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

Jose Ramon Gonzalez-Porras; Danylo Palomino; Luis Mario Vaquero-Roncero; Jose María Bastida

doi:10.1055/a-1837-7581

TH Open, Table of Contents

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

¹Department of Hematology, Instituto de Investigación Biomédica de Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca (CAUSA), Universidad de Salamanca (USAL), Salamanca, Spain

,

Danylo Palomino

¹Department 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

²Department 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

¹Department of Hematology, Instituto de Investigación Biomédica de Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca (CAUSA), Universidad de Salamanca (USAL), Salamanca, Spain

› Author Affiliations

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

Full Text

References

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Supplementary Material

Supplementary Material