Evaluation of glucocorticoid compared with immunoglobulin therapy of severe immune thrombocytopenia during pregnancy: Response rate and complication.

PROBLEM: Evaluate the response rate of glucocorticoid (GC) and/or immunoglobulin (IVIg) therapy in severe thrombocytopenia of immune thrombocytopenia (ITP) pregnant patients and the influence on maternal and neonatal outcomes.

METHOD OF STUDY: This is a prospective observational cohort study. Pregnant ITP patients with platelet count less than 30 × 109 /L and their newborn infants participated in this research. Over a 3-year period, 87 patients were allocated to 4 groups: group 1 (n = 18) were treated by oral prednisone, group 2 (n = 20) with IVIg, group 3 (n = 22) with prednisone/methlyprednisone plus IVIg, and group 4 were non-treatment controls (n = 27). Diagnosis and therapy were based on guideline from the 2011 American Society of Hematology criteria, and the initial dose of prednisone was 1 mg/kg day. Their newborns were followed up to 1 year old.

RESULTS

The response rate among patients who ever received prednisone therapy was 35.5% (11/31) overall, while the IVIg response rate was 55.9% (19/34). The incidence of pregnancy induced hypertension in GC therapy group was significantly higher than controls (22.2% and 13.6% vs 0%). There was no significant difference in neonatal outcomes in treatment groups in comparison with controls. The rate of Neonatal follow-up within 1 year old was 63%, and there is no evidence indicated intrauterine GC exposure influence the growth and development.

CONCLUSION

GC therapy of 1 mg/kg for ITP patients during pregnancy is less efficiency than non-pregnant population and increases the incidence of hypertensive disorders. The use of lower starting doses of prednisone may be suggested for use in pregnancy.