Maayan-Metzger A, Leibovitch L, Schushan-Eisen I, Strauss T, Kenet G, Kuint J. Predictors for neonatal thrombocytopenia in infants of thrombocytopenic mothers during pregnancy.  Pediatr Blood Cancer. 2010;  55 145-148
  • 9 Sainio S, Kekomäki R, Riikonen S, Teramo K. Maternal thrombocytopenia at term: a population-based study.  Acta Obstet Gynecol Scand. 2000;  79 744-749
  • 10 Silver R M, Branch D W, Scott J R. Maternal thrombocytopenia in pregnancy: time for a reassessment.  Am J Obstet Gynecol. 1995;  173 479-482
  • 11 Wiedmeier S E, Henry E, Sola-Visner M C, Christensen R D. Platelet reference ranges for neonates, defined using data from over 47,000 patients in a multihospital healthcare system.  J Perinatol. 2009;  29 130-136
  • 12 Sekhon S S, Roy V. Thrombocytopenia in adults: a practical approach to evaluation and management.  South Med J. 2006;  99 491-498 quiz 499-500 533
  • 13 McCrae K R, Samuels P, Schreiber A D. Pregnancy-associated thrombocytopenia: pathogenesis and management.  Blood. 1992;  80 2697-2714
  • 14 McCrae K R. Thrombocytopenia in pregnancy: differential diagnosis, pathogenesis, and management.  Blood Rev. 2003;  17 7-14
  • 15 McCrae K R, Bussel J B, Mannucci P M, Remuzzi G, Cines D B. Platelets: an update on diagnosis and management of thrombocytopenic disorders.  Hematology (Am Soc Hematol Educ Program). 2001;  282-305
  • 16 Payne S D, Resnik R, Moore T R, Hedriana H L, Kelly T F. Maternal characteristics and risk of severe neonatal thrombocytopenia and intracranial hemorrhage in pregnancies complicated by autoimmune thrombocytopenia.  Am J Obstet Gynecol. 1997;  177 149-155
  • 17 Ajzenberg N, Dreyfus M, Kaplan C, Yvart J, Weill B, Tchernia G. Pregnancy-associated thrombocytopenia revisited: assessment and follow-up of 50 cases.  Blood. 1998;  92 4573-4580
  • 18 Win N, Rowley M, Pollard C, Beard J, Hambley H, Booker M. Severe gestational (incidental) thrombocytopenia: to treat or not to treat.  Hematology. 2005;  10 69-72
  • 19 Parnas M, Sheiner E, Shoham-Vardi I et al.. Moderate to severe thrombocytopenia during pregnancy.  Eur J Obstet Gynecol Reprod Biol. 2006;  128 163-168
  • 20 Ozkan H, Cetinkaya M, Köksal N et al.. Neonatal outcomes of pregnancy complicated by idiopathic thrombocytopenic purpura.  J Perinatol. 2010;  30 38-44
  • 21 Whittaker P G, Macphail S, Lind T. Serial hematologic changes and pregnancy outcome.  Obstet Gynecol. 1996;  88 33-39
  • 22 Maternal Adaptations to Pregnancy. In: Cunningham F G, Gant N R, Leveno K J, Gilstrap L C, Hauth J C, Wenstrom K D, eds. Williams Obstetrics. New York: McGraw-Hill; 2001: 167-200
  • 23 Medical and Surgical Complications in Pregnancy: Hematological Disorders. In: Cunningham F G, Gant N R, Leveno K J, Gilstrap L C, Hauth J C, Wenstrom K D, eds. Williams Obstetrics. New York: McGraw-Hill; 2001: 1307-1338
  • 24 Crowther M A, Burrows R F, Ginsberg J, Kelton J G. Thrombocytopenia in pregnancy: diagnosis, pathogenesis and management.  Blood Rev. 1996;  10 8-16
  • 25 Burrows R F, Andrew M. Neonatal thrombocytopenia in the hypertensive disorders of pregnancy.  Obstet Gynecol. 1990;  76 234-238
  • 26 Sola M C, Del Vecchio A, Rimsza L M. Evaluation and treatment of thrombocytopenia in the neonatal intensive care unit.  Clin Perinatol. 2000;  27 655-679
  • 27 Sola M C. Evaluation and treatment of severe and prolonged thrombocytopenia in neonates.  Clin Perinatol. 2004;  31 1-14
  • 28 Burrows R F, Kelton J G. Pregnancy in patients with idiopathic thrombocytopenic purpura: assessing the risks for the infant at delivery.  Obstet Gynecol Surv. 1993;  48 781-788
  • 29 al-Mofada S M, Osman M E, Kides E, al-Momen A K, al Herbish A S, al-Mobaireek K. Risk of thrombocytopenia in the infants of mothers with idiopathic thrombocytopenia.  Am J Perinatol. 1994;  11 423-426
  • 30 Webert K E, Mittal R, Sigouin C, Heddle N M, Kelton J G. A retrospective 11-year analysis of obstetric patients with idiopathic thrombocytopenic purpura.  Blood. 2003;  102 4306-4311
  • 31 Sainio S, Järvenpää A L, Renlund M, Riikonen S, Teramo K, Kekomäki R. Thrombocytopenia in term infants: a population-based study.  Obstet Gynecol. 2000;  95 441-446
  • 32 Schwartz K A. Gestational thrombocytopenia and immune thrombocytopenias in pregnancy.  Hematol Oncol Clin North Am. 2000;  14 1101-1116

Susan E WiedmeierM.D. N.I.C.U. 

Gardner Women's Center

Intermountain Medical Center, Murray, UT

Email: Susan.Wiedmeier@imail.org

    >