Table 1

Pregnancy outcomes in women following recovery from TTP associated with acquired, severe ADAMTS13 deficiency

Age, race, BMIYearPregnancyTTPADAMTS13Risk factors for pregnancy complicationsMaternal complicationsPregnancy outcome
Patient 1        
 25 yo, W, 27 kg/m2 1999 1 1 <5%  Initial TTP at 35 wk, delivery. Normal child 
1999  2 11%  
1999  3 ND  
1999  4 8%  
2000  5* <5%  
2001 2  ND None Elective delivery, 36 wk. Normal child 
2004 3 ND None None Normal child 
Patient 2        
 33 yo, W, 42 kg/m2 1984 1    None Normal child 
1991 2    None Early fetal death, 10 wk 
2001  1 <5%    
2004 3  ND 36 yo, obesity, HTN None Early fetal death, 13 wk 
2006 4  78% (7 wk gest) 38 yo, obesity, HTN None Early fetal death, 12 wk 
Patient 3        
 20 yo, B, 51 kg/m2 2001 1 1 <5% Obesity None. Initial TTP, 9 d postpartum. Normal child 
2003 2  ND Obesity None Normal child 
2005 3 57% (4 wk pre) Obesity None Normal child 
Patient 4        
 34 yo, B, 33 kg/m2 1987 1   None None Embryonic pregnancy loss, 6 wk 
2001  1 <5%    
2004  2 <5%    
2006  3† <5%    
2007 2  100% (20 wk pre) 39 yo, obesity Severe preeclampsia, 33 wk delivery. Normal child 
2008 3  ND 41 yo, obesity, prior preeclampsia Severe preeclampsia Normal child 
Patient 5        
 19 yo, W, 25 kg/m2 2000 1   None None Normal child 
2005  1† <5%    
2012 2  100% (4 wk gest) None None Normal child 
Patient 6        
 21 yo, B, 26 kg/m2 2006  1 <5%    
2008 1  75% (30 wk gest) None Preeclampsia Normal child 
2009 2 2 70% (20 wk pre)
<5% (29 d post) 		Prior preeclampsia Preeclampsia, TTP relapse 29 d postpartum. Normal child 
Patient 7        
 34 yo, B, 28 kg/m2 1994 1    None Normal child 
2001 2    None Normal child 
2009  1† <5%    
2011 3 2 50% (15 wk gest) 37 yo, SLE Severe preeclampsia, TTP relapse 9 d postpartum. Normal child 
Patient 8        
 24 yo, W, 35 kg/m2 2009  1 8%    
2010  2† 9%    
2011 1  100% (18 wk gest) Obesity None Spontaneous pregnancy loss, 20 wk 
2013 2  ND Obesity None Normal child 
Patient 9        
 29 yo, W, 29 kg/m2 2010 1 1 8% None Severe preeclampsia, 31 wk delivery. Initial TTP 45 d postpartum. Normal child 
2012 2  57% (31 wk pre) Prior preeclampsia None Normal child 
Patient 10        
 22 yo, B, 40 kg/m2 2009 1   Obesity Placental abruption, 31 wk delivery. Normal child 
2011  1 <5%    
2013 2  ND Obesity, HTN, SLE SLE flare, 23 wk, rituximab. 37 wk delivery. Normal child 
Age, race, BMIYearPregnancyTTPADAMTS13Risk factors for pregnancy complicationsMaternal complicationsPregnancy outcome
Patient 1        
 25 yo, W, 27 kg/m2 1999 1 1 <5%  Initial TTP at 35 wk, delivery. Normal child 
1999  2 11%  
1999  3 ND  
1999  4 8%  
2000  5* <5%  
2001 2  ND None Elective delivery, 36 wk. Normal child 
2004 3 ND None None Normal child 
Patient 2        
 33 yo, W, 42 kg/m2 1984 1    None Normal child 
1991 2    None Early fetal death, 10 wk 
2001  1 <5%    
2004 3  ND 36 yo, obesity, HTN None Early fetal death, 13 wk 
2006 4  78% (7 wk gest) 38 yo, obesity, HTN None Early fetal death, 12 wk 
Patient 3        
 20 yo, B, 51 kg/m2 2001 1 1 <5% Obesity None. Initial TTP, 9 d postpartum. Normal child 
2003 2  ND Obesity None Normal child 
2005 3 57% (4 wk pre) Obesity None Normal child 
Patient 4        
 34 yo, B, 33 kg/m2 1987 1   None None Embryonic pregnancy loss, 6 wk 
2001  1 <5%    
2004  2 <5%    
2006  3† <5%    
2007 2  100% (20 wk pre) 39 yo, obesity Severe preeclampsia, 33 wk delivery. Normal child 
2008 3  ND 41 yo, obesity, prior preeclampsia Severe preeclampsia Normal child 
Patient 5        
 19 yo, W, 25 kg/m2 2000 1   None None Normal child 
2005  1† <5%    
2012 2  100% (4 wk gest) None None Normal child 
Patient 6        
 21 yo, B, 26 kg/m2 2006  1 <5%    
2008 1  75% (30 wk gest) None Preeclampsia Normal child 
2009 2 2 70% (20 wk pre)
<5% (29 d post) 		Prior preeclampsia Preeclampsia, TTP relapse 29 d postpartum. Normal child 
Patient 7        
 34 yo, B, 28 kg/m2 1994 1    None Normal child 
2001 2    None Normal child 
2009  1† <5%    
2011 3 2 50% (15 wk gest) 37 yo, SLE Severe preeclampsia, TTP relapse 9 d postpartum. Normal child 
Patient 8        
 24 yo, W, 35 kg/m2 2009  1 8%    
2010  2† 9%    
2011 1  100% (18 wk gest) Obesity None Spontaneous pregnancy loss, 20 wk 
2013 2  ND Obesity None Normal child 
Patient 9        
 29 yo, W, 29 kg/m2 2010 1 1 8% None Severe preeclampsia, 31 wk delivery. Initial TTP 45 d postpartum. Normal child 
2012 2  57% (31 wk pre) Prior preeclampsia None Normal child 
Patient 10        
 22 yo, B, 40 kg/m2 2009 1   Obesity Placental abruption, 31 wk delivery. Normal child 
2011  1 <5%    
2013 2  ND Obesity, HTN, SLE SLE flare, 23 wk, rituximab. 37 wk delivery. Normal child 

Patients 1 (pregnancies 2,3), 2 (pregnancy 3), and 3 (pregnancy 2) were included in our previous report.1  Patients’ ages are at the time of their initial diagnosis of TTP. ADAMTS13 activity data are from routine annual samples taken during remission which, by chance, occurred either during pregnancy (gest, weeks’ gestation) or prior to conception (pre, weeks prepregnancy). Postpartum TTP was diagnosed in patient 6 during her routine annual evaluation. Patient 2, who had 3 early fetal deaths, has been tested for antiphospholipid antibodies with negative results. Data for all pregnancies that occurred with the initial presentation of TTP and following recovery from TTP were obtained from both patient interviews in 2013 and medical record review. Data for pregnancies preceding the initial episode of TTP were obtained from patient interviews in 2013 and also from medical records for patients 5, 7, and 10. When delivery time is not specified, delivery was at term (≥37 wk). Child outcomes were described as normal in the patient interviews in 2013. The risk factor of age was ≥35 years old10 ; for obesity was ≥30 kg/m2.12  Other risk factors that were documented included chronic hypertension, diabetes mellitus, and SLE; if they are not described in the table, they were not present.

B, black; W, white; gest, weeks’ gestation; HTN, chronic hypertension; ND, ADAMTS13 measurement not done; pre, weeks prepregnancy; yo, years old.

*

Adjunctive treatment of TTP episodes preceding pregnancies: splenectomy.

†

Adjunctive treatment of TTP episodes preceding pregnancies: rituximab.

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