CONTENTS:
- Maternal ITP and its Effects on Newborns
- Video: Is there a big difference between a platelet count of 5k, 7k, or 10k?
Maternal ITP and its Effects on Newborns
- By Matthew Ross, BS; Sashi Goteti, MD, MCR; Elizabeth Gunn, MD; and Kirsty Hillier, MD
About 1 in 10 pregnancies are complicated by thrombocytopenia (low platelets).1 Several pregnancy-related conditions leading to thrombocytopenia should be considered. Maternal immune thrombocytopenia (ITP) is one of these conditions, and it accounts for about 1-4 percent of cases of low platelets in pregnancy.1 Sometimes, maternal ITP occurs in women who already had ITP before they were pregnant. In other patients, ITP is diagnosed for the first time during pregnancy. Although there is no specific test for ITP, a hematologist or other physician can perform a thoughtful history, physical examination, and labs to determine the most likely cause of the low platelet count. The physician may diagnose maternal ITP after ruling out other causes of low platelets.
In most cases, maternal ITP does not require any treatment other than careful monitoring. However, if the platelet count drops too low or if the patient experiences bleeding symptoms, a physician may prescribe medications to increase the platelet count. Steroids and intravenous immunoglobulin (IVIG) are the most common medications used to treat maternal ITP. Both medications stop the mother’s immune system from destroying platelets. Hematologists, obstetricians, and other medical providers follow patients with maternal ITP closely as the due date approaches to ensure the delivery is safe. The medical team may provide treatments to increase the mother’s platelet count prior to delivery. Fortunately, previous research has shown that pregnancy does not increase the risk of major bleeding for women with ITP.2
Parents may be concerned about how maternal ITP may affect the child. Most babies born to mothers with ITP have no symptoms. About 1 in 4 babies will have a low platelet count.3 A low platelet count in a baby, also known as neonatal thrombocytopenia, can occur because antibodies from the mother’s blood cross the placenta and attach to the baby’s platelets, tagging them for destruction.3 Neonatal thrombocytopenia due to maternal ITP is often evident within the first 24 hours of life, and the platelet count usually hits its lowest point between 2 and 5 days after birth.4
Some babies with low platelets develop symptoms such as bruising or easy bleeding. Bleeding may require immediate treatment. For this reason, it is important that the medical team is aware of the maternal ITP so that they can follow the baby carefully in the first few days of life to ensure that the baby is safe and healthy. The medical team may also obtain a platelet count from the baby to determine if the baby has low platelets. Doctors may use IVIG, steroids, or platelet transfusions to increase the baby’s platelet count if they are concerned about the potential for bleeding.4
There is no known method of predicting or preventing the onset of neonatal thrombocytopenia due to maternal ITP. Treating ITP during pregnancy does not appear to affect the baby’s platelet counts after delivery.5 Fortunately, the baby’s platelet count usually rises to normal levels within several weeks without further complications.4,6 Neonatal thrombocytopenia due to maternal ITP is considered a separate entity from childhood ITP and thus is not thought to increase the child’s risk of developing ITP later in life.7
Breastfeeding is generally considered safe in maternal ITP. In rare cases where babies have persistently low platelets, a thoughtful discussion between the mother and hematologist about discontinuing breastfeeding may be considered to see if the platelet counts improve.8
In summary, maternal ITP should be monitored carefully to ensure a safe pregnancy and healthy baby. The infant should also be monitored carefully for lower platelets and possible bleeding symptoms. Regular check-ins with hematologists and other medical providers are essential to make sure that the risk of bleeding is minimized for the mother and child.
REFERENCES
1. Subtil SFC, Mendes JMB, Areia A, Moura J. Update on Thrombocytopenia in Pregnancy. Rev Bras Ginecol Obstet. Dec 2020;42(12):834-840. Atualizacao sobre trombocitopenia na gravidez. doi:10.1055/s-0040-1721350
2. Guillet S, Loustau V, Boutin E, et al. Immune thrombocytopenia and pregnancy: an exposed/nonexposed cohort study. Blood. Jan 5 2023;141(1):11-21. doi:10.1182/ blood.2022017277
3. Luo H, Li D, Gao F, Hong P, Feng W. A meta-analysis of neonatal outcomes in pregnant women with immune thrombocytopenic purpura. J Obstet Gynaecol Res. Sep 2021;47(9):2941-2953. doi:10.1111/jog.14890
4. Aslan MT, İnce Z, Bilgin L, Kunt İşgüder Ç, Çoban A. Is it possible to predict morbidities in neonates born to mothers with immune thrombocytopenic purpura?: A retrospective cross-sectional study. Medicine (Baltimore). Jun 21 2024;103(25):e38587. doi:10.1097/md.0000000000038587
5. Marti-Carvajal AJ, Pena-Marti GE, Comunian-Carrasco G. Medical treatments for idiopathic thrombocytopenic purpura during pregnancy. Cochrane Database Syst Rev. Oct 7 2009;2009(4):CD007722. doi:10.1002/14651858.CD007722.pub2
6. Karakurt N, Uslu I, Albayrak C, et al. Neonates born to mothers with immune thrombocytopenia: 11 years experience of a single academic center. Blood Coagul Fibrinolysis. Sep 2018;29(6):546-550. doi:10.1097/MBC.0000000000000758
7. D’Orazio JA, Neely J, Farhoudi N. ITP in children: pathophysiology and current treatment approaches. J Pediatr Hematol Oncol. Jan 2013;35(1):1-13. doi:10.1097/ MPH.0b013e318271f457
8. Hauschner H, Rosenberg N, Seligsohn U, et al. Persistent neonatal thrombocytopenia can be caused by IgA antiplatelet antibodies in breast milk of immune thrombocytopenic mothers. Blood. 2015;126(5):661-664. doi:10.1182/ blood-2014-12-614446
Learn more about ITP in Pregnancy.
