What You Need to Know About ITP Chronic During Pregnancy

Pregnancy leads to a variety of changes in a person’s body. Common symptoms of pregnancy such as morning sickness, weight gain, cravings for sour and sweet foods, etc. However, if a person experiences conditions like decreased immune platelet count or spontaneous decreased platelet count bleeding, this is a serious issue. This condition is called ITP. When chronic ITP occurs during pregnancy, it can increase the risk of bleeding, directly affecting childbirth and the health of the baby. Nevertheless, the mother should not worry too much. The important thing is to equip oneself with sufficient knowledge, have regular check-ups according to the doctor’s appointment schedule, and come for a check-up when there are any unusual symptoms.

According to a 2018 study from the New England Journal of Medicine conducted with over 7,000 childbirths, pregnancy reduces the platelet count or enhances blood clotting ability to prevent excessive bleeding. The study shows that the average platelet count in pregnant women during the first trimester is 251,000 – within the normal range of 150,000 to 450,000 platelets per microliter of blood.

Although a decrease in platelet count during pregnancy may be normal, if a woman has chronic ITP, the problem becomes more serious. In this case, the doctor will monitor the platelet count every month during the first and second trimesters, and when entering the third trimester, the test will be conducted every 2 weeks until successful childbirth.

Here are common symptoms in people with ITP:

• Bleeding gums
• Rash with small spots on the legs (also called petechiae)
• Unexplained bleeding from the gums
• Appearance of unexplained bruises
• Presence of blood in stool or urine

Note that the above symptoms are not accurate indicators that a person has chronic ITP. Accurate results need to be based on tests prescribed by a doctor.

The condition of chronic ITP in mothers directly affects the fetus’s body

There is no evidence to show whether vaginal delivery is safer than cesarean delivery and vice versa. However, for those who are about to give birth with a low platelet count, they are at risk and need to be closely monitored to determine the appropriate plan.

Cindy Neunert, MD, a hematologist-oncologist at Columbia University, states that in the weeks before giving birth, doctors usually prescribe taking at least 50,000 platelets per microliter of blood to reduce the risk of excessive bleeding. However, some studies suggest that when the body lacks enough platelets, it can increase the risk of severe bleeding around the spine after epidural anesthesia. Those with severe low platelet counts may not be able to have epidural anesthesia, giving them fewer options for pain control. After birth, babies will also have their blood taken from the umbilical cord to test the platelet count. However, even if the newborn has a low platelet count, it will naturally recover.

In another aspect, doctors believe that when a mother has chronic ITP during pregnancy, breastfeeding can transmit anti-platelet antibodies from the mother to the baby. However, this does not mean that the baby has to fully use formula milk. Doctors can still apply some methods to help the baby continue to use breast milk without being greatly affected by ITP.

Breastfeeding can lead to the transmission of anti-platelet antibodies from mother to child

Can chronic ITP during pregnancy be treated?

Neil Morganstein, MD, a hematologist and oncologist at the Carol G. Simon Cancer Center at Overlook Medical Center, states that most people with chronic ITP do not need treatment while pregnant. However, if the platelet count drops below a safe level, they still need medical intervention.

The most commonly applied treatment method for chronic ITP is using corticosteroids. This is a way to increase the platelet count safely, without affecting the mother’s body and the fetus. However, no matter what method is used, the patient may still encounter certain risks that are difficult to predict.

Another treatment method that experts often consider safe during pregnancy is intravenous immunoglobulin therapy (IVIG) – receiving antibodies from donated serum. This can quickly increase the platelet count. Therefore, this method is often applied in emergency cases.

Depending on the specific condition, doctors may require pregnant women to use different medications to minimize the ITP condition

In addition to the above two options, some proposed solutions include: Using rituximab immune suppressants to prevent the body from destroying too many platelets, but it can cross the placenta and affect the fetus so it is not widely applied.

If you have severe ITP and current treatment methods are ineffective, spleenectomy to reduce platelet destruction will be recommended by doctors. Surgeons can perform spleen removal surgery in the second trimester.

Regardless of the severity of the ITP condition, patients need to regularly monitor their counts, have regular check-ups, and maintain a good lifestyle, sufficient sleep, and adequate vitamin supplementation.