Timely recognition and intervention for fetal anemia, which is often caused by hemolytic disease of the fetus and newborn (HDFN), can significantly improve survival and long-term outcomes for babies, according to a narrative review published recently in Clinical Obstetrics and Gynecology.
HDFN occurs when a mother’s immune system attacks her unborn baby’s red blood cells, leading to anemia that may be life-threatening if untreated. This immune reaction happens when a mother who lacks certain red blood cell antigens is exposed to fetal red blood cells carrying those antigens, most commonly through pregnancy or prior transfusions.
The resulting antibodies can cross the placenta, destroy the baby’s red cells and cause serious complications such as hydrops fetalis or stillbirth.
“Neonates with a history of IUT [intrauterine transfusion] should undergo postnatal evaluation for anemia and may require blood transfusions and ESAs [erythropoietin stimulating agents],” explained the authors of this review. They continued, “Timely and effective antenatal management of fetal anemia can reduce long-term and postnatal complications.”
Read more about the prognosis of HDFN
Fortunately, advances in prenatal screening have made it easier to detect fetal anemia earlier and less invasively. Cell-free DNA testing can identify the fetus’s red cell antigens using a blood sample from the mother as early as 10 weeks into pregnancy. If the fetus is found to be at risk, Doppler ultrasound of the middle cerebral artery can help monitor for anemia, reducing the need for invasive procedures.
When fetal anemia is suspected or confirmed, several treatment options are available. Intravenous immunoglobulin therapy given to the mother can help reduce antibody production and delay the need for early intervention. In more severe cases, an intrauterine transfusion is used to deliver healthy red blood cells directly to the fetus. Intrauterine transfusion has become a life-saving procedure for babies with severe anemia, although it carries risks such as bleeding or premature labor.
Emerging therapies such as nipocalimab, a monoclonal antibody, aim to prevent the harmful maternal antibodies from reaching the fetus. In clinical trials, it has shown promise in delaying fetal anemia and lowering the number of transfusions needed during pregnancy.
For infants at risk of HDFN, these diagnostic and treatment advances may help speed recovery. With proper monitoring and care, affected pregnancies can result in healthy births and fewer complications for both mother and baby.
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