Transfusion · 2025
Fetal and maternal morbidity in pregnant patients with thrombotic thrombocytopenic purpura: A Nationwide analysis.
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Mahmoud Amir A, Eltaher Basant, Shah Purva, Antun Ana, Masias Camila, Sridharan Meera, Chaturvedi Shruti
Аннотация
BACKGROUND: Pregnancy is a known trigger for thrombotic thrombocytopenia purpura (TTP); however, there is limited data on the impact of a TTP diagnosis on pregnancy outcomes.
STUDY DESIGN: We used retrospective data from the National Inpatient Sample database to identify all hospital admissions of pregnant patients (≥18 years), with and without TTP from 2012 to 2021 using ICD-9/10 codes. To describe the impact of TTP on maternal and fetal morbidity, we identified different morbidity indicators using standard CDC definitions.
RESULTS: We identified 7,397,411 pregnancy hospitalizations with a mean age of 29 years. Of these, 233 had TTP, with 73 receiving therapeutic plasma exchange (TPE) during admission, which was treated as a surrogate for active TTP. Severe maternal morbidity rates were several-fold higher in women with TTP (133 per 100 admissions; 95% CI 112-155) compared to those without TTP (6.75 per 100 admissions; 95% CI 6.74-6.79) (p < 0.001). This included significantly higher rates of acute myocardial infarction, acute renal failure, acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), pulmonary edema/acute heart failure, puerperal cerebrovascular disorders, sepsis, shock, air/thrombotic embolism, blood transfusion, and mechanical ventilation. Amongst fetal outcomes, fetal growth restriction (6.9% vs. 2.3%) was more common in TTP, while there was no statistical difference between the two groups in rates of preterm delivery. In the multivariate analysis, Charlson comorbidity index (CCI) ≥ 1 and age ≥ 35 years were associated with higher likelihood of morbidity.
CONCLUSION: Pregnancy associated with TTP is associated with inferior maternal and fetal health outcomes.
STUDY DESIGN: We used retrospective data from the National Inpatient Sample database to identify all hospital admissions of pregnant patients (≥18 years), with and without TTP from 2012 to 2021 using ICD-9/10 codes. To describe the impact of TTP on maternal and fetal morbidity, we identified different morbidity indicators using standard CDC definitions.
RESULTS: We identified 7,397,411 pregnancy hospitalizations with a mean age of 29 years. Of these, 233 had TTP, with 73 receiving therapeutic plasma exchange (TPE) during admission, which was treated as a surrogate for active TTP. Severe maternal morbidity rates were several-fold higher in women with TTP (133 per 100 admissions; 95% CI 112-155) compared to those without TTP (6.75 per 100 admissions; 95% CI 6.74-6.79) (p < 0.001). This included significantly higher rates of acute myocardial infarction, acute renal failure, acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), pulmonary edema/acute heart failure, puerperal cerebrovascular disorders, sepsis, shock, air/thrombotic embolism, blood transfusion, and mechanical ventilation. Amongst fetal outcomes, fetal growth restriction (6.9% vs. 2.3%) was more common in TTP, while there was no statistical difference between the two groups in rates of preterm delivery. In the multivariate analysis, Charlson comorbidity index (CCI) ≥ 1 and age ≥ 35 years were associated with higher likelihood of morbidity.
CONCLUSION: Pregnancy associated with TTP is associated with inferior maternal and fetal health outcomes.