The use of intravenous immunoglobulinIntravenous immunoglobulin A therapy made from donated antibodies that may help reduce the mother’s immune response and protect the fetus. (IVIGIntravenous immunoglobulin A therapy made from donated antibodies that may help reduce the mother’s immune response and protect the fetus.) in pregnancies at risk for developing severe hemolytic disease of the fetus and newborn (HDFN) appears to be beneficial for the overall health of the fetus, according to findings from an individual patient data meta-analysis presented recently at the 34th World Congress on UltrasoundUltrasound An imaging test that uses sound waves to monitor fetal growth, development and signs of complications during pregnancy. in Obstetrics and Gynecology.
It is well known that in pregnancy, red blood cell (RBC) alloimmunizationAlloimmunization When a person’s immune system develops antibodies against foreign antigens from the same species—such as when an Rh-negative mother’s body forms antibodies against her baby’s Rh-positive red blood cells. can be associated with serious fetal complications, such as anemiaAnemia A condition that occurs when the body doesn’t have enough healthy red blood cells to carry oxygen to its tissues. In HDFN, anemia occurs when maternal antibodies destroy fetal red blood cells., heart failure, fluid buildup, decreased levels of oxygen and fetal death. In fact, high-risk RBC alloimmunized pregnancies are reported when the mother’s immune system generates 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. that attack the fetus’s RBCs. This can occur, for example, when the mother and the fetus have different 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.) blood types.
The researchers sought to explore the outcomes linked to the administration of IVIG in patients with high-risk RBC alloimmunized pregnancies. They performed a systematic literature search and meta-analysis up to June 2023.
The meta-analysis comprised all studies that reported on pregnancies with severe RBC alloimmunization. In these studies, pregnancies with severe RBC alloimmunization were defined as those with “either a previous fetal or neonatal death or the need for intrauterine transfusionIntrauterine transfusion A procedure that delivers donor red blood cells to the fetus through the umbilical vein to treat severe anemia caused by HDFN. (IUTIntrauterine transfusion A procedure that delivers donor red blood cells to the fetus through the umbilical vein to treat severe anemia caused by HDFN.) before 24 weeks in the previous pregnancy as a result of…HDFN, that were treated with IVIG.”
Read more about HDFN prognosis
The Bayesian framework was utilized to perform an individual patient data (IPD) meta-analysis. The IPD meta-analysis comprised eight studies that included 97 cases and 97 controls.
Results of the analysis revealed that at the time of the first UIT, treatment with IVIG was associated with prolonged gestational age (GA), a reduced risk of fetal hydrops, reduced risk of fetal death and increased likelihood of a live birth.
No significant differences were observed in the number of IUTs performed, hemoglobin levels at birth, bilirubinBilirubin A yellow substance produced when red blood cells break down. High bilirubin levels in newborns with HDFN can cause jaundice or, in severe cases, brain damage. concentrations at birth or survival at hospital discharge for live births.
“IVIG treatment in pregnancies at risk [for] severe early HDFN seems to have a clinically relevant beneficial effect on the course and severity of disease,” the authors concluded.
