Abstract - 2018 - Research and Practice in Thrombosis and Haemostasis

Mandy Moore Says No Epidural During Birth Due To Rare Blood Disorder ...

Mandy Moore is expecting her second child with her husband Taylor Goldsmith, 36, and recently revealed to "Today" that she'll have to give birth without pain medication due to a rare autoimmune blood disorder called immune thrombocytopenic purpura (ITP).

"My platelets are too low for an epidural," Moore, 38, told the outlet. She said had to take the same precaution when she gave birth to her son August "Gus" Goldsmith, who is now 17 months old. 

A post shared by Mandy Moore (@mandymooremm)

"It was awful. But I can do it one more time. I can climb that mountain again," Moore continued, reflecting on her first birth experience. "I wish medication was an option — just the idea of it being on the table is so nice. But we'll just push forth like we did last time."

Moore is taking extra care of herself during her second pregnancy. In late June, she canceled the remainder of her "In Real Life" tour, telling her followers that she wasn't pregnant when the dates were initially booked. She noted that the traveling required to tour while pregnant had "taken its toll" on her. 

"I know that I have to put my family and my health (and the health of my baby) first and the best place for me to be right now is at home," Moore's statement continued. 

A post shared by Mandy Moore (@mandymooremm)

On Thursday, Moore updated her followers on her condition in a now-expired Instagram Story. "I am fine. I just have to continue to get my blood checked — my platelet levels checked — throughout pregnancy," she shared in her stories, according to "Today."

She continued: "They're low, but they've always been low. But I'm all good. Everything's good."

What is immune thrombocytopenic purpura? Actor Mandy Moore attends the 69th Annual Primetime Emmy Awards at Microsoft Theater. David Crotty/Patrick McMullan via Getty Images

ITP is a rare blood disorder characterized by "unusually low levels of platelets" in the blood, per the Mayo Clinic.

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The Platelet Disorder Support Association reported that only about 50000 people in the US are "currently living" with  ITP. Worldwide, the Rare Disease Database estimated that "well over 200,000 people" are "affected by ITP."

According to the Mayo Clinic, the autoimmune disorder is "more common among young women."

Since platelets are cells that help stop bleeding, they can result in "excessive bruising and bleeding," according to the Mayo Clinic. Low platelet levels usually occur because the "immune system mistakenly attacks and destroys platelets," according to the Mayo Clinic. ITP can also be "triggered" by infections like HIV and hepatitis in adults, while kids may experience a viral illness such as the flu, per the Mayo Clinic.

The most extreme complication of ITP the Mayo Clinic listed is "bleeding into the brain, which can be fatal." 

Moore's "This Is Us" character Rebecca was once pregnant with triplets. Ron Batzdorff/NBC

Moore needs to take extreme precautions and have unmedicated childbirth because Mayo Clinic stated that pregnant people have a "greater risk of heavy bleeding during delivery."

Dr. Ashley Roman, the director of Maternal-Fetal Medicine at NYU Langone Health clarified for "Today" that the risk of excessive bleeding exists whether someone chooses to have a vaginal birth or a cesarean.

"There is also a risk to the fetus. The antibodies that cause the low platelets in the mother, can cross the placenta and affect the baby's platelet count as well," Dr. Roman continued. "In really rare cases, the platelet count in the fetus can be so low that it leads to bleeding problems in the baby."

Mandy Moore Will Have Unmedicated Birth Due To Rare Blood Disorder

Mandy Moore revealed that she will have an unmedicated birth when she welcomes her second baby this fall.

In a Today Parents interview published on Friday, the This Is Us star, 38, opened up about not being able to receive an epidural during childbirth due to an autoimmune disorder called immune thrombocytopenic purpura (ITP).

Moore and her husband Taylor Goldsmith are already parents to 17-month-old son Gus, whom she also delivered without medication due to the condition.

"My platelets are too low for an epidural," Moore shared. "It was awful. But I can do it one more time. I can climb that mountain again."

She continued, "I wish medication was an option — just the idea of it being on the table is so nice. But we'll just push forth like we did last time."

Mandy Moore Instagram

On Thursday, the singer also shared a positive pregnancy update on Instagram.

"I am fine. I just have to continue to get my blood checked — my platelet levels checked — throughout pregnancy. They're low, but they've always been low," Moore said, per Today. "But I'm all good. Everything's good."

According to Mayo Clinic, the disorder can "lead to easy or excessive bruising and bleeding. The bleeding results from unusually low levels of platelets — the cells that help blood clot."

Pregnant women who suffer from ITP are at a "greater risk of heavy bleeding during delivery," according to the clinic.

Dr. Ashley Roman, director of Maternal Fetal Medicine at NYU Langone Health, told Today that if an expectant mother's platelet count is very low, then placing an epidural during labor can cause injury around the spinal cord.

In an interview with Today Parents earlier this month, Moore opened up about her decision to end her In Real Life tour early as she prepares to welcome her second baby.

"As it turns out, being on a set is worlds away from being on a tour bus. It was like trying to sleep on a wooden roller coaster," Moore explained at the time. "Gus would be standing up in his Pack N' Play while the bus was shaking — and I was like, 'No, no, no. We can't do this anymore.' "

"I foolishly thought 'if I did it before, I can do it again,' " she continued. "But every pregnancy is different. This time, I was caring for a toddler. I was walking around feeling like an absolute shell of myself."

RELATED VIDEO: I Wish Someone Told Me: Mandy Moore

Moore also noted that she was afraid her lack of sleep and busy schedule would negatively impact her baby's health.

"I was scared I was going to adversely affect my [unborn] baby and his growth," she admitted.

"I'd been looking forward to this for a decade and half," Moore said of being back on tour after 15 years. "But ultimately, nothing trumps your health, and the health of your baby."

Moore echoed similar sentiments in her social media announcement last month, sharing that being on tour was "too challenging" amid her pregnancy.

"Friends, It is with a heavy heart and much consideration that I have to let you all know that I am canceling my remaining show dates in 2022," Moore informed fans.

"It has been an honor and an absolute dream to return to the stage again this past month, performing for all of you. When we booked these shows, I wasn't pregnant and although I truly thought I could power through, the way we are traveling (long hours on the bus and not getting proper rest) has caught up, taken its toll, and made it feel too challenging to proceed," she continued.

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"I know that I have to put my family and my health (and the health of my baby) first and the best place for me to be right now is at home. Thank you for all of your support along the way and thank you in advance for respecting my decision," she concluded. "I can't wait to get back out there soon to bring this music and show your way!!"

The actress announced on Instagram earlier in June that she is pregnant, expecting her second baby boy with Goldsmith this fall.

Decrease In Mean Platelet Counts Seen During Pregnancy

HealthDay News —  All women have a decrease in mean platelet counts during pregnancy, according to a study published in the July 5 issue of the New England Journal of Medicine.

Jessica A. Reese, PhD, from the University of Oklahoma Health Sciences Center in Oklahoma City, and colleagues examined platelet counts throughout pregnancy in 7,351 women who delivered between 2011 and 2014. Platelet counts were compared with those of non-pregnant women included in the National Health and Nutrition Examination Survey from 1999 through 2012.

The researchers found that 4,568 women had uncomplicated pregnancies, 2,586 had pregnancy-related complications, and 197 had pre-existing disorders associated with thrombocytopenia. The mean platelet count in the first trimester was 251,000/mm³ among women with uncomplicated pregnancies, compared with the mean platelet count of 273,000/mm³ among the 8,885 non-pregnant women (P < 0.001). Overall, 9.9% of women with uncomplicated pregnancies had a platelet count below 150,000/mm³ at the time of delivery. Only 45 women (1%) had a platelet count below 100,000/mm³ during the course of the uncomplicated pregnancies and deliveries. Women who had pregnancy-related complications more often had platelet counts of less than 150,000/mm³ at the time of delivery than women with uncomplicated pregnancies (11.9 vs 9.9%).

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"Mean platelet counts decreased during pregnancy in all the women, beginning in the first trimester," the authors write.

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