The antibodies that are responsible for hemolytic disease of the fetus and newborn (HDFN) could be transmitted to newborns through breast milk, according to recently published case reports in Transfusion, a medical journal concerning patient blood management, tissue transplantation and hematopoietic, cellular and gene therapies.
HDFN is caused by antibodies that bind to the red blood cells of fetuses and newborns, leading to their destruction, which in turn causes anemia. These antibodies have been thought to be passed exclusively from mother to fetus through the placenta, an organ responsible for delivering nutrients and oxygen to the fetus during pregnancy.
Now, some medical researchers suggest that persistent cases of HDFN after birth could be caused by maternal antibodies transmitted through breast milk. Furthermore, studies on mice have shown that these antibodies can, in fact, be transmitted through breast milk.
However, the correlation between antibody transmission through breast milk and persistent HDFN after birth has not yet been fully proven.
Read more about HDFN causes
Researchers identified two separate cases of infants with persistent HDFN after birth. Both cases involved newborns with a history of HDFN during pregnancy that required blood transfusions. The patients were born with high bilirubin levels in the blood, a toxic byproduct of red blood cell destruction, and anemia. After birth, both newborns received blood transfusions and were discharged with an indication of close follow-up.
The persistent anemia and bilirubin accumulation after discharge, combined with the detection of maternal antibodies in the blood of the newborns, led doctors to test the breast milk in each case in search of antibodies. In both cases, antibody testing turned out positive.
“We recommend individual shared decision-making between physician and patient prior to deciding to halt breastfeeding, given the numerous benefits of breastfeeding,” the authors wrote. “However, if the individual ultimately does decide to stop breastfeeding, alternatives such as the use of donor breast milk and/or continued expression of breast milk to trial response may be considered.”
Although the study authors consider the findings an important step in knowledge regarding HDFN, they admit that they are inconclusive and that further research is warranted before producing formal recommendations based on these results.
