Maternal and neonatal outcomes in pregnant women with severe thrombocytopenia: insights from a retrospective 8-year cohort study in China

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Objective To characterize the clinical features, maternal outcomes, and neonatal outcomes across different strata of platelet counts in pregnant women with severe thrombocytopenia. Design Retrospective cohort study. Setting A single tertiary care center in South China. Participants 175 pregnant women with a platelet count ≤30 × 10 9 /L. Methods We conducted a retrospective analysis of 175 cases over an 8-year period. Etiologies, maternal characteristics, and maternal-neonatal outcomes were compared across three platelet count strata: ≤10, >10 to ≤20×10 9 /L, and >20 to ≤30×10 9 /L. Statistical analyses included t-tests, the Kruskal-Wallis H test, chi-square tests, and ANOVA. Main Outcome Measures Maternal and neonatal outcomes. Results Primary immune thrombocytopenia (ITP) was the predominant etiology (62.3%, 109/175). The incidence of postpartum hemorrhage was highest in the ≤10×10 9 /L group (12.5%), compared with the >10 to ≤20×10 9 /L (4.8%) and >20 to ≤30×10 9 /L (3.6%) groups. Preterm birth was also most common in the ≤10×10 9 /L group (58.9%), versus the >10 to ≤20×10 9 /L (27.0%) and >20 to ≤30×10 9 /L (23.2%) groups. The rates of neonatal thrombocytopenia were 33.9%, 23.8%, and 14.3% in the three groups, respectively. The overall rate of neonatal intracranial hemorrhage was 3.4% (6/175). Conclusions Primary ITP is the leading cause of severe thrombocytopenia in pregnancy. A lower platelet count, particularly ≤10×10 9 /L, is associated with an increased risk of preterm birth and postpartum hemorrhage. Neonatal intracranial hemorrhage is a rare complication. Severe thrombocytopenia may correlate with preterm delivery but no statistical difference in the incidence of neonatal thrombocytopenia was observed across the maternal platelet strata. Funding : This work was supported by the Guangzhou Fundamental Research Project Jointly Funded by School (Institution) (High-Level University) [No. 202102010131].

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