Title :

The challenging follow-up of pregnancy in women with known thrombotic thrombocytopenic purpura: a single-center experience of a preemptive management protocol.

Author(s) :

Hamroun, Aghiles [Auteur]
Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167 [RID-AGE]
Prouteau, Camille [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Lenain, Remi [Auteur]
Service de Néphrologie et Transplantation rénale [CHRU-lille]
Roger, Camille [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Bauters, Anne [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Zawadzki, Christophe [Auteur]
Récepteurs nucléaires, maladies cardiovasculaires et diabète - U 1011 [RNMCD]
Subtil, Damien [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Gibier, Jean-Baptiste [Auteur]
Miniaturisation pour la Synthèse, l’Analyse et la Protéomique - UAR 3290 [MSAP]
Stichelbout, Morgane [Auteur]
Maladies RAres du DEveloppement embryonnaire et du MEtabolisme : du Phénotype au Génotype et à la Fonction - ULR 7364 [RADEME]
Coppo, Paul [Auteur]
CHU Saint-Antoine [AP-HP]
Lionet, Arnaud [Auteur]
Service de Néphrologie et Transplantation rénale [CHRU-lille]
Maanaoui, Mehdi [Auteur]
Recherche translationnelle sur le diabète - U 1190 [RTD]
Hazzan, Marc [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]
Provôt, François [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]

Journal title :

Journal of Nephrology

Pages :

2519–2529

Publisher :

Italian Society of Nephrology/Springer

Publication date :

2023-10-14

ISSN :

1121-8428

English keyword(s) :

Thrombotic thrombocytopenic purpura
Pregnancy
Preemptive strategy

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

BackgroundAlthough thrombotic thrombocytopenic purpura frequently affects women of childbearing age, there is no clear recommendation for the management of subsequent pregnancies in women with established thrombotic ...
Show more >BackgroundAlthough thrombotic thrombocytopenic purpura frequently affects women of childbearing age, there is no clear recommendation for the management of subsequent pregnancies in women with established thrombotic thrombocytopenic purpura.MethodsThis single-center, retrospective, observational study included all women with hereditary thrombotic thrombocytopenic purpura or immune thrombotic thrombocytopenic purpura who had had at least one subsequent pregnancy after thrombotic thrombocytopenic purpura diagnosis between 2003 and 2022. The strategy comprised weekly surveillance of platelet count during pregnancy (and quarterly monitoring of ADAMTS13 activity) for women with immune thrombotic thrombocytopenic purpura, without any routine prophylactic treatment. In case of thrombocytopenia < 150,000/mm3 (with or without hemolysis relapse), women with hereditary thrombotic thrombocytopenic purpura systematically received plasma infusions twice weekly until platelet count normalized.ResultsA total of 13 patients were included (7 with hereditary thrombotic thrombocytopenic purpura and 6 with immune thrombotic thrombocytopenic purpura, with 20 planned pregnancies (11 and 9, respectively). All pregnancies resulted in live births, and all mothers survived. There was a marked improvement in pregnancy terms in the hereditary thrombotic thrombocytopenic purpura group compared to index pregnancies (37 [35;39] versus 31 [24;38] weeks, p = 0.037) and birth weights (3265 [3029;3410] versus 2160 [1240;2705] grams, p = 0.016), with need for plasma support mostly starting during the third trimester (5/7 patients, 7/11 pregnancies). A single hereditary thrombotic thrombocytopenic purpura relapse occurred, with rapid resolution after plasma support intensification. There were no relapses in the immune thrombotic thrombocytopenic purpura group, with ADAMTS13 activity systematically above 40% during all monitored pregnancies.ConclusionThese real-life data support the feasibility of a preemptive approach to pregnancy monitoring in women with known thrombotic thrombocytopenic purpura who undergo active surveillance within a multidisciplinary network.Show less >

Language :

Anglais

Popular science :

Non

Collections :

• Miniaturisation pour la Synthèse, l'Analyse et la Protéomique (MSAP) - USR 3290

Source :

Harvested from HAL