Immune Thrombocytopenia in Pregnancy

Résumé ou Introduction

Thrombocytopenia occurs mostly in pregnant women, in which immune thrombocytopenia is believed to be one of the least prevalent forms of thrombocytopenia. Clinical studies indicate that immune thrombocytopenia occurs at a low rate of 11% compared to gestational thrombocytopenia, which occurs at a rate of 59%. However, it is characterized with moderate and severe thrombocytopenia with platelet counts decreasing below 100x109/L. Ordinarily, immune thrombocytopenia is caused by auto-immune reactions against platelets by anti-platelet antibodies, which destroy glycoprotein membranes forming platelet membranes.

Immune thrombocytopenia in pregnancy causes several risks to women and newborns. ITP pregnant women experience high risks of maternal hemorrhage compared to those suffering from other forms of thrombocytopenia. Despite the low percentage of ITP rates in pregnant women, extensive monitoring and management are required, primarily during prenatal care to reduce the risks associated with the disorder.

On the other hand, immune thrombocytopenia in pregnancy presents numerous neonatal concerns. The notion that, immune thrombocytopenia influences delivery alternatives has been disapproved by the recent clinical reports, which are based on randomized clinical trials. In the past, cesarean delivery was considered as a significant obstetric indication in ITP pregnant women. Currently, vaginal birth has been found to reduce trauma in newborns born of ITP mothers.

Moreover, treatment provided to immune thrombocytopenic women prior or during pregnancy causes neonatal concerns. For instance, splenectomy treatment prior to pregnancy has been found to increase free anti-platelet antibodies in maternal circulation, causing a significant risk of anti-platelet reactions in the fetus.

It has also been confirmed that IgG anti-platelet antibodies are transferred from maternal circulation into the fetal body, and this may predispose the fetus to neonatal alloimmune thrombocytopenia (NAIT), leading to neonatal hemorrhage. In conclusion, maternal and neonatal concerns associated with ITP can be reduced through platelet count monitoring during prenatal care.