Treatment in Pregnancy with Counts Under 20

Hello,

I am currently pregnant with my first child. I was diagnosed with ITP 6 months before becoming pregnant. My platelet counts without treatment when not pregnant range from 16,000-45,000. I was able to avoid treatment for the first trimester of my pregnancy, but am now taking 20mg of prednisone daily after my platelets dropped to 12,000 to maintain a stable count. My counts over the past three months have been 14,000-30,000. I'm curious if any others have been in a similar situation. If so, did you increase your prednisone dosage above 20mg in pregnancy? Were there any harmful effects? Also, did your doctor ever discuss alternative treatment options in pregnancy? My hematologist hasn't dealt with many pregnant patients and it feels like I am the one making treatment decisions, not him. Options we have discusses are IVIg and Imuran (azathioprine). I am of the mindset that the fewer drugs I can take, the better. What levels did your hematologist want to treat?

Thank you for your input.

I haven't been pregnant with ITP but I have taken azathioprine and it takes about three months to start working so not a quick fix. I also know that it can cause miscarriage or premature birth so really would try to avoid it during pregnancy if at all possible.

The usual drugs during pregnancy are IVIG and steroids but as you say steroids only after the first trimester. There's another poster here in a similar situation and who is living with low counts while pregnant.

pdsa.org/forum/23-everything-pregnancy/24999-common-treatment-during-pregnancy.html

I would think about getting a hemo who is more familiar with this type of situation. Also, I'd consider a high risk OB-GYN.

I would not take Imuran during pregnancy. I'm pretty sure it's contraindicated.

Hi Beachgal. I was diagnosed with ITP prior to my pregnancy. My hemotologist told me with my platlet count about 65k I was okay to get pregnant. On week 11 my platelet count dropped to 36k. I maintained predinsone throughout the pregnancy. The predinsone ended up giving me ashtma and diabeties. The diabetes was gone the day after delivery. I maintained on Predisone with doses in the range of 20-80 mg through out the pregnancy. My hemo wanted to try to keep me above 50k but I read over 20k is what it takes to keep baby safe. I only took 80 mg prednisone for a short time as needed. I delivered one month early with preclampsia. My platelets were down below 20k when it was time to deliver and although they told me they didn't know if I would make it through a c-section one platelet transfusion brought my platelet count up to 90k and they were able to do a spinal. My son was born fully developed (able to breath, eat, keep warm and no itp). I have read the cortosteriods help develop your child a little earlier than usual. And it is not uncommon for a predinsone baby to be born on the average a month early. My son is 1.5 years old and is very bright for his age. The predinsone had no effect on him what so ever. I will be praying for you and your little one. May God watch over you both and keep you and your little one safe.
Jayne.