Abstract Number: OC 53.3
Meeting: ISTH 2021 Congress
Theme: Platelet Disorders, von Willebrand Disease and Thrombotic Microangiopathies » ADAMTS13 and TTP
Background: Pregnancy may precipitate immune thrombotic thrombocytopenic purpura (iTTP) and iTTP may recur with subsequent pregnancies. Other than relapse, the maternal and fetal outcomes of subsequent pregnancy in women with prior iTTP are not well documented.
Aims: We conducted this retrospective cohort study to evaluate pregnancy outcomes in women with iTTP from the Johns Hopkins Thrombotic Microangiopathy Cohort.
Methods: iTTP was diagnosed on the basis of ADAMTS13 <10% at initial diagnosis or relapse. Outcomes were summarized as counts and proportions.
Results: Of the 168 patients in the registry, 102 were females of childbearing age (15-49 years) at initial diagnosis of iTTP and were included in the analysis. Twenty-one pregnancies were recorded; 7 during the presenting episode of TTP were excluded and the remaining 14 pregnancies (in 9 women) that occurred after the initial diagnosis of TTP were included in the analysis. Median duration from TTP diagnosis to pregnancy was 4.5 years. Maternal outcomes: TTP relapse occurred in 9 (64%) pregnancies in 5 women. Four (29%) pregnancies were complicated by pre-eclampsia or HELLP syndrome. No pregnancy was complicated by venous thrombosis. Fetal outcomes: Fetal loss occurred in 9 (64%) pregnancies at a median of 7.5 (IQR: 4.75-11.5) weeks of gestation including 6 in the setting of TP relapse and 3 pregnancies that were electively terminated due to concern for TTP recurrence. Of 3 live births, 2 were premature.
Conclusions: Discussion: Pregnancy in women with prior TTP is associated with high risk of TTP relapse and fetal loss. Preeclampsia/HELLP syndrome are also more common than the general US population (29% vs. 5%). The incidence of venous thrombosis does not appear to be increased. The majority of these pregnancies occurred prior to routine monitoring of ADAMTS13 during remission. Whether ADAMTS13 monitoring and preemptive therapy consistently improves pregnancy outcomes needs to be evaluated prospectively.
| Patient | Race | Age at TTP dx | Pregnancy Number | Age at Pregnancy | TTP relapse (gestational age at relapse) | Preeclampsia /HELLP | Fetal Loss/Miscarriage (gestational age) | C-section |
| 1 | African American | 17 | 1 | 18 | Y (3) | N | Y(4) | N |
| 2 | 22 | Y(23) | N | Y(23) | N | |||
| 2 | African American | 19 | 1 | 21 | Y(9) | N | Y(9) | N |
| 2 | 22 | Y(8) | N | Y(8) | N | |||
| 3 | 24 | Y(7) | N | ongoing pregnancy | ongoing pregnancy | |||
| 3 | African American | 21 | 1 | 28 | N | Y | Y(GA unknown) | N |
| 2 | 30 | N | N | Y(7) | N | |||
| 4 | Caucasian | 26 | 1 | 32 | Y(28+3) | Y | N | Y |
| 5 | African American | 1 | 30 | y(30) | N | Y(4) | N | |
| 2 | 36 | Y(30) | Y | N | Y | |||
| 6 | Caucasian | 28 | 1 | 36 | N | N | unknown | N |
| 7 | African American | 29 | 1 | 30 | N | N | N | N |
| 8 | Caucasian | 31 | 1 | 32 | Y(19) | Y | Y(19) | N |
| 9 | African American | 33 | 1 | 36 | N | N | Y(5) | N |
Pregnancy outcomes in women with a history of immune TTP
To cite this abstract in AMA style:
Brown J, Hussain S, Mazepa M, Moliterno A, Chaturvedi S. Outcomes of Subsequent Pregnancy in Women with a History of Immune Thrombotic Thrombocytopenic Purpura [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/outcomes-of-subsequent-pregnancy-in-women-with-a-history-of-immune-thrombotic-thrombocytopenic-purpura/. Accessed December 7, 2021.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/outcomes-of-subsequent-pregnancy-in-women-with-a-history-of-immune-thrombotic-thrombocytopenic-purpura/