Maternal and fetal outcomes of pregnancy occurring after a diagnosis of immune-mediated thrombotic thrombocytopenic purpura

Jenna Brown, Bindu Potugari, Marshall A. Mazepa, Ruhail Kohli, Alison R. Moliterno, Robert A. Brodsky, Jason A. Vaught, Richard Burwick, Shruti Chaturvedi

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Pregnancy is a well-established trigger for a first episode or relapse of immune thrombotic thrombocytopenic purpura (iTTP). Other outcomes of subsequent pregnancy after a diagnosis of iTTP are less well described. We conducted this retrospective cohort study to evaluate maternal and fetal outcomes of pregnancy in women with prior iTTP from the Johns Hopkins Thrombotic Microangiopathy Cohort. Of 168 women in the cohort, 102 were of reproductive age at diagnosis. Fourteen pregnancies (in 9 women) that occurred after the initial iTTP episode were included in the analysis. iTTP relapse occurred in 9 (64%) pregnancies. Out of the 9 instances of relapse, 5 relapses occurred in 2 women. Seven pregnancies (50%) ended in fetal death or miscarriage in the setting of iTTP relapse and three were electively terminated due to fear of relapse. Four pregnancies (50% of the 8 that progressed beyond 20 weeks) were complicated by preeclampsia or HELLP syndrome, which is over ten-fold higher than that of the general population. No maternal deaths occurred. Only 4 pregnancies resulted in live births, of which, 2 were pre-term. Pregnancy in women with prior iTTP is associated with a substantial risk of iTTP relapse and fetal loss. Preeclampsia and HELLP syndrome is also more common than that in the general population. ADAMTS13 monitoring and preemptive therapy may improve pregnancy outcomes, which needs to be evaluated prospectively.

Original languageEnglish (US)
Pages (from-to)2159-2167
Number of pages9
JournalAnnals of Hematology
Volume101
Issue number10
DOIs
StatePublished - Oct 2022

Bibliographical note

Funding Information:
This work was supported by a grant from the National Heart Lung and Blood Institute (K99HL150594) and an American Society of Hematology Scholar Award to S. Chaturvedi.

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Keywords

  • ADAMTS13
  • Preeclampsia
  • Pregnancy
  • Thrombotic thrombocytopenic purpura

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