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Corticosteroids, immune globulin induce similar platelet count responses for ITP during pregnancy
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Pregnant women with immune thrombocytopenia had similar maternal platelet count responses whether treated with IV immune globulin or corticosteroids, according to the results of a retrospective study.
Neonatal outcomes also were comparable regardless of treatment platform, and the majority of women reviewed required no therapy, results showed.
“Immune thrombocytopenia purpura (ITP) affects 1 to 10 in 10,000 pregnancies,” Dongmei Sun, MD, MSc, FRCPC, assistant professor of medicine at Western University’s Schulich School of Medicine and Dentistry in London, Ontario, and colleagues wrote. “Most women with ITP have mild and moderate thrombocytopenia and approximately 30% to 35% require intervention during pregnancy. Similar to the treatment of ITP in the nonpregnant individual, both corticosteroids and IV immune globulin are acceptable treatments.”
Sun and colleagues retrospectively reviewed 195 women with ITP. The cohort had a total of 235 singleton pregnancies (one pregnancy, n = 161; two pregnancies, n = 28; three pregnancies, n = 6).
The study included data from women who developed ITP during pregnancy and those whose condition predated their pregnancy.
Fifty-eight percent of pregnancies (n = 137) required no treatment.
The remaining 98 pregnancies, in 91 women, required treatment with corticosteroids (52%; n = 51) or IV immune globulin (48%; n = 47); physician choice determined treatment platform.
IV immune globulin had a mean initial dose of 1 g/kg. The majority (92%; n = 46) of pregnancies using corticosteroids included prednisone as initial treatment (median initial dose, 50 mg/day); four pregnancies (7.8%) used dexamethasone (40 mg/day for all) and one pregnancy (2%) used both.
The median duration of prednisone treatment was 10 days (interquartile range, 1-18).
Both groups had similar mean maternal platelet counts at birth (immune globulin vs. corticosteroids, 69 x 109/L vs. 77 x 109/L).
The proportion of mothers achieving a platelet count response also did not significantly differ (38% vs. 39%).
The researchers did not observe any fatal or severe maternal, fetal or neonatal hemorrhages. Mild adverse events occurred in 13% (n = 7) of pregnancies treated with immune globulin and 13% (n = 9) of pregnancies treated with corticosteroids.
Four neonates died in utero; the remaining 231 pregnancies resulted in live births. The researchers had access to at least one postnatal platelet count from 88% (n = 203) of live-born neonates.
Twenty-eight percent (n = 56) had a birth platelet count lower than 150 x 109/L and 9% (n = 18) had a platelet count lower than 50 x 109/L.
Thirty-percent of neonates had the nadir neonatal platelet count in the cord sample, and the majority of neonates had it at birth. However, two neonates did not reach nadir until up to 6 days after birth.
Two neonates had an intracranial hemorrhage. Both were born to mothers with histories of ITP but who did not require treatment. One neonate was delivered via emergency Caesarian section at 38 weeks and achieved a nadir platelet count of 135 x 109/L; the other had a spontaneous vaginal delivery at 38 weeks and a nadir platelet count of 18 x 109/L.
The researchers observed no neonatal deaths.
Study limitations included its retrospective design and the potential that a small number of pregnancies with ITP were excluded. The researchers further reported that adverse event data may not have been properly captured.
“This observational study comparing IV immune globulin and corticosteroids in pregnant women with ITP demonstrated no significant differences between the two regimens, but highlighted the need for ongoing neonatal count monitoring throughout the first week of life, regardless of maternal platelet count,” Sun and colleagues wrote. “Prospective studies are needed to better characterize the safety of these regimens, to determine the optimal dose of corticosteroids, to identify risk factors for neonatal thrombocytopenia, and to explore new therapeutic options.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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