(406) Thrombotic thrombocytopenic purpura and pregnancy outcomes: a cohort study

A retrospective cohort study was conducted using the United States’ Healthcare Cost and Utilization Project, Nationwide Inpatient Sample. A cohort of women who delivered between 1999-2015 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 13,792,544 women delivered between 1999-2015, of which 280 had a TTP diagnosis (2/100,000). Women with a TTP diagnosis, compared with those without, had more pre-existing health conditions: diabetes, hypertension, and obesity. TTP was associated with several adverse outcomes: maternal death, OR 215.50, 95% CI 121.19-383.22, preeclampsia, 18.63,14.57-23.82, eclampsia, 27.80, 13.08-59.11, placental abruption, 5.20,3.18-8.50, disseminated intravascular coagulation, 139.11,81.97-236.09, venous thromboembolism, 10.69,5.25-21.73, sepsis, 118.42,63.62-220.42, myocardial infarction, 268.60, 84.30-855.81, post-partum hemorrhage, 15.00, 11.66-19.29, requiring a blood transfusion, 59.77, 46.54-76.76, and cesarean delivery, 3.52, 2.74-4.53. Neonates born to women with a TTP diagnosis were at increased risk for preterm birth, 3.40, 2.58-4.49, intrauterine growth restriction, 2.73, 1.68-4.41, and stillbirth, 9.41, 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 within a multidisciplinary team.