Thrombotic Thrombocytopenic Purpura and Pregnancy Outcomes: A Cohort Study [A258]

INTRODUCTION: Thrombotic thrombocytopenic purpura (TTP) is a rare microangiopathy. Little is known of its impact on pregnancy. The aim was to evaluate the association between maternal TTP and pregnancy and neonatal outcomes. METHODS: A retrospective cohort study was conducted using the U.S. Healthcare Cost and Utilization Project–Nationwide Inpatient Sample. A cohort of women who delivered between 1999 and 2015 was created. Then ICD-9 code 446.6 was used to identify women with a diagnosis of TTP, with the remaining women without a TTP diagnosis being the comparison group. Multivariate logistic regression estimated the effect of TTP on maternal and neonatal outcomes, while adjusting for maternal baseline variables. RESULTS: A total of 13,792,544 women delivered between 1999 and 2015, of whom 280 had a TTP diagnosis (2/100,000). Women with a TTP diagnosis, compared to those without, had more preexisting health conditions (diabetes, hypertension, and obesity). TTP was associated with several adverse outcomes: maternal death (odds ratio [OR], 215.50; 95% CI, 121.19–383.22), preeclampsia (OR, 18.63, 14.57–23.82), eclampsia (OR, 27.80; 95% CI, 13.08–59.11), placental abruption (OR, 5.20; 95% CI, 3.18–8.50), disseminated intravascular coagulation (OR, 139.11; 95% CI, 81.97–236.09), venous thromboembolism (OR, 10.69; 95% CI, 5.25–21.73), sepsis (OR, 118.42; 95% CI, 63.62–220.42), myocardial infarction (OR, 268.60; 95% CI, 84.30–855.81), postpartum hemorrhage (OR, 15.00; 95% CI, 11.66–19.29), requiring a blood transfusion (OR, 59.77; 95% CI, 46.54–76.76), and cesarean delivery (OR, 3.52; 95% CI, 2.74–4.53). Neonates born to women with a TTP diagnosis were at increased risk for preterm birth (OR, 3.40; 95% CI, 2.58–4.49), intrauterine growth restriction (OR, 2.73; 95% CI, 1.68–4.41), and stillbirth (OR, 9.41; 95% CI, 5.95–14.88). CONCLUSION: TTP increases the risk of adverse maternal and neonatal outcomes, including maternal and fetal death. Women with TTP in the past or present should be followed closely by a multidisciplinary team.