Clinical Characteristics and Maternal-Neonatal Outcomes of Thrombocytopenia in Pregnancy: A Retrospective Study

Background: Pregnancy complicated with thrombocytopenia (PT) is the second most common hematologic disorder during gestation and poses notable clinical challenges. This study aims to investigate the effects of thrombocytopenia severity and etiology on clinical characteristics and maternal-neonatal outcomes. Methods: A retrospective analysis was conducted on 517 pregnant patients with PT who delivered at the Affiliated Hospital of Nantong University between January 2012 and October 2020. Based on the lowest platelet count (PLT), patients were classified into three groups: mild (50 × 109/L ≤ the lowest PLT < 100 × 109/L), moderate (30 × 109/L ≤ the lowest PLT < 50 × 109/L), and severe (the lowest PLT <30 × 109/L). Based on etiology, they were classified into four groups: gestational thrombocytopenia (GT), immune thrombocytopenia (ITP) in pregnancy, hypertensive disorder complicating pregnancy (HDCP), and other etiologies. Clinical characteristics and maternal-neonatal outcomes were compared across groups. Results: GT was the most common etiology of mild thrombocytopenia (76.06%), whereas ITP was the most frequent cause of severe cases (50.00%). Regarding the impact of disease severity on maternal and neonatal outcomes, the severe group had the highest rates of cesarean delivery, blood product transfusion, and neonatal intensive care unit (NICU) admission. Regarding the impact of etiology on outcomes, the HDCP group had the highest rates of maternal referral, postpartum hemorrhage volume, birth asphyxia, NICU admission, and full-term low birth weight (LBW) infants. The ITP group required blood product transfusion most frequently. In contrast, the GT group was associated with the least adverse maternal-neonatal outcomes. Conclusions: GT is a benign condition, whereas both ITP and HDCP are associated with higher risks of adverse maternal-neonatal outcomes. In the management of PT, both the etiology and severity should be evaluated simultaneously.