Maternal and fetal outcomes of pregnancy occurring after a diagnosis of immune-mediated thrombotic thrombocytopenic purpura
Maternal and fetal outcomes of pregnancy occurring after a diagnosis of immune-mediated thrombotic thrombocytopenic purpura
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DOI：
10.1007/s00277-022-04936-2
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发表时间：
2022-08-06
影响因子：
3.5
通讯作者：
Chaturvedi, Shruti
中科院分区：
文献类型：
--
作者：
Brown, Jenna;Potugari, Bindu;Chaturvedi, Shruti
妊娠是免疫性血栓性血小板减少性紫癜（iTTP）首次发作或复发的明确触发因素。诊断为iTTP后后续妊娠的其他结局描述较少。我们进行了这项回顾性队列研究，以评估来自约翰霍普金斯血栓性微血管病队列的既往iTTP女性的妊娠结局和胎儿结局。在队列中的168名妇女中，102名在诊断时处于生育年龄。分析中纳入了14例（9例女性）在首次iTTP发作后发生的妊娠。9例（64%）妊娠发生iTTP复发。在9例复发病例中，2名女性发生5例复发。7例妊娠（50%）在iTTP复发的情况下以胎儿死亡或流产结束，3例因担心复发而选择性终止妊娠。4例妊娠（超过20周的8例中有50%）并发先兆子痫或HELLP综合征，比一般人群高出10倍以上。没有发生产妇死亡。只有4例怀孕导致活产，其中2例早产。既往患有iTTP的女性妊娠与iTTP复发和胎儿丢失的重大风险相关。子痫前期和HELLP综合征也比一般人群更常见。ADAMTS13监测和抢先治疗可能改善妊娠结局，需要前瞻性评估。
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.