About 1 in 5 pregnant women attending prenatal care at a hospital in northwest Ethiopia had a low platelet countPlatelet count A measure of how many platelets are in the blood. FNAIT is characterized by severely reduced counts in a fetus or newborn., according to a study recently published in Scientific Reports. Most cases were mild.
Platelets are blood cells that help blood clot. A platelet count below 150×10⁹/L is called thrombocytopeniaThrombocytopenia A platelet count that is lower than normal.. Pregnant women with thrombocytopenia are more likely to bleed heavily during or after childbirth, especially if they need a cesarean section or other surgery. The risk is greatest when platelet counts fall to severe levels, which can lead to serious complications for both mother and baby. Most cases during pregnancy, however, are mild.
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A low platelet count in the mother does not necessarily mean her baby will have thrombocytopenia, the core feature of fetal and neonatal alloimmune thrombocytopenia (FNAIT). In FNAIT, the baby’s low platelet count is caused by the mother’s immune system, which makes antibodies that attack the baby’s platelets.
Researchers from Debre Tabor University tested blood from 422 pregnant women who visited the antenatal care clinic at Debre Tabor Comprehensive Specialized Hospital between January and April 2024. They excluded women with conditions or medications known to affect platelets, including malaria, bleeding disorders, chronic heart, kidney or liver disease, and use of heparin or aspirin.
Overall, 85 women, or 20.1%, had thrombocytopenia. Of these, 81% had mild cases, 8% had moderate cases and 11% had severe cases, defined as a platelet count below 50×10⁹/L.
Low platelet counts became more common as pregnancy advanced, affecting 10.5% of women in the first trimester, 21.7% in the second and 23.7% in the third. The authors wrote that this may reflect normal changes in pregnancy. As the volume of blood plasma expands, platelets become diluted. Platelets are also used up faster and can collect in the placenta.
Read more about FNAIT causes and risk factors
Other factors linked to higher odds of low platelets were older maternal age, not taking iron and folic acid supplements, attending two or fewer prenatal visits and a history of heavy menstrual bleeding.
Heavy bleeding is associated with several blood disorders, including anemia, thrombocytopenia and clotting problems, and the authors called the link “biologically and clinically plausible.” Iron is essential for making blood cells, including megakaryocytes, the bone marrow cells that produce platelets. Without enough iron, these cells may not grow and mature properly, which can lower platelet counts. Iron supplements can help restore normal platelet production.
The authors also suggested that women who attend prenatal care more often are more likely to receive iron and folic acid supplements. These women are also more likely to be screened for conditions that can lower platelet counts, such as high blood pressure disorders and infections.
Acknowledging the limitations of their study, the authors called for larger studies at multiple sites that follow women over time and include more thorough testing for nutritional problems and infections.
