Idiopathic thrombocytopenic purpura (ITP) is an immune-mediated hematologic disorder caused by a low blood platelet count (thrombocytopenia). Antiplatelet antibodies act against the platelets resulting in platelet destruction by the spleen. In adults, the clinical features of ITP often have an insidious onset and are highly variable, ranging from no symptoms, mild bruising, to mucosal bleeding, and skin discolorations. Management of ITP during pregnancy is complex because of large differences between maternal and fetal platelet counts. The circulating antibodies can cross the placenta and cause a neonatal passive immune thrombocytopenia that may increase the risk of cerebral haemorrhage in the newborn infant. For this reason, it seems reasonable that cesarean section delivery is safer for the infant than vaginal delivery yet the mode of delivery may not affect the rate of haemorrhage. Many different pharmacological interventions are used for treating this medical disorder and treatment for ITP in pregnant women is not standardised. Some of these drugs have potential side effects for pregnant women and some can cause fetal malformation.
Current evidence from one randomised controlled trial indicates that betamethasone does not reduce the risk of neonatal thrombocytopenia and neonatal bleeding in ITP during pregnancy when compared to no medication. We could not identify evidence on other medical treatments for ITP during pregnancy.
This review included one controlled trial in which 38 women (41 pregnancies) were randomised, with only 26 women (28 pregnancies) being analysed. There was also a severe imbalance between comparison groups. Giving the mother betamethasone (1.5 mg/day) did not result in a difference in the neonatal platelet count at birth and at the first week of life. The study reported that the maternal platelet count of peripheral blood did not change significantly during the study period for both the betamethasone and no treatment groups. Maternal postpartum haemorrhage and neonatal intracranial haemorrhage were not studied. Nor were maternal clinical and pregnancy outcomes reported. The researchers used no treatment in the control group, which may have increased the risk of performance bias in the trial.