ITP and Pregnancy: Important Considerations, Trimester by Trimester

Whether you were diagnosed with immune thrombocytopenia (ITP) before becoming pregnant or developed it during pregnancy, living with an autoimmune condition can feel overwhelming. The good news is that most people with ITP can have a healthy pregnancy and a healthy baby.

Knowing what to expect and working closely with your hematologist and OB-GYN can help you manage ITP throughout your pregnancy. Here’s what you need to know about ITP during pregnancy, including what to expect during each trimester and how your healthcare team can help keep you and your baby healthy.

What Does It Mean To Have ITP During Pregnancy?

Immune thrombocytopenia affects about 1 in every 1,000 to 10,000 pregnancies. It can occur in people who already have ITP as well as in those who develop it for the first time during pregnancy.

Having ITP doesn’t mean you shouldn’t become pregnant. There’s no research that says you should avoid pregnancy or childbirth. However, you’ll need to take some precautions and work closely with your hematologist and OB-GYN to manage your condition and reduce the risk of complications.

This usually means regular checkups throughout your pregnancy. During your first and second trimester, your healthcare team may see you about once a month. Starting around 28 weeks, visits become more frequent, such as every two weeks, and then weekly beginning around 36 weeks.

At these visits, your healthcare team will monitor your blood pressure, check your urine for protein, and measure your platelet counts. They’ll also ask about any bleeding symptoms or other concerns. Together, this information helps them decide whether treatment is needed and plan for a safe delivery.

How Does ITP Affect Pregnancy in Each Trimester?

During pregnancy, it’s normal for platelet counts to decrease slightly because your blood volume increases. On average, platelet counts can fall by about 10 percent. This drop usually isn’t enough to cause thrombocytopenia.

For someone whose platelet count is at the lower end of the normal range — around 150,000 per microliter of blood — this normal drop could lower the count to around 135,000 per microliter. By comparison, platelet counts in people with ITP during pregnancy are often below 70,000 to 80,000 per microliter.

If your platelet count is below 150,000 per microliter but not low enough to suggest ITP, it may be due to normal changes during pregnancy. Lower platelet counts can also be caused by pregnancy-related conditions such as preeclampsia, a complication that causes high blood pressure and can affect the organs.

Gestational thrombocytopenia, the most common cause of low platelet counts during pregnancy, is another possibility. It usually develops later in pregnancy and causes only mild thrombocytopenia.

Here’s what you can expect during each trimester.

Risks of Low Platelets During Pregnancy

Because ITP affects everyone differently, your healthcare team will closely monitor your platelet count and bleeding symptoms throughout your pregnancy. Most people with ITP have healthy pregnancies and deliveries, but there are some risks to be aware of, including:

• A rare risk of an epidural hematoma (when blood collects around the spinal cord, which can cause serious nerve damage) if you receive an epidural or spinal anesthesia with a very low platelet count
• An increased risk of bleeding during delivery, especially if your platelet count is very low
• A risk that your baby will have a low platelet count at birth, although severe or life-threatening cases occur in only about 4 percent of babies born to mothers with ITP

What Are the Key Treatment Considerations During Pregnancy?

Whether you already had ITP or are newly diagnosed, your healthcare team will monitor you throughout your pregnancy to see if you need treatment. Many people don’t need treatment until later in the pregnancy, if at all.

Many health experts recommend delaying treatment with prednisone until about week 35 or 36 of pregnancy, when your healthcare team starts preparing for delivery. This approach may help reduce side effects such as diabetes, high blood pressure, and insomnia during pregnancy.

Once prednisone is started, it may continue through delivery. Afterward, it can usually be tapered as long as your platelet count is higher than 20,000 per microliter. IVIG is sometimes added if prednisone doesn’t bring your platelet count up enough.

IVIG’s effects usually last only a few weeks, so it’s often given closer to delivery to help raise platelet counts to a safe level before your baby is born. Most people with ITP won’t need treatment during pregnancy. If prednisone and IVIG don’t work well enough, your healthcare team may discuss other treatment options.

According to the journal Hematology/Oncology Clinics of North America, one study found that women who were diagnosed with ITP before becoming pregnant were less likely to need therapy than those who were newly diagnosed.

What Are the Key Delivery and Postpartum Considerations?

As you’re putting together your birth plan, your healthcare team will discuss the benefits and risks of vaginal birth and cesarean section (C-section). Sometimes, a C-section is recommended for reasons unrelated to ITP, such as if your baby is breech or you have a problem with the placenta.

In most cases, vaginal delivery is preferred when it’s safe for you and your baby. Current research doesn’t show that a planned C-section is safer than a vaginal delivery for people with ITP. Instead, the decision should be based on your individual pregnancy and any obstetric concerns.

What To Expect Postpartum

The healthcare team will usually check a newborn’s platelet count using blood from the umbilical cord. Although most babies born to mothers with ITP have normal platelet counts, this test helps identify the small number who may need closer monitoring or treatment. The risk of serious bleeding is low — about 1 percent overall — but a baby whose platelet count is below 50,000 per microliter may need treatment.

Rarely, a healthcare provider may recommend temporarily pausing breastfeeding until a baby’s platelet count improves. To maintain your milk supply, you can pump until you can start breastfeeding again. Most people with ITP can breastfeed successfully.

Keep in mind that you’re recovering, too, so be kind to yourself. Give yourself time to rest, stay hydrated, and keep your follow-up appointments. If you notice new symptoms, have heavier bleeding than expected, or are having trouble managing everyday activities, let your healthcare team know and ask for help.

Your healthcare team can evaluate any new symptoms, adjust your care if needed, and connect you with support groups, mental health professionals, or other resources to support your recovery.