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Being diagnosed with immune thrombocytopenia (ITP) during pregnancy raises a lot of questions. One of the biggest is what it means for your baby.
Because ITP is an autoimmune condition that lowers your platelet count, the antibodies causing it can sometimes cross the placenta and lower your newborn’s platelet count, too.
Most babies born to people with ITP do just fine. Even so, understanding why neonatal thrombocytopenia happens can help you feel more prepared.
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This article covers how maternal ITP can affect a newborn, what evaluation after birth looks like, which treatments help, and how delivery planning fits in.
Maternal ITP — meaning immune thrombocytopenia diagnosed before or during pregnancy — can lead to a low platelet count in a newborn, a condition called neonatal thrombocytopenia. It doesn’t happen to every baby, and when it does, it’s usually mild and temporary. Here’s a closer look at how that happens and why platelet counts alone don’t tell the whole story.
With ITP, the immune system makes antibodies that mark platelets for removal. These are a type of antibody called immunoglobulin G, which can cross the placenta and attach to the fetus’s platelets. This can lower the newborn’s platelet count.
You might have heard about a similar-sounding condition called fetal and neonatal alloimmune thrombocytopenia (FNAIT, also known as NAIT), but it’s different from maternal ITP.
The key difference is what the mother’s immune system targets. In maternal ITP, it mistakenly targets the mother’s own platelets, and the antibodies can also affect fetal platelets. In FNAIT, the immune system reacts to certain proteins on fetal platelets that were inherited from the other parent.
A higher platelet count doesn’t necessarily mean a lower risk of thrombocytopenia for the newborn. One study of more than 45,000 pregnancies found only a weak link between maternal and newborn platelet counts.
ITP made up a small share of maternal cases in that study, but 4 out of 48 newborns born to people with ITP developed neonatal thrombocytopenia. Those four newborns made up half of the neonatal thrombocytopenia cases in the study.
Other conditions can lower platelets during pregnancy, and they generally affect newborns differently than ITP does:
Your care team can use your health history, symptoms, blood tests, and other findings to determine the likely cause of a low platelet count.
Estimates vary, but studies have reported that about 1 in 4 to 1 in 3 babies born to people with maternal ITP will have a low platelet count.
Most cases are mild, and severe complications are uncommon. Most affected newborns recover within weeks without lasting problems. Because this condition is separate from childhood ITP, it isn’t believed to increase a child’s risk of developing ITP as they grow older.
In one study of 40 pregnancies affected by ITP, all the newborns had normal Apgar scores, which are used to assess a newborn’s condition shortly after birth.
Neonatal thrombocytopenia linked to maternal ITP often shows up within the first day of life. The platelet count typically hits its lowest point, or nadir, between two and five days after birth. Some research points to a low point as late as two weeks after birth.
For most newborns, the platelet count returns to normal within a few weeks, as the maternal antibodies gradually clear from the baby’s system.
Most babies with neonatal thrombocytopenia have no symptoms. When symptoms do appear, they usually include bruising or petechiae (small spots caused by bleeding).
Petechiae may look red, purple, or brown. On darker skin, petechiae may be easier to spot on the palms, soles, or inside the mouth, or they may appear as darker patches.
Severe thrombocytopenia is less common. Serious bleeding complications, including intracranial hemorrhage (ICH), or bleeding inside the skull, are rare. Research puts ICH risk under 1 percent.
In one study, a mother’s history of splenectomy (surgical removal of the spleen) — a treatment option for severe ITP — was linked to a higher risk of neonatal thrombocytopenia. Even then, most babies do well.
Contact your baby’s healthcare provider right away if you notice any of these symptoms:
Also contact your baby’s healthcare provider about other concerning changes, such as unusual sleepiness or trouble feeding. Seek emergency medical care for severe or uncontrolled bleeding or if your baby seems seriously ill.
Because maternal ITP raises the chances of a low platelet count in a newborn, most care teams monitor the baby during the first few days after delivery.
Right after birth, your baby’s care team will check the platelet count, often using umbilical cord blood. If the count is low or there are signs of bleeding, the care team will typically take blood directly from the baby to confirm the result and monitor the platelet count over the next few days.
Counts can keep dropping before they recover, so your baby will be watched closely for bruising or bleeding, not just monitored through lab work.
A normal platelet count at birth doesn’t rule out a later drop, since the count may reach its lowest point a few days after delivery. Because of this, care teams may continue checking during the first several days. Monitoring may continue longer if the count is low or falling.
Treatment depends on how low your baby’s platelet count is and whether there’s bleeding.
Most babies with neonatal thrombocytopenia don’t need treatment. If the platelet count is only mildly low and there’s no bleeding, the care team may monitor the baby closely. The count usually recovers on its own within a few weeks.
Treatment may be needed if a baby’s platelet count is severely low or there’s active bleeding. Options include intravenous immunoglobulin (IVIG, a blood-derived product that can help raise platelet levels), corticosteroids, or a platelet transfusion. Some babies who need treatment for severe thrombocytopenia may be cared for in a neonatal intensive care unit (NICU).
Delivery planning for maternal ITP works best as a team effort, with an obstetrician, a hematologist, and a pediatrician or neonatologist coordinating before delivery so everyone understands the plan.
A common question is whether a cesarean delivery is safer for the baby. Research doesn’t support routinely choosing a cesarean delivery because of maternal ITP. Studies of more than 800 newborns found that ICH risk was similarly low regardless of delivery method, and bleeding complications weren’t linked to how a baby is delivered.
Because of this, medical guidelines recommend basing the mode of delivery on standard obstetric factors, not on maternal ITP alone.
After birth, blood from the umbilical cord can be used to check the newborn’s platelet count. Checking the fetal platelet count before birth requires invasive procedures that carry risks and generally isn’t recommended.
Maternal ITP can affect a newborn’s platelet count, but for most babies, that effect is mild and temporary. Knowing what to expect can help you feel more prepared going into delivery.
During your next appointment, ask your care team how your baby’s platelet count will be monitored after delivery and when the first check is likely to happen. You can also ask which signs of bleeding or other changes to watch for at home and when to call your baby’s healthcare provider.
Your care team and your baby’s care team can provide guidance tailored to your health, your baby’s health, and your family’s needs.
On myITPteam, people share their experiences with immune thrombocytopenia, get advice, and find support from others who understand.
What questions are you planning to ask your baby’s care team about monitoring after delivery? Let others know in the comments below.
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