Maternal Bleeding Outcomes in Pregnant Women With Immune Thrombocytopenia (ITP): A National Database Study

Immune thrombocytopenic purpura (ITP) is a hematological disorder commonly affecting women of reproductive age, but limited studies explore the maternal morbidity in pregnant patients with ITP. This study aimed to investigate whether pregnant women with ITP are at higher risk of bleeding complications during and after delivery.

We analyzed the National Inpatient Sample (NIS) database for pregnant patients admitted for delivery from 2016 to 2018. Patients were stratified into two cohorts: those with ITP and those without. The two cohorts were matched in a 1:1 ratio based on multiple factors. Univariate and binary logistic regression analyses were used to evaluate outcomes, including intrapartum hemorrhage, postpartum hemorrhage, transfusion requirements, and mode of delivery.  Results: Among 207,511 pregnant patients, 215 had ITP. Intrapartum hemorrhage was more frequent in the ITP cohort, though not statistically significant (0.9% vs. 0.3%; p=0.107). In contrast, postpartum hemorrhage was significantly higher in patients with ITP (10.2% vs. 4.4%; p<0.001). Transfusion requirements were similar between the two groups (2.3% vs. 1.4%; p=0.223). Mode of delivery did not differ significantly between cohorts (p=0.883), though patients with ITP requiring platelet transfusions were more likely to undergo C-section (83.3% vs. 51.5%; p=0.03). Intravenous immunoglobulin use did not significantly impact delivery mode (p=0.516).  Conclusion: Pregnant patients with ITP have a significantly higher risk of postpartum hemorrhage, emphasizing the need for vigilant monitoring and proactive management. These findings highlight the importance of heightened peripartum surveillance and individualized management strategies to mitigate bleeding risk in this population.