To investigate pregnancy and perinatal outcomes in women with immune thrombocytopenic purpura (ITP). A retrospective study comparing all singleton pregnancies of women with and without ITP was conducted. Deliveries occurred between the years 1988 and 2007. Multiple logistic regression models were performed to control for confounders. During the study period, 186,602 deliveries were recorded, out of which 104 (0.06%) occurred in patients with ITP. In a multivariable analysis, we found the following conditions to be significantly and independently associated with ITP: hypertensive disorders, diabetes mellitus, and preterm delivery (<34 weeks gestation). Patients with ITP had significantly higher rates of preterm delivery (<34 weeks gestation; 6.7%vs. 2.2%; p < 0.001) and perinatal mortality (4.8%vs. 1.3%; p = 0.011) when compared with patients without ITP. Two multivariable logistic regression models were constructed with perinatal mortality and preterm delivery (<34 weeks gestation) as the outcome variables to control for possible confounders such as congenital malformations, hypertension, diabetes mellitus, and maternal age. In these models, ITP was found to be an independent risk factor for perinatal mortality (OR = 3.77; 95% CI 1.32-10.78, p = 0.013), as well as for preterm delivery before 34 weeks gestation (OR = 3.01; 95% CI 1.39-6.52, p = 0.005). ITP is significantly and independently associated with preterm delivery before 34 weeks gestation and with perinatal mortality.