(787) The Association Between Maternal Immune Thrombocytopenia Purpura (ITP) and Adverse Perinatal Outcomes

Immune thrombocytopenia purpura (ITP) is a common cause of thrombocytopenia in pregnancy, however, limited data exist on perinatal complications associated with maternal ITP. This study aimed to evaluate the impact of maternal ITP on adverse perinatal outcomes.

Study Design: This is a retrospective cohort study of linked vital statistics and hospital discharge data among singleton, non-anomalous births delivered between 23-42 weeks in California (2008-2020). Patients were stratified by diagnosis of ITP. Maternal outcomes included gestational hypertension, preeclampsia, gestational diabetes (GDM), preterm delivery < 37 weeks, postpartum hemorrhage, and severe maternal morbidity (SMM). Neonatal outcomes included cephalohematoma, intraventricular hemorrhage, and congenital thrombocytopenia. We utilized chi-squared tests for univariate analyses and multivariable logistic regression analyses to evaluate the association of ITP with outcomes.

Results: Among 5,061,386 patients in our final sample, 4,346 (90 cases per 1000 deliveries) had a diagnosis of ITP. Compared to patients without ITP, individuals with ITP had increased rates of gestational hypertension (4.21% vs 3.44%, aOR=1.18, 95% CI: 1.02-1.37), preeclampsia (7.23% vs 3.80%, aOR=1.74, 95% CI: 1.56-1.95), GDM (11.99% vs 9.58%, aOR=1.98, 95% CI: 1.10-1.31), preterm delivery < 37 weeks (10.47% vs 6.39%, aOR=1.69, 95% CI: 1.54-1.86), postpartum hemorrhage (9.27% vs 3.37%, aOR=2.63, 95% CI: 2.38-2.91), and SMM (11.64% vs 1.18%, aOR=9.21, 95% CI: 8.42-10.07) (Table 1). Neonates born to mothers with ITP had higher rates of intraventricular hemorrhage and congenital thrombocytopenia, compared to those without ITP. These associations remained in sub-analyses of vaginal versus cesarean deliveries only (Table 2).

Conclusion:

Maternal ITP was associated with increased rates of gestational hypertension, preeclampsia, GDM, preterm delivery < 37 weeks, postpartum hemorrhage, and SMM. Further research to elucidate specific aspects of patients with ITP and perinatal complications will be important to identify those that may benefit from more aggressive interventions.