Pregnancy in essential thrombocythaemia: treatment and outcome of 17 pregnancies

Objective: To evaluate treatment and outcome of 17 pregnancies in nine pati ents with essential thrombocythaemia (ET) seen at our institution from 1988 to 1998. Methods. Treatment and outcome of 17 pregnancies in nine ET patie nts were retrospectively analyzed. Results. Seventeen pregnancies in nine p atients with ET resulted in 11 (65%) live births and ended in six (35%) spo ntaneous abortions. Abortion could not be predicted from ET-associated comp lications before (p=0.23) or during (p=0.39) pregnancy. Maternal complicati ons occured during six pregnancies (35%): Three major bleedings in two pati ents with an acquired von Willebrand disease and two minor bleedings in pat ients treated with low-dose acetylsalicylic acid (ASA) were observed during pregnancy or at term; one patient suffered from transient visual loss whil e pausing low-dose ASA. Platelet counts prior to pregnancy were significant ly higher as compared to the platelet nadir observed during pregnancy (p = 0.0017). Postpartum clinical course was uneventful in all patients. No spec ific treatment was given during 11 pregnancies. Six women received low-dose ASA during pregnancy followed by low-molecular-weight heparin until the en d of the sixth week postpartum in five cases. This treatment was correlated with a favourable outcome (live birth versus abortion) when compared to no treatment (p=0.04. Conclusion: Pregnancy in ET can be complicated by first trimester abortion and/or maternal haemorrhage. Our limited observation su ggest a positive impact of low-dose ASA during pregnancy followed by low-mo lecular-weight heparin postpartum on pregnancy outcome in ET; nevertheless, confirmation by prospective documentation is mandatory.