For couples whose infant has been diagnosed with hemolytic disease of the fetus and newborn (HDFN), pregnancy, birth and postnatal recovery can be a challenging time that places extra strain on their relationship. This is why it’s vital for couples affected by HDFN to support one another, and when possible, seek professional counseling services to ensure the family unit doesn’t suffer due to the diagnosis.
About HDFN
In HDFN, a rapid breakdown of a baby’s red blood cells (RBCs) occurs. During pregnancy, a mismatch between the mother’s and the baby’s blood type (A, B, AB, O) or Rhesus (RhRh factor A protein or antigen found on red blood cells. When an Rh-negative mother carries an Rh-positive fetus, her immune system may make antibodies that attack the fetus' red blood cells.) factor—Rh-positiveRh-Positive A blood type trait that means your red blood cells have the Rh(D) antigen. or Rh-negativeRh-Negative A blood type trait that means your red blood cells lack the Rh(D) antigen.—may be reported.
Rh-positive individuals have the Rh(D) antigen on their RBCs; their blood type is Rh(D)-positive. Rh-negative individuals, on the other hand, do not have the Rh(D) antigen on their RBCs; their blood type is RhD-negative.
Most individuals are Rh-positive—meaning they have inherited the Rh factorRh factor A protein or antigen found on red blood cells. When an Rh-negative mother carries an Rh-positive fetus, her immune system may make antibodies that attack the fetus' red blood cells. from their mother or their father. A fetus that does not inherit the Rh factor from either the mother or the father is considered Rh-negative.
What is HDFN?
Hemolytic disease of the fetus and newborn (HDFN) is an immune-mediated red blood cell (RBC) disorder that occurs when a baby’s RBCs break down quickly, which is called hemolysis. HDFN is caused by a mismatch between a mother’s and her baby’s blood type (A, B, AB, or O) or Rhesus (Rh) factor (Rh-positive or Rh-negative) during pregnancy. Numerous antibodiesAntibody A protein made by the immune system that recognizes and attacks foreign substances, such as bacteria, or in HDFN, fetal red blood cells carrying incompatible antigens. to RBC antigensAntibody A protein made by the immune system that recognizes and attacks foreign substances, such as bacteria, or in HDFN, fetal red blood cells carrying incompatible antigens. can be linked to HDFN, such as those from the ABO and Rh blood groupBlood group A classification of blood based on inherited markers found on red blood cells. The ABO and Rh blood groups are most common in HDFN. systems.
What is the most common cause of HDFN?
Most often, HDFN is reported when an Rh-negative mother becomes pregnant with a baby whose father is Rh-positive. In such instances, if the unborn baby is Rh-positive—like the father—problems can result if the baby’s RBCs cross the placenta to the Rh-negative mother. The immune system of the Rh-negative mother will recognize the baby’s Rh-positive RBCs as foreign and react by producing antibodies to destroy them.
What complications may occur with HDFN?
During the mother’s pregnancy, possible complications may include an enlarged fetal heart, liver, or spleen. Fluid buildup in the lungs, stomach, heart, or skin may be reported as well.
To prevent such complications, physicians will usually perform blood tests early on in a pregnancy, to determine the mother’s blood type and Rh factor. In couples with the same blood type, several preconception tests should be conducted prior to a baby’s birth, to help guarantee a healthy pregnancy. These tests include blood typing, Rh factor testing, and antibodyAntibody A protein made by the immune system that recognizes and attacks foreign substances, such as bacteria, or in HDFN, fetal red blood cells carrying incompatible antigens. screening.
Couples with the same blood type may also wish to consider genetic counseling, which can help to identify possible genetic conditions that can be passed on to their baby.
Read more about HDFN symptoms and risks
What additional testing options are available for couples?
Other additional testing options include free fetal DNA analysis (if the mother’s partner is not available for testing), fetal middle cerebral Doppler ultrasound assessment, and cordocentesis (also called umbilical blood sampling).
What type of counseling is available for couples?
A prenatal diagnosis of HDFN, or the possibility of birthing a child with HDFN, can present the parents-to-be with major challenges. The mother and father are entitled to meaningful information from their physician or medical care team on the possible outcomes for their baby.
Parental counseling has become more and more important as fetal abnormalities are able to be detected in the prenatal stage. Specific symptoms associated with HDFN are often not noticed during a mother’s pregnancy. Instead, the disorder is more often suspected when abnormal findings are observed on a fetal ultrasound. The signs and symptoms of HDFN can differ with each pregnancy and with each child.
What is preconception health?
Preconception health describes the health of individuals during their reproductive years—the time span when they can conceive a child. It centers on initiating measures to protect the health of all babies a couple plans on having in the future.
Preconception health care refers to the medical care a person receives from a physician or other health care provider that focuses on those components that increase the likelihood of having a healthy baby.
Preconception health is an important consideration for both women and men.
How can couples counseling be helpful?
Research has demonstrated that counseling and psychotherapy are the most effective and safe methods that couples can use to help manage anxiety, depression and stress.
Couples who are dealing with high-risk pregnancies, such as those that involve a diagnosis of HDFN, may be faced with multiple feelings. Counseling can help to ensure the emotional support by a partner during a difficult pregnancy. Those couples who have experienced a prior traumatic or difficult birth, including a miscarriage or a stillborn birth, can benefit from counseling as well.
Couples’ counseling is a valuable approach for improving communication between the parents-to-be. It can help a couple work out any conflicts in their relationship. Such counseling can also help guide partners’ decisions when disagreement exists with respect to treatment options.
