Severe health problems before and after birth continue to occur in babies affected by hemolytic disease of the fetus and newborn (HDFN), even though rates during pregnancy have remained stable over time and newborn rates have declined, according to a study published recently in Clinical and Experimental Obstetrics and Gynecology.
In a 24-year review of nationwide data from Maccabi Healthcare Services in Israel, researchers found that about one-third of affected pregnancies were severe and many newborns experienced anemia or jaundice during their first year of life.
HDFN happens when a pregnant woman’s immune system makes antibodies that attack her baby’s red blood cells. Between 1998 and 2021, the rate of HDFN diagnosed during pregnancy ranged from 0.4 to 1 per 10,000 pregnancies. In newborns, the rate declined from 1.8 per 10,000 newborns in 1998 to 1.1 per 10,000 in 2021, a statistically significant decrease.
“Routine maternal blood testing for alloantibodies during early gestation can enable early diagnosis and management of HDFN pregnancies at risk for development of fetal anemia,” explained this study’s authors.
Read more about the prognosis of HDFN
The study identified 76 HDFN pregnancies in 70 women. Medical details were available for 73 pregnancies. Severe HDFN was diagnosed in 22 of 73 pregnancies, or 30.1%. Most severe cases required at least one intrauterine transfusion, a procedure in which blood is given directly to the fetus. Hydrops, a dangerous buildup of fluid in the fetus, was diagnosed in 8 pregnancies. One pregnancy ended in intrauterine death.
Overall, 57 of 73 pregnancies, or 78.1%, resulted in live births. However, 33% of those babies were born preterm and most of those were late preterm. Among severe cases, 81.3% of live-born infants were preterm. The average birthweight was 2964.2 grams.
Researchers identified 450 newborns diagnosed with HDFN during their first year of life. About one-third developed anemia and a similar proportion developed jaundice. Twelve percent were diagnosed with developmental disorders by age 1. Five cases of kernicterus, a rare but serious type of brain damage caused by very high bilirubin levels, were reported. Among babies whose mothers had confirmed antibodies, 31.8% required blood transfusions and 10.6% received phototherapy.
The results show that while many babies recover and blood levels usually return to normal by one year of age, HDFN can still lead to serious complications. For patients and families, this underscores the importance of close monitoring during pregnancy and careful follow-up after birth. Researchers said further studies are needed to better understand which treatments improve short- and long-term outcomes and how care can be optimized to reduce preventable harm.
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