If a first pregnancy leads to fetal and neonatal alloimmune thrombocytopenia (FNAIT) and the child develops an intracranial hemorrhage (ICH), the second FNAIT-affected child is highly likely to experience an ICH as well, according to a study that will be presented at the 66th American College of Hematology (ASH) Annual Meeting & Exposition from Dec. 7-10 in San Diego, CA.
In an effort to evaluate the risk for ICH in a woman’s subsequent pregnancies, researchers sent a survey to members of a mothers-with-FNAIT group known as Naitbabies. Based on findings from the survey, the investigators sought to explore possible treatments for the prevention of ICH in FNAIT-impacted pregnancies.
Findings from part one of the study imply that a real risk for ICH exists in a second pregnancy and that treatment appears to prevent ICH, and part two studies the recommended treatment in order to minimize the risk for ICH by attempting to maintain an adequate fetal platelet counts (FPCs).
Read more about FNAIT testing and diagnosis
Part one: Risk of ICH in second pregnancy
In part one of the analysis, a survey was sent to a group of mothers whose newborns had been impacted by FNAIT. A total of 324 women responded to the survey, with 156 of them reporting having given birth to two or more FNAIT-affected babies. Of these 156 women, 29 had had a first child with FNAIT who experienced an ICH; in the remaining 127, no ICH was reported in their first child.
Results of the survey showed that of the 127 births in which no ICH had been reported in the first child, three ICHs that were not linked directly to FNAIT were reported in the second child. Of the 29 patients who had experienced an ICH in their initial pregnancy, only one of them experienced an ICH in their second pregnancy. Among these women, 24 received antenatal treatment, one of whom experienced an ICH, whereas five did not receive any treatment, none of whom had experienced an ICH.
There were four ICHs associated with FNAIT. Of these four events, 10% of the ICHs occurred among the women who had not received any antenatal treatment in their second FNAIT-impacted pregnancy and one was reported among the 93 women who had undergone antenatal management with intravenous immunoglobulin (IVIG), corticosteroids, and/or weekly fetal platelet transfusions.
Part two: Evaluating treatment for maintaining adequate FPCs
Based on the 10% incidence of ICH reported in a second untreated pregnancy in the survey, in Part 2 of the study, the researchers examined treatment options for preventing ICH. They used an FPC of 30,000 as a surrogate marker.
Patients were divided into two arms: arm A received IVIG two times per week; arm B received IVIG plus prednisone.
There were no ICHs reported among those fetuses with low FPCs.
“[I]ntensifying treatment at 32 weeks (IVIGx2+Pred) until delivery improves outcomes by substantially lessening the risk [for] ICH,” the authors highlighted. “Clearly a biomarker (to be developed) would restore a balance of not overtreating many patients who do not need it and not undertreating those at highest risk [for] ICH,” they concluded.
