Better testing protocols could prevent Rh isoimmunization and improve outcomes in hemolytic disease of the fetus and newborn (HDFN), according to a study published recently in the International Journal of Reproduction, Contraception, Obstetrics and Gynecology.
This new study from Bangladesh found that newborns of Rh-negative mothers who became isoimmunized had significantly worse blood counts and more complications than those born to Rh-negative mothers without isoimmunization.
The study, conducted at Mymensingh Medical College Hospital, examined 80 Rh-negative pregnant women between July and December 2019. Five of these women were isoimmunized, meaning they had developed antibodies against Rh-positive blood cells, which can attack the fetus’s red blood cells. The rest of the women in the study were not isoimmunized.
“Rh isoimmunization remains a significant cause of neonatal morbidity in Rh-negative pregnancies, shown by anemia, hyperbilirubinemia, and increased treatment needs,” explained this study’s authors. They continued, “This study highlights the need for enhanced antenatal care with universal anti-D prophylaxis and improved fetal monitoring to manage hemolytic disease effectively.”
Read more about HDFN causes and risk factors
Results showed that 60% of the babies from isoimmunized pregnancies had hemoglobin levels below 12 g/dL, indicating anemia. None of the non-isoimmunized babies had such low levels. In addition, 80% of the affected babies had bilirubin levels at or above 4 mg/dL, a sign of excessive red blood cell breakdown and a risk factor for brain damage if left untreated. All tested babies from isoimmunized mothers were positive on the direct Coombs test, confirming immune-related hemolysis.
Treatment needs were also higher. Four out of five of these newborns required phototherapy for jaundice and three needed an exchange transfusion, a more invasive and risky procedure. Most of the babies born to non-isoimmunized mothers required no treatment. Apgar scores at five minutes, which are a key indicator of a newborn’s health, were also lower in the isoimmunized group, with 40% scoring below 6 compared to just 12% in the non-isoimmunized group.
This study also linked poor outcomes to maternal risk factors. Most isoimmunized mothers had high gravidity, little or no prenatal care and did not receive anti-D prophylaxis, a preventive treatment widely recommended to stop Rh-negative mothers from becoming sensitized to Rh-positive blood.
These results, the authors stated, underscore the urgent need for improved prenatal screening, access to anti-D immunoglobulin and enhanced care for pregnant Rh-negative women to reduce the burden of HDFN and improve outcomes for affected infants.
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