Gonzalez-Porras Jose Ramon, Palomino Danylo, Vaquero-Roncero Luis Mario, Bastida Jose María
Department of Hematology, Instituto de Investigación Biomédica de Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca (CAUSA), Universidad de Salamanca (USAL), Salamanca, Spain.
Department of Anesthesiology, Reanimation and Pain Medicine, Instituto de Investigación Biomédica de Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca (CAUSA), Universidad de Salamanca (USAL), Salamanca, Spain.
TH Open. 2022 Aug 29;6(3):e230-e237. doi: 10.1055/a-1837-7581. eCollection 2022 Jul.
Immune thrombocytopenia (ITP) during pregnancy has received little attention from researchers. Reliable information about the outcome of mothers and newborns is required to properly counsel women who are pregnant or planning to become pregnant. Our primary outcomes were the frequency and severity of maternal and neonatal bleeding events in the setting of ITP in pregnancy. Mode of delivery, neonatal thrombocytopenia, and maternal/infant mortality were secondary outcomes. We comprehensively reviewed the prospective studies that enrolled ≥20 pregnant women with primary ITP. Two reviewers, blinded to each other, searched Medline and Embase up to February 2021. Meta-analyses of the maternal and newborn outcomes were performed. Weighted proportions were estimated by a random-effects model. From an initial screening of 163 articles, 15 were included, encompassing 1,043 pregnancies. The weighted event rate for bleeding during pregnancy was 0.181 (95% confidence interval [CI], 0.048-0.494). Most of these were nonsevere cases. The weighted event rates were 0.053 (95% CI, 0.020-0.134) for severe postpartum hemorrhage, 0.014 (95% CI, 0.008-0.025) for intracerebral hemorrhage, and 0.122 (0.095-0.157) for severe thrombocytopenia events in neonates (platelet count <50,000/μL). There were no reliable predictors of severe neonatal thrombocytopenia. The incidence of neonatal mortality was 1.06%. There were no maternal deaths. Primary ITP in pregnant women is rarely associated with poor outcomes.
孕期免疫性血小板减少症（ITP）一直未受到研究人员的太多关注。为了给正在怀孕或计划怀孕的女性提供恰当的咨询建议，需要有关母亲和新生儿结局的可靠信息。我们的主要结局是孕期ITP情况下孕产妇和新生儿出血事件的频率和严重程度。分娩方式、新生儿血小板减少症以及母婴死亡率为次要结局。
我们全面回顾了纳入≥20例原发性ITP孕妇的前瞻性研究。两位相互 blinded 的审阅者检索了截至2021年2月的Medline和Embase数据库。对孕产妇和新生儿结局进行了荟萃分析。采用随机效应模型估计加权比例。
从对163篇文章的初步筛选中，纳入了15篇，涵盖1043例妊娠。孕期出血的加权事件发生率为0.181（95%置信区间[CI]，0.048 - 0.494）。其中大多数为非严重病例。严重产后出血的加权事件发生率为0.053（95%CI，0.020 - 0.134），脑出血为0.014（95%CI，0.008 - 0.025），新生儿严重血小板减少事件（血小板计数<50,000/μL）为0.122（0.095 - 0.157）。没有严重新生儿血小板减少症的可靠预测因素。新生儿死亡率为1.06%。没有孕产妇死亡。
孕妇原发性ITP很少与不良结局相关。
