At 30 weeks, I underwent a routine third trimester blood screening that tests for various indicators of anemia and potential clotting disorders. I have a history of low iron levels that, while vastly improved by switching to the Paleo diet (I used to be a rather anemic vegetarian!), still requires that I take an iron supplement on a regular basis. For lack of any other pathology or obvious cause, my doctor has attributed it to my high level of physical activity and the fact that my body is constantly turning over red blood cells in order to repair and build muscle. In other words, I have a higher than average need for iron that cannot be satisfied by my diet alone. As a result, I undergo blood testing a couple of times a year in order to ensure that all of my indicators remain within the normal range. As it so happens, I’d had a blood screening done right before I became pregnant, which has provided a helpful baseline with which to compare any pregnancy blood test results.
Even though I have been supplementing consistently throughout the pregnancy, my 30 week blood test showed decreased ferritin (stored iron) levels, from 60 down to 23, and decreased platelets, from 189,000 per microlitre of blood down to 129,000 (the normal range being 150,000 to 400,000). I doubled my daily iron supplement and went back for a re-test two weeks later, which showed ferritin levels unchanged, but even lower platelet levels (125,000). At the same time, in order to provide a more complete picture of any potential problems, I also had tests to assess Vitamin B12 levels, folate levels and blood coagulation factors (essentially Vitamin K levels). All returned with normal results.
One of my midwives assured me that it is actually quite normal to have lower ferritin levels during late pregnancy, as the body is simply unable to store extra iron while the growing baby’s needs are so high, but that the first few months post-partum are a particularly good time to re-build these stores. She advised me to continue with my double supplementation in order to keep my levels as high as possible for the remainder of the pregnancy.
As for the platelet count, while 125,000 would be considered too low under most normal circumstances, she told me that the midwives generally do not worry about platelet count during pregnancy unless it falls below 100,000. She gave me a requisition for a re-test at 36 to 37 weeks.
Fast forward to five weeks later (37 weeks), and my platelet count decreased to 110,000, putting me at risk of falling below the 100,000 threshold before the baby is born (amazingly, my ferritin has actually increased to 32!). We reviewed our birth plans with the midwife, and she recommended that A) I have an IV saline lock inserted during active labour to allow for an emergency access point if my blood volume drops precipitously due to hemorrhaging; and B) I allow them to give me a shot of oxytocin immediately after the baby is born, in order to stimulate uterine contractions and expulsion of the placenta, and thus reduce the risk of a post-partum hemorrhage. We agreed to both recommendations, as they sounded like reasonable precautions against a potentially dangerous situation.
Concerned, I began to research platelet disorders and pregnancy, and I discovered that thrombocytopenia (platelet deficiency) affects approximately eight percent of all pregnancies. While about 30 percent of those cases are caused by conditions such as autoimmune responses (e.g. lupus, abnormal destruction of platelets), infections, pre-eclampsia or HELLP syndrome, the remaining 70 percent fall under the category of non-pathological gestational thrombocytopenia, which “just happens” to some women and presents no risks to either mother or fetus.
Gestational thrombocytopenia occurs due to a combination of accelerated platelet destruction during pregnancy (the platelets have a shorter lifespan and are simply not replaced as quickly as they are destroyed), and increased blood volume (platelet concentration becomes diluted). If a woman’s pre-pregnancy platelet count is already on the low end of normal, as mine was, it is very easy for it to fall below normal levels over the course of the pregnancy. While there are fewer platelets, they are thought to be larger and possibly more effective, thus to some degree compensating for their lower concentration. This condition does not in any way impact the platelet count or clotting abilities of the baby’s blood, and thus does not put the baby at increased risk of Vitamin K deficiency bleeding.
Unfortunately, there is no test to conclusively distinguish between non-pathological GT and a more dangerous condition known as immune (or autoimmune) thrombocytopenic purpura (ITP or ATP); however, most women who have garden variety GT develop the condition in the third trimester, maintain a platelet count over 70,000, have no previous (non-pregnancy) history of thrombocytopenia or abnormal bleeding, and recover to normal platelet levels within three months of giving birth. Platelet levels between 70,000 and 100,000 are considered to be a “mild” case of GT, and do not require any special considerations for labour and delivery.
Given that all of my other blood indicators are completely normal, and that I have had no symptoms whatsoever of autoimmune issues, infection, pre-eclampsia or HELLP syndrome, I feel very strongly that I am simply one of the five to six percent of women who experience this condition during pregnancy, and go on to have a perfectly normal labour, delivery and recovery.
We are now in the process of reconsidering the necessity of the IV saline lock and the oxytocin shot. My preference would be to forego both procedures: the saline lock because it makes other interventions (such as the administration of IV pain medication) more likely to occur, and the oxytocin shot because I would really like to trust my body’s ability to undergo the birth process with as little external assistance as possible. I also know that the oxytocin is kept close at hand throughout the birth, and can be administered at any time if it appears that excessive bleeding is occurring. Armed with this new information (and another blood test to be done tomorrow), we will discuss our decision with the midwife at our next appointment.
Friday is my official due date, though I’m definitely not getting any indication that he’s going to make his grand appearance this week. I’m not concerned at this point, as I still feel great, and I know that he will show up whenever he’s good and ready. Besides, we could definitely use one more leisurely weekend of sleeping in and lazing about :)