The administration of anti-D immunoprophylaxis in pregnant women postnatally (ie, after birth) does not completely prevent alloimmunization, which causes hemolytic disease of the fetus and newborn (HDFN), according to a study recently published in the Open Journal of Blood Diseases.
Immunoprophylaxis is a form of therapy that is used to prevent the occurrence of a disease before it even manifests. In HDFN, red blood cells from a RhD-positive fetus comes into contact with the maternal circulation of a mother who is RhD-negative; this incompatibility causes the mother’s body to produce antibodies against fetal red blood cells, resulting in their destruction.
Anti-D immunoprophylaxis is administered with the hopes of preventing this from happening. Existing studies indicate that anti-D immunoprophylaxis is most effective when administered early in pregnancy, which is a common practice in higher-income countries.
A team of researchers investigated the outcomes of postnatal administration of anti-D immunoprophylaxis among a group of pregnant women in Benin, a middle-income country in Africa. From an initial group of 174 pregnant women, the research team found 131 individuals who were RhD-negative and had RhD-positive partners, meaning that they were potentially at risk of HDFN.
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Approximately half of the participants in this study were between 25 and 35 years of age. The 131 patients included in this study all received postnatal anti-D immunoprophylaxis. A small percentage (5.71%) of patients still developed anti-D antibodies despite being administered this therapy. The research team found no significant correlation between the number of times a woman had given birth (ie, parity) and immunization status. There was also no significant association between immunization status and history of blood transfusions/miscarriage.
“This study demonstrates that postnatal anti-D immunoprophylaxis in RhD-negative pregnant women is not entirely effective, as a proportion of women still developed anti-D antibodies despite receiving prophylaxis,” the authors of the study concluded. “These findings highlight the need for improved preventive strategies, including earlier administration of immunoprophylaxis and routine fetal RhD genotyping.”
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