Pregnancy brings along a slew of changes to your body—no surprises there! While most pregnant people already know about the obvious stuff (morning sickness, weight gain, pickle cravings that feel impossible to fully satisfy), there are additional changes to keep in mind if you have a health condition like chronic immune thrombocytopenia (or idiopathic thrombocytopenic purpura, also known as ITP). Dealing with chronic ITP in pregnancy can make the symptoms of this bleeding and bruising disorder more intense and, without monitoring and treatment, potentially impact your delivery or your baby’s health. This doesn’t mean you’re destined to have health scares or complications if you’re pregnant with chronic ITP—just that it’s worth preparing yourself with information and having a thorough chat with your doctor so you and your baby can stay as safe as possible. Here’s what you need to know if you’re pregnant with chronic ITP.
Pregnancy can lower your platelet count even if you don’t have chronic ITP.
It’s normal for pregnancy to reduce a person’s level of platelets, or the cells that help your blood clot to prevent excessive bleeding, according to a 2018 study from the New England Journal of Medicine, which looked at data on more than 7,000 deliveries. The research showed that the mean platelet count in pregnant participants during their first trimester was 251,000—still in the 150,000 to 450,000 platelets per microliter of blood that Johns Hopkins Medicine considers normal, but about 22,000 platelets per microliter lower than that of non-pregnant women in the study.
Even though it can be normal to experience a drop in platelets during pregnancy, this reduction can be worrisome if you have chronic ITP, per the Merck Manual. Your doctor will probably want to check your platelet count regularly to make sure it doesn’t dip to a dangerously low level. For instance, they may check your platelet count once a month during your first and second trimesters, then every two weeks after 28 weeks, and weekly once you pass the 36-week mark.
It’s smart to look out for any new or worse ITP symptoms in pregnancy.
“The course of ITP in pregnancy is variable, and there is no set rule for how pregnancy affects a patient’s disease,” Lisa Zuckerwise, M.D., assistant professor of obstetrics and gynecology at Vanderbilt University Medical Center, who specializes in treatment of pregnant people with chronic ITP, tells SELF.
Some people find that pregnancy makes no impact on their symptoms of chronic ITP. But if you start noticing symptoms you haven’t experienced in a while (or ever!), that might be a sign that you need treatment (more on that below). Keep an eye out for some of the most common symptoms of chronic ITP, including:
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Random nosebleeds
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A rash made up of tiny spots on your legs (also known as petechiae)
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Bleeding from your gums from no known cause (i.e., flossing)
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Mysterious bruises
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Blood in your pee or poop
While these symptoms are definitely all worth noting, they’re not all a definitive sign that your chronic ITP is getting worse in pregnancy.
“Nosebleeds and gum bleeding are actually common in healthy pregnant patients; however, for those with ITP, any bleeding signs should be followed up with a blood draw to check platelet level,” advises Dr. Zuckerwise.
Here’s how having chronic ITP can affect your delivery and your baby’s health.
There’s no evidence that vaginal delivery is safer than a C-section (or vice versa) for parents-to-be with low platelet count, says Dr. Zuckerwise.
“This means that, all things being equal, we will plan for a vaginal delivery with cesarean reserved for normal reasons,” she says, like your cervix not dilating enough within the usual time frame.
In the weeks leading up to delivery, your doctor will want to get your platelet count up to at least 50,000 per microliter of blood to reduce the risk of excessive bleeding, says Cindy Neunert, M.D., who specializes in pediatric hematology-oncology at Columbia University Irving Medical Center and chairs the guidelines panel for the 2019 American Society of Hematology Clinical Practice Guidelines on ITP. A platelet count above 80,000 per microliter of blood by the time of delivery is even better, Mohamad Cherry, M.D., medical director of hematology at Atlantic Health System Morristown Medical Center, tells SELF.
That higher-end goal of at least 80,000 platelets per microliter of blood is a big factor when it comes to your pain relief options during childbirth, particularly epidurals. Some research suggests that not having enough platelets may increase the risk of serious bleeding around the spine after an epidural. People with severely low platelet count may not be able to get an epidural, leaving them with fewer options for pain control, Dr. Zuckerwise says.
Remind your delivery team about your ITP so they can adjust their interventions accordingly. For example, they might want to forgo the use of forceps, which could otherwise lead to tearing and bleeding, says Dr. Zuckerwise.
It’s also worth noting that, although the Mayo Clinic points out that this is rare, your baby’s platelet count may be low after delivery too. After the delivery, your doctor should collect blood from the umbilical cord to check your baby’s platelet count, says Dr. Zuckerwise. Luckily, even if your baby does have low platelet count after childbirth, this will typically rectify itself on its own, the Mayo Clinic says. If not, treatments are available that may help.
Finally, as you’re looking into facts about chronic ITP in pregnancy, you’ll probably come across research that suggests you can pass anti-platelet antibodies to your baby through breast milk. “[This] may prolong the time that the infant has a low platelet count,” says Dr. Neunert. That doesn’t mean you have to go straight to formula if you would prefer to try to breastfeed, though. If you can, Dr. Neunert recommends working with a specialist like a pediatric hematologist to monitor your baby’s platelet count as you breastfeed and help provide you with any insight you’re seeking.
It’s possible to treat chronic ITP during pregnancy if necessary.
For what it’s worth, most people with chronic ITP won’t need treatment during their pregnancy, says Neil Morganstein, M.D., who specializes in hematology and oncology at Overlook Medical Center’s Carol G. Simon Cancer Center. But if your platelet count falls below a level your doctor deems safe, you might need medical intervention.
Some ITP treatments are generally safe during pregnancy, while others may come with significant risks that you’ll have to weigh against the benefits with your doctor. Doctors will usually first try corticosteroids, which are typically an effective way to boost platelets and a relatively safe option for pregnant people and their fetuses.
Another chronic ITP treatment that experts generally view as safe during pregnancy is intravenous immunoglobulin (IVIg), which involves receiving antibodies from donor plasma. This can boost your platelet level quickly, which makes it an option in an urgent situation.
“While there is always a risk-benefit assessment that goes into medication use during pregnancy, both of these are considered relatively safe and appropriate for use, especially during the second half of pregnancy and as we are planning for delivery,” says Dr. Zuckerwise.
Beyond those two options, the risk-benefit analysis becomes more nuanced. For example, the immune-suppressing drug rituximab can stop your body from destroying too many platelets, but it isn’t recommended during pregnancy because it can cross the placenta and affect the fetus, Natalia Neparidze, M.D. assistant professor of medical oncology and hematology at Yale University School of Medicine, tells SELF. Other immune-suppressing drugs that help boost your platelet count could increase your risk of infections, which can become even more important to avoid during pregnancy. It’s really about talking through your options with your doctor to determine how severe your ITP is and when the benefits of a specific treatment may outweigh the risks.
If you have severe ITP and the available treatments aren’t working, splenectomy—removing your spleen, the organ that destroys platelets in ITP—might be an option for some people. Dr. Zuckerwise says surgeons can often do a safe splenectomy during the second trimester if absolutely necessary, but getting major surgery probably isn’t something you dreamed of doing during your pregnancy, so you’ll want to exhaust other options first.
The bottom line
Chronic ITP probably won’t change the overall course of your pregnancy—and may not even affect it at all. Work closely with your care team (which may include an obstetrician, hematologist, and pediatrician or neonatologist) to figure out whether you need treatment for chronic ITP and which option might be best during your pregnancy. Other than that, try to do the normal stuff that’s recommended for pregnant people, like getting enough sleep and taking your prenatal vitamins, and take comfort in the fact that chronic ITP is often a completely manageable illness—before, during, and after pregnancy.
Related:
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6 Things You Should Know If You Live With Chronic ITP
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6 Treatment Options for Chronic ITP
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Everything You Should Know About the Condition That Makes You Bruise Like a Peach