In high-risk pregnancies such as those affected by fetal and neonatal alloimmune thrombocytopenia (FNAIT), the risk of complications can be life-threatening for the baby.
Home births are not advised in FNAIT-affected pregnancies due to the risk of bleeding and hemorrhage for the baby. There is no access to NICU specialized care outside of a hospital, and most FNAIT-affected newborns urgently require platelet transfusions. At times, during labor and a planned vaginal birth, fetal distress and unforeseen complications may lead to an emergency cesarean.
What is FNAIT?
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is a rare but serious condition that affects 0.1% of pregnancies in which a pregnant mother’s immune system produces antibodies against the platelets of her fetus. This occurs when a fetus inherits platelet antigens from the father that are not compatible with the mother, typically involving a protein called human platelet antigen (HPA). The mother’s immune system recognizes the fetal platelets as foreign, attacking and destroying them, leading to low platelet levels (thrombocytopenia) in the fetus or newborn.
Risks of FNAIT during pregnancy and delivery
In FNAIT, the mother’s antibodies cross the placenta to attack the fetus’s platelets, causing them to progressively break down and leading to thrombocytopenia. As the fetus’s blood platelet count falls, the blood’s capacity to clot is impacted. This puts the fetus and newborn at risk of uncontrolled bleeding and hemorrhage.
Learn more about FNAIT treatment and care
In utero, thrombocytopenia is harder to treat as platelet transfusions are invasive and can potentially lead to bleeding in the fetus or even miscarriage. To remove the fetus from the toxicity of the mother’s antibodies and allow for effective treatment, the fetus can be induced from 37 weeks’ gestation or delivered by cesarean at any time.
In utero and post-delivery, the greatest fear is the onset of intracranial hemorrhage (ICH), which can lead to long-term neurological damage. Hemorrhages in other organs such as the brain, lungs, eyes and gastrointestinal tract are less common, but can have severe long-term side effects if left untreated or not treated urgently.
Often, FNAIT is not diagnosed until after delivery. If the neonate presents with bruising, petechiae a pinprick rash, reddish purple purpura skin discoloration, unexplained bleeding, hematomas or a low blood platelet count, urgent platelet transfusions are recommended before confirming a FNAIT diagnosis. Any delay can have serious consequences for the baby.
Have a flexible birth plan
A high-risk pregnancy can be difficult to navigate, creating a feeling of powerlessness that can extend to not having the birth you’d planned. A home birth is not advised in FNAIT pregnancies, and if you have long dreamt of a natural birth, at home, it can take some time to process. On the advice of your healthcare team, based on the medical needs of your baby, it may be that you end up giving birth via a cesarean delivery.
However, in pregnancies affected by FNAIT, a vaginal birth can still be possible, but it may be risky. Though there is no evidence to show that ICH is associated with a vaginal delivery, research is limited, and there may be other risks, such as an increased risk of hemorrhaging.
Talk to your healthcare team to find out if your pregnancy is too high-risk for a safe home birth. Of course, it is important to stay flexible in case a medical need arises, causing you to change your birth plan to ensure the best outcomes for your baby.
