Intravenous immunoglobulin (IVIG) could delay the need for intrauterine transfusions (IUTs) and decrease hemolysis in pregnancies at risk of developing hemolytic disease of the fetus and newborn (HDFN), according to a recently published study in the American Journal of Obstetrics and Gynecology.
Pregnancies in which the mother has a different blood type from the fetus, particularly regarding the RH antigen, are considered to be at risk of developing HDFN, in which maternal antibodies cross the placenta and cause the destruction of fetal red blood cells, leading to a potentially deadly complication during pregnancy and after birth.
In second pregnancies in which the mother has not received the RhoGAM vaccine after the first pregnancy, treatment mostly consists of treating HDFN complications after they arise. This is often done through IUTs to treat fetal anemia and phototherapy to treat neonatal jaundice.
Learn more about HDFN treatment and care
However, a recent study has shed light on a potential breakthrough in managing high-risk pregnancies at risk. The study aimed to evaluate the effectiveness of maternal administration of intravenous immunoglobulin (IVIG) in delaying the need for IUTs and mitigating the severity of HDFN.
Researchers systematically reviewed data from multiple databases until June 2023, selecting 11 relevant studies. These studies focused on pregnancies with severe risk, defined by previous fetal or neonatal death due to HDFN or the necessity of IUT before 24 weeks of gestation in previous pregnancies. The studies included pregnancies receiving IVIG to delay IUT compared to those undergoing IUT alone.
The result revealed that pregnancies receiving IVIG showed a significant delay in the gestational age (GA) at the first IUT compared to those undergoing IUT alone. Furthermore, the IVIG group exhibited higher hemoglobin levels at the time of the initial IUT, indicating a potential protective effect against severe anemia. Additionally, the GA at delivery was notably later in the IVIG group, suggesting a beneficial impact on prolonging pregnancy duration.
Although these findings signify a promising alternative in the management of high-risk pregnancies, Further research and clinical trials are warranted to validate these findings and establish IVIG as a standard therapeutic option in such cases.
“IVIG treatment in pregnancies at risk of severe early HDFN seems to have a potential clinically relevant beneficial effect on the course and severity of the disease,” the authors wrote.
