Immune thrombocytopenia and pregnancy: an exposed/nonexposed cohort study

被引：19

作者：

Guillet, Stephanie ^{[1
,35
]}

Loustau, Valentine ^{[1
,2
,35
]}

Boutin, Emmanuelle ^{[3
,4
,35
]}

Zarour, Anissa ^{[3
,35
]}

Comont, Thibault ^{[5
,35
]}

Souchaud-Debouverie, Odile ^{[6
,35
]}

Chalumeau, Nathalie Costedoat ^{[7
,8
,35
]}

Pan-Petesch, Brigitte ^{[9
,35
]}

Gobert, Delphine ^{[10
,35
]}

Cheze, Stephane ^{[11
]}

Viallard, Jean Francois ^{[12
,35
]}

Morin, Anne -Sophie ^{[13
,35
]}

Sauvetre, Gaetan ^{[14
,35
]}

Cliquennois, Manuel ^{[15
,35
]}

Royer, Bruno ^{[16
,17
,35
]}

Masseau, Agathe ^{[18
,35
]}

Terriou, Louis ^{[19
,35
]}

Fieschi, Claire ^{[20
,35
]}

Lambotte, Olivier ^{[21
,35
]}

Girault, Stephane ^{[22
,35
]}

Lioger, Bertrand ^{[23
,35
]}

Audia, Sylvain ^{[24
,35
]}

Sacre, Karim ^{[25
,26
,35
]}

Lega, Jean Christophe ^{[27
,28
,35
]}

Langlois, Vincent ^{[29
,35
]}

Benachi, Alexandra ^{[30
,35
]}

Orvain, Corentin ^{[31
,35
]}

Devidas, Alain ^{[32
,35
]}

Humbert, Sebastien ^{[33
,35
]}

Gambier, Nicolas ^{[34
,35
]}

Ruivard, Marc ^{[35
]}

Zarrouk, Virginie ^{[35
]}

Ebbo, Mikael ^{[35
,36
]}

Willems, Lise ^{[35
,37
]}

Segaux, Lauriane ^{[35
,38
]}

Mahevas, Matthieu ^{[1
,35
]}

Haddad, Bassam ^{[35
,39
]}

Michel, Marc ^{[1
,35
]}

Poitrine, Florence Canoui ^{[3
,35
,38
]}

Godeau, Bertrand ^{[1
,35
,40
]}

机构：

[1] Univ Paris Est Creteil, Hop Henri Mondor, Assistance Publ Hop Paris AP HP, Ctr Natl Reference Cytopenies Autoimmunes Adulte,S, Creteil, France

[2] Ctr Hosp Alpes Leman, Serv Med Interne, Contamine Sur Arve, France

[3] Hop Univ Henri Mondor, AP HP, Unite Rech Clin URC Mondor, Creteil, France

[4] Univ Paris Est Creteil, Equipe CEpiA Clin Epidemiol & Ageing, INSERM, IMRB, Creteil, France

[5] CHU Toulouse, Serv Med Interne & Immunopathol, IUCT Oncopole, Toulouse, France

[6] CHU Poitiers, Serv Med Interne, Poitiers, France

[7] Hop Cochin, AP HP, Ctr Reference Malad Autoimmunes & Syst Rares, Serv Med Interne, Paris, France

[8] Univ Paris, Hop Hotel Dieu, Ctr Clin Epidemiol, Ctr Res Epidemiol & Stat, Paris, France

[9] Univ Brest, Serv Hematol, CHU Brest, Brest, France

[10] Sorbonne Univ, Hop St Antoine, AP HP, Serv Med Interne, Paris, France

[11] Ctr Hosp Caen Normandie, Inst Hematol Basse Normandie, Caen, France

[12] Univ Bordeaux, Hop Haut Leveque, Serv Med Interne, Bordeaux, France

[13] Hop Jean Verdier, AP HP, Serv Med Interne, Bondy, France

[14] Univ Rouen, Hop Charles Nicolle, Serv Med Interne, Rouen, France

[15] Hop St Vincent De Paul, GH Inst Catholique Lille, Onco Hematol Adulte, Lille, France

[16] Hop St Louis, Serv Immuno Hematol, Paris, France

[17] CHU Amiens, Hematol Clin, Amiens, France

[18] CHU Nantes, Serv Med Interne, Nantes, France

[19] Univ Lille, Serv Med Interne & Immunol Clin, CHU Lille, Lille, France

[20] Hop St Louis, AP HP, Serv Immunol Clin, Paris, France

[21] Univ Paris Saclay, Hop Bicetre, Serv Med Interne & Immunol Clin, Le Kremlin Bicetre, France

[22] CHU Dupuytren, Serv Hematol Clin & Therapie Cellulaire, Limoges, France

[23] CH Simone Veil, Serv Med Interne, Blois, France

[24] CHU Dijon Bourgogne, Hop Francois Mitterrand, Ctr Reference Constitut Cytopenies Autoimmunes, Serv Med Interne & Immunol Clin, Dijon, France

[25] Hop Bichat Claude Bernard, Serv Med Interne, AP HP, Paris, France

[26] Univ Paris, Ctr Rech Inflammat, INSERM UMR1149, CNRS ERL 8252,Lab Excellence Inflamex, Paris, France

[27] Univ Lyon, Hop Lyon Sud, Serv Med Interne & Med Vasc, Hosp Civils Lyon, Lyon, France

[28] Univ Lyon 1, Lab Biometrie & Biol Evolut, CNRS, UMR 5588, Lyon, France

[29] Univ Paris Saclay, Hop Antoine Beclere, AP HP, Serv Obstetr & Gynecol, Clamart, France

[30] Univ Angers, Hop Anger, Serv Hematol, INSERM,CRCINA, Angers, France

[31] CH Sud Francilien, Serv Hematol Clin, Corbeil Essonnes, France

[32] CHU Besancon, Serv Med Interne, Besancon, France

[33] CH Gen Delafontaine, Serv Med Interne, St Denis, France

[34] CHU Estaing, Serv Med Interne, Clermont Ferrand, France

[35] Hop Beaujon, AP HP, Serv Med Interne, Clichy, France

[36] Univ Aix Marseille, Hop Conception, AP HP, Serv Med Interne, Marseille, France

[37] Hop Cochin, Serv Hematol Clin, Paris, France

[38] Hop Univ Henri Mondor, AP HP, Serv St Publ, Creteil, France

[39] Univ Paris Est Creteil, Inst Mondor Rech Biomed IMRB, Ctr Hosp Paris Est Creteil, INSERM U955,Serv Gynecol Obstet & Med Reprod, Creteil, France

[40] Serv Med Interne, 51 Ave Marechal Lattre Tassigny, F-94000 Creteil, France

来源：

BLOOD | 2023年 / 141卷 / 01期

关键词：

SEVERE NEONATAL THROMBOCYTOPENIA; MATERNAL CHARACTERISTICS; PERINATAL HEALTH; PURPURA; WOMEN; EPIDEMIOLOGY; RISK; DEFINITIONS; MANAGEMENT; NATIONWIDE;

D O I：

10.1182/blood.2022017277

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

The risk of immune thrombocytopenia (ITP) worsening during pregnancy and neonatal ITP (NITP) have never been prospectively studied. We included 180 pregnant and 168 nonpregnant women with ITP in a prospective, multicenter, observational cohort study. A total of 131 pregnant women with ITP were matched to 131 nonpregnant women with ITP by history of splenectomy, ITP status (no response, response, complete response), and duration. Groups were followed for 15 months. The primary outcome was the first occurrence of ITP worsening defined by a composite end point including bleeding events and/or severe thrombocytopenia (<30 x 10(9)/L) and/or ITP treatment modification. We also studied the recurrence of ITP worsening and the incidence of NITP and risk factors. The first occurrence of ITP worsening did not differ between pregnant and nonpregnant women with ITP (53.4 per 100 person-years [95% confidence interval {CI}, 40.8-69.9] vs 37.1 [95% CI, 27.5-50.0]; hazard ratio {HR}, 1.35 [95% CI, 0.89-2.03], P = .16). Pregnant women with ITP were more likely to have recurrence of severe thrombocytopenia and treatment modification (HR, 2.71 [95% CI, 1.41-5.23], P = .003; HR, 2.01 [95% CI, 1.14-3.57], P = .017, respectively). However, recurrence of severe bleeding events was not different between groups (P = .4). Nineteen (14%) neonates showed NITP <50 x 10(9)/L. By multivariable analysis, NITP was associated with a previous offspring with NITP and maternal platelet count <50 x 10(9)/L within 3 months before delivery (adjusted odds ratio, 5.55 [95% CI, 1.72-17.89], P = .004 and 4.07 [95% CI, 1.41-11.73], P = .009). To conclude, women with ITP do not increase their risk of severe bleeding during pregnancy. NITP is associated with NITP history and the severity of maternal ITP during pregnancy. These results will be useful for counseling women with ITP.

引用

页码：11 / 21

页数：11

共 31 条

[1] Idiopathic thrombocytopenic purpura in pregnancy:: a single institutional experience with maternal and neonatal outcomes [J].