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Journal Articles Blood Year : 2023

Immune thrombocytopenia and pregnancy: an exposed/nonexposed cohort study

Nathalie Costedoat Chalumeau
  • Function : Author
Stéphane Cheze
  • Function : Author
Manuel Cliquennois
Claire Fieschi
Bertrand Lioger
  • Function : Author
Sylvain Audia
  • Function : Author
Karim Sacre
Jean Christophe Lega
Vincent Langlois
  • Function : Author
Alexandra Benachi
Corentin Orvain
Alain Devidas
  • Function : Author
Sebastien Humbert
Nicolas Gambier
  • Function : Author
Marc Ruivard
  • Function : Author
Virginie Zarrouk
  • Function : Author
Mikael Ebbo
  • Function : Author
Lise Willems
  • Function : Author
Matthieu Mahevas
  • Function : Author
Bassam Haddad
  • Function : Author
Marc Michel
  • Function : Author
Bertrand Godeau
  • Function : Author

Abstract

Abstract The risk of immune thrombocytopenia (ITP) worsening during pregnancy and neonatal ITP (NITP) have never been prospectively studied. We included 180 pregnant and 168 nonpregnant women with ITP in a prospective, multicenter, observational cohort study. A total of 131 pregnant women with ITP were matched to 131 nonpregnant women with ITP by history of splenectomy, ITP status (no response, response, complete response), and duration. Groups were followed for 15 months. The primary outcome was the first occurrence of ITP worsening defined by a composite end point including bleeding events and/or severe thrombocytopenia (<30 × 109/L) and/or ITP treatment modification. We also studied the recurrence of ITP worsening and the incidence of NITP and risk factors. The first occurrence of ITP worsening did not differ between pregnant and nonpregnant women with ITP (53.4 per 100 person-years [95% confidence interval {CI}, 40.8-69.9] vs 37.1 [95% CI, 27.5-50.0]; hazard ratio {HR}, 1.35 [95% CI, 0.89-2.03], P = .16). Pregnant women with ITP were more likely to have recurrence of severe thrombocytopenia and treatment modification (HR, 2.71 [95% CI, 1.41-5.23], P = .003; HR, 2.01 [95% CI, 1.14-3.57], P = .017, respectively). However, recurrence of severe bleeding events was not different between groups (P = .4). Nineteen (14%) neonates showed NITP <50 × 109/L. By multivariable analysis, NITP was associated with a previous offspring with NITP and maternal platelet count <50 × 109/L within 3 months before delivery (adjusted odds ratio, 5.55 [95% CI, 1.72-17.89], P = .004 and 4.07 [95% CI, 1.41-11.73], P = .009). To conclude, women with ITP do not increase their risk of severe bleeding during pregnancy. NITP is associated with NITP history and the severity of maternal ITP during pregnancy. These results will be useful for counseling women with ITP.
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Dates and versions

hal-04154085 , version 1 (06-07-2023)

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Stéphanie Guillet, Valentine Loustau, Emmanuelle Boutin, Anissa Zarour, Thibault Comont, et al.. Immune thrombocytopenia and pregnancy: an exposed/nonexposed cohort study. Blood, 2023, 141 (1), pp.11-21. ⟨10.1182/blood.2022017277⟩. ⟨hal-04154085⟩
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