Planning pregnancy - what precaution to note?

hi,

My husband and myself are thinking to plan for pregnancy and had visited a hatmo yesterday to find out the support we can receive during/post pregnancy but was advised that it is not safe to plan with a count of less than 50k since it is anticipated that the counts will decrease further during pregnancy and this may increase risk of bleeding.
My lowest was 3k with usual abt 25k for the last 7 years, but the last 6m it was hovering at the level of 40-60k w/out treatment.

I have read some post here with pregnancy during low counts, and baby delivered healthy.
Feeling bit worried i would like to ask

- if the mother experienced any form of discomfort/bleeding during pregnancy?

- also noted that the final counts during/close to delivery is the most important: is there mother who continued medication post delivery in order to maintain a safe count to heal the surgery wounds normally-faster? Or if not, what was the healing experience at a low count - or does experience tell that counts usually rebound after delivery?

In the meantime, i am also trying to find out if natural therapy can improve my counts -
tried blood well, , Vit C supplement for more than a year, 4life transfer plus about 3m, astragalus for about 3m and all of them did not work.

For the last few months i have been taking spoonful pure honey from the black sea mountain and I am observing whether this contributes to the recent increase. I have also come across research studies stating that ginkgo bilbao can increase blood counts/clotting but this seems a very sensitive herbs - because as i cross check different sites it says not safety not known for consumption during pregancny - consult doctor if on medication (because it could conflict/decrease the effect of the drug) etc. So, have anyone tried this herbs with good result?

Sorry it has been a long post!

:-X

Steph

I am currenlty 28 weeks pregnant. When I found out I was pregnant my counts were at 30 they have stayed there pretty much throughout. They did drop to 20 --but I had the flu and a week later they came back up on their own. I have not had any type of treatment though I am monitored regularly. Blood work every 2 weeks now and I see the OB every 3 weeks. I have had to do extra ultrasouds to check that the baby has not been effected by my low platlets but he is normal. All the lenght measurements, and heart and brain are normal. I will do treatment prior to delivery IVIG and steriods as well as transfussions. I have had no bleeding well except for my gums...but thats normal during pregnancy.

Honestly if your body is handeling the low platelets and your not treating I dont see why. I did become anemic--but again a very normal pregnancy symptom. Easily treated with iron pills. I even slit my thumb open a few weeks ago and it didnt bleed any more then usual. I am planning to have my counts above 100 for delivery just in case I need a c section. They will not do an epidural without counts being above 100. So for that there will be IVIG and steriods, the transfussion will help with any active bleeding I have. I think its important to get a hematologist and OB that have privallages at the same hospital. I also see a neonatologist for the baby. So currently I have 3 doctors who all work together. I will be induced 2 weeks before my due date to ensure that I will be able to get the treatment and have my counts high for the delivery. My pregnancy wasnt planned but we are making the best of it and doing what we can.

Steph - if you are normally around 25K and have been a bit higher these last few months I would think this is a good time for you to have a baby. No doctor can say for sure what will happen to your count during pregnancy. I was told my count would go down as all women do with the increase in plasma production that dilutes platelets. Then, I was told my count would go up because most autoimmune conditions get better during pregnancy (but again that is not always true). I went into remission a few months before I got pregnant and it has stuck so far. I'm due in 2 weeks. I'm more worried about my counts tanking after the birth.

I can see why you'd want to raise your count for the healing afterward and also for the birth to have the epidural/spinal option. If your hemo isn't comfortable, maybe visit a high risk OB as they see this and much worse all the time. There was a girl on the old forum who had IVIg every week her entire pregnancy. Not ideal but it can be done.

Thanks for both the input, it feels assuring the ITP can be assissted well. I would feel terrified to have a count of less than 30k during pregnancy for god knows how the foetus will be coping in the womb and whether any damage is being done. At the same time, the psychological effect of thinking how consuming medication might affect the foetus development also scares me.

Do any of you know that if a mother has a count of less than/about 20k with no form of bleeding/bruising/normal hgb count etc - does it also mean that bb is safe and that it is not experiencing any bleeding as well ?

I have recently relocated to turey and not familiar with what is available/treatment here. In the meantime i like to gather as much information as i can from my "home" doctor, and also from people who has experience with ITP so that when i start looking for a gynae (or OB) i will understand whether we are in the same line of frequency.

Gsh - hopefully all will be fine now that your counts have stabilized. All the best!

Tigereyes - I think we are in similar boat with counts level. I hope all goes ok and you dont need a transfusion. My platelet crashed badly last january during a holiday trip home and lost a lot of blood during time of the month and of course was admitted to hospital. My Hgb was about 6 and i received 4 packets of blood plus platelet trnsfusion. On top of it they pumped a lot of steriods to bring up my count and it was horrible. My entire body was aching my face became bloated and i was becoming very temperamental etc.
Anyway i hope nobody needs to go through health problem.

wishing both and every pregnant woman a perfect and safe journey to motherhood. :-X

rgds
steph

Stef,
I am worried about the steriods but both the neonatologist and the OB tell me it is perfectly safe for the baby. I am holding off as long as possible. I know that the transfussion in in my future becuase of the active bleeding during delivery. My doctors are great and taking every precaution necessary to ensure that delivery is easy and that the baby will not be in distress. My counts are holding strong at 40--which is good for me usually I hover between 20-30 without treatment so. I go for another fetal growth ultrasound at 30 weeks and 35 weeks. At 35 weeks they will pick the date to induce so that I can get IVIG and steriods prior to the delivery.

I think the main issue with steroids while pregnant is risk of increasing your blood pressure but they would be safe for the baby.

Stef - there is no relationship between the mom's platelet count and the baby's. They can't predict what the baby would be at by the mom, in other words. There are women who had awesome platelets and the baby didn't and vise versa of course. Overall, the risk of a baby have very low platelets (eg. under 50K and needing treatment) is about 5% for women who have ITP - no matter what their ITP is doing at the time. That's my understanding anyway.

gsh, would you mind letting me know where you found out this statistic?

"Overall, the risk of a baby have very low platelets (eg. under 50K and needing treatment) is about 5% for women who have ITP - no matter what their ITP is doing at the time."

I'm planning on a future pregnancy and would like to know more information about this. Thanks!

Hello everyone,

Gsh you have probably already given birth by now and enjoying the little one now. Congrats!
As for tiger eyes, you are not too far from picking a date to induce birth - congratulation!

Whenever either/both of you have the time, can you please give me some information on what drug was used during birth - for instance pred or others to increase the count in order to be prepared for the delivery; whether it was a C-section, or normal birth?

I think I now need to find out more about post-delivery;

*what was the count post birth
*how was the recovery progress for the mother
*Whether medication continued after delivery - and whether this affect breast feeding?

I am also arranging to see a gynae sometime this 2 weeks to discuss and see how comfortable we are with each other/ my condition.

Congratulation to motherhood once again. Nothing can be more beautiful.

Lots of kisses
steph

Wendigil - there are lots of papers on ITP and pregnancy. This international report is a good place to start. Read the pregnancy section. It says 3% (not 5% but I've seen that number elsewhere):
bloodjournal.hematologylibrary.org/cgi/content/full/115/2/168

Steph- yes - see my birth announcement!
My count was fine at birth but if it was under 100K we would have either had IVIg or prednisone prior to birth so I could get the spinal. When I was diagnosed and treating I was also breastfeeding my first baby. IVIg and prednisone were safe. Dexamethasone was safe too but it was certainly a higher dose of steroid than the pred. I had the safety confirmed by a breastfeeding/drug expert. Good luck.