Bleeding Complications Associated with Pregnancy with Primary Immune Thrombocytopenia: A Meta-Analysis

Introduction  Immune thrombocytopenia (ITP) during pregnancy has received little attention from researchers. Reliable information about the outcome of mothers and newborns is required to properly counsel women who are pregnant or planning to become pregnant. Our primary outcomes were the frequency and severity of maternal and neonatal bleeding events in the setting of ITP in pregnancy. Mode of delivery, neonatal thrombocytopenia, and maternal/infant mortality were secondary outcomes. Material and Methods  We comprehensively reviewed the prospective studies that enrolled ≥20 pregnant women with primary ITP. Two reviewers, blinded to each other, searched Medline and Embase up to February 2021. Meta-analyses of the maternal and newborn outcomes were performed. Weighted proportions were estimated by a random-effects model. Results  From an initial screening of 163 articles, 15 were included, encompassing 1,043 pregnancies. The weighted event rate for bleeding during pregnancy was 0.181 (95% confidence interval [CI], 0.048-0.494). Most of these were nonsevere cases. The weighted event rates were 0.053 (95% CI, 0.020-0.134) for severe postpartum hemorrhage, 0.014 (95% CI, 0.008-0.025) for intracerebral hemorrhage, and 0.122 (0.095-0.157) for severe thrombocytopenia events in neonates (platelet count <50,000/μL). There were no reliable predictors of severe neonatal thrombocytopenia. The incidence of neonatal mortality was 1.06%. There were no maternal deaths. Conclusion  Primary ITP in pregnant women is rarely associated with poor outcomes.