Estimation of the risk of thrombocytopenia in the offspring of pregnant women with presumed immune thrombocytopenic purpura

Article Abstract:

Immune thrombocytopenic purpura is a disease which occurs commonly in young women. It is characterized by a reduction in the number of thrombocytes, or platelets, and a concomitant increase in hemorrhages, hence the purpura, or bruised appearance. In pregnancy, this disorder can be especially treacherous and may cause cerebral hemorrhage of the newborn. Unfortunately, it is not easy to identify which pregnancies are at high risk. There is little correlation between the platelet counts of a mother and newborn. Furthermore, mild reductions in platelet counts are a common feature of normal pregnancy. However, in a study of 162 pregnant women with immune thrombocytopenic purpura, it was found that, while it is not yet possible to identify infants at high risk, it is possible to determine that some infants have a low risk and do not require special concern. In the study population, 88 women had a history of thrombocytopenia prior to pregnancy; 18 of their infants had severe thrombocytopenia at birth. Of the remaining 74 women, who only developed thrombocytopenia during pregnancy, none had infants with the disorder. Furthermore, it was observed that all 18 infants with severe thrombocytopenia were among the 70 babies born to women with circulating antibodies to platelets. None of the remaining 18 infants, who were born to mothers with a history of the disease, but without antibodies to platelets, was affected. The results suggest that the risk of thrombocytopenia in infants is minimal in the absence of a maternal history of thrombocytopenic purpura prior to pregnancy, or in the absence of maternal antibodies to platelets. (Consumer Summary produced by Reliance Medical Information, Inc.)

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"Gestational" thrombocytopenia: a plea for conservative management

Article Abstract:

In a report published in the July 26, 1990, issue of The New England Journal of Medicine, Philip Samuels et al. report that there is little risk of serious complications developing in the newborns of many women with immune thrombocytopenic purpura. Since immune thrombocytopenic purpura, or ITP, can cause cerebral hemorrhage in newborns, some clinicians have advocated aggressive intervention in the birth when the pregnant mother has ITP. Over 11 years, the researchers gathered information which demonstrated that the risk to the infant was not equal among all pregnant women with ITP. Infants born to mothers without a past history of ITP were found to have little risk of complications during birth, despite maternal ITP during pregnancy. Furthermore, even among women with a history of ITP, newborns of mothers without antibodies to platelets had little risk of complications. Although there still is a need for the early detection of infants at high risk for thrombocytopenia, it now seems that aggressive intervention in all cases of pregnant women with immune thrombocytopenic purpura is simply not appropriate. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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Plasma concentration of endothelin-1 in women with cocaine-associated pregnancy complications

Article Abstract:

Pregnant women who abuse cocaine may have increased blood levels of endothelin-1. Endothelin-1 is a substance released after injury to the endothelium, or the lining of blood vessels. Among 118 women whose blood levels of endothelin-1 were measured, 30 were pregnant and suffering from severe cocaine intoxication, 32 were pregnant with preeclampsia, or pregnancy-induced hypertension, 14 were pregnant with chronic hypertension, 26 were pregnant without any complications and 16 were not pregnant. The average blood level of endothelin-1 among women who abused cocaine was similar to that of women suffering from preeclampsia. Women who abused cocaine had significantly higher blood levels of endothelin-1 than those with chronic hypertension or uncomplicated pregnancies. Women with uncomplicated pregnancies had blood levels of endothelin-1 that were similar to those of non-pregnant women.

Health aspects, Measurement, Endothelin, Cocaine, Drug abuse in pregnancy

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