Now whilst I am yet to experience pregnancy with my new found condition ITP (Immune Thrombocytopenia) I still think it is important to address this subject. Especially since more woman are diagnosed with ITP than men. I have been over this subject many times, done some personal research and have had many discussions with my hematologist as she is very much aware of my hopes to still have another child. Yes! I already have 1 child and no I did not have ITP when I had him. To further explain ITP is not something you are born with (shocking I know). Sometimes for no apparent reason your body has a malfunction and ITP takes over. There is no cure for ITP, however there have been a lot of cases where people have gone into remission. I want to make this very clear ITP is not cancer although it showcases some similar symptoms. ITP is basically a low platelet count due to an immune system malfunction - a healthy person should have a platelet count ranging from 150,000 - 400,000 a person with ITP has a much lower count.
Ok I think I have bi-passed the overview of ITP now let's move on to ITP and pregnancy. You may wonder why we need to address this subject and the reason is having a low platelet count can cause you to be a higher risk pregnancy. And due to low platelets causing your blood to prevent clotting this is a major concern when giving birth, you are at risk of bleeding out. However please note that in some cases women with ITP have fallen pregnant and the pregnancy has in fact increased their platelet count. So it's not all doom and gloom - plus with today's technology even if you do have a low platelet count whilst pregnant doctor's are well prepared for action.
Before Falling Pregnant
The whole reason I have only taken prednisone as a form of treatment for my ITP is the fact that I still really want to have another baby. Prednisone is the safest form of treatment to take whilst pregnant. Rituximab on the other hand you cannot have when pregnant and must have finished your treatment for at least 6 months prior to trying to conceive. From what I understand Rituximab can cause birth defects so it is really not a treatment you want to take when you are not using contraception. Therefore if you have ITP and you are not using contraception, or you have plans on having a baby all these things need to be addressed with your hematologist prior to starting any treatment for your condition. Please note prednisone is not the only treatment you can take whilst pregnant.
Pregnancy
The good news here is that your low platelets should not affect the baby during pregnancy and for majority of women their low platelet count simply means they require some extra monitoring. This means more blood tests (to check your platelet levels more frequently) and maybe some more ultrasounds. The most important step here is that your doctor, midwife and hematologist are working cohesively to ensure everything is running as smoothly as it should be.
Birth
This is where things start to get real. There is always risks when giving birth however giving birth with low platelets just adds to the risk factor. The good news is you already know you have low platelets so the doctor's/midwife's are well prepared.
The aim here for the Doctor's is to try and have your platelet levels above the 50 mark so you can have a normal birth. In order to have the epidural your levels need to be above 80 otherwise no epidural for you.
During or even after the birth there is going to be a lot of blood loss. Please note there is even more loss of blood if a C-section is required. In comparison to other organs in the body your uterus has the largest supply of blood. If a C-section is required, large blood vessels have to be cut to open the uterus wall. Due to your platelet levels being low and your blood struggling to clot this increases the risk of excessive blood loss.
Remember the doctors are already well aware of your condition and should have something in place as a back up if you do require extra attention.
After Birth
After your birth a sample of your babies blood will need to be obtained, this is generally obtained from the umbilical cord to check their platelet levels. A study done by Oxford University suggests that Approx 1 in 4 babies born to mothers who have ITP will have a low platelet count at birth however only 1 in 10 will be at risk of bleeding. Basically a babies low platelet count can be due to antibodies crossing from the circulation between mother and baby during pregnancy but this issue will get better once the antibodies have left the babies system in a few short weeks.