Carolien Zwiers1, Johanna G van der Bom2, Inge L van Kamp3, Nan van Geloven4, Enrico Lopriore5, John Smoleniec6, Roland Devlieger7, Pauline E Sim8, Marie Anne Ledingham8, Eleonor Tiblad9, Kenneth J Moise10, Karl-Philip Gloning11, Mark D Kilby12, Timothy G Overton13, Ditte S Jørgensen14, Katrine V Schou14, Bettina Paek15, Martin Walker15, Emma Parry16, Dick Oepkes3, Masja de Haas17. 1. Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: c.zwiers@lumc.nl. 2. Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands; Center for Clinical Transfusion Research, Sanquin Research, Leiden University Medical Center, Leiden, The Netherlands. 3. Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands. 4. Department of Medical Statistics and Bio-informatics, Leiden University Medical Center, Leiden, The Netherlands. 5. Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands. 6. Feto-Maternal Unit, Liverpool Hospital, Liverpool, Australia. 7. Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium. 8. Ian Donald Fetal Medicine Unit, Queen Elizabeth Hospital, Glasgow, United Kingdom. 9. Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden. 10. McGovern Medical School, UT Health; Fetal Center, Children's Memorial Hermann Hospital, Houston, TX. 11. Pränatal Medizin München, Frauenärtze und Humangenetiker, München, Germany. 12. Fetal Medicine Center, Birmingham Women's and Children's Foundation Trust, and Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, Birmingham, United Kingdom. 13. Fetal Medicine Unit, St Michael's Hospital, Bristol, United Kingdom. 14. Center of Fetal Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. 15. Evergreen Fetal Therapy Program, Evergreen Health Medical Center, Kirkland, WA. 16. Maternal-Fetal Medicine, Auckland District Health Board, Auckland, New Zealand. 17. Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands; Center for Clinical Transfusion Research, Sanquin Research, Leiden University Medical Center, Leiden, The Netherlands; Immunohematology Diagnostic Services, Sanquin Blood Supply, Amsterdam, The Netherlands.
Abstract
BACKGROUND: Intrauterine transfusion for severe alloimmunization in pregnancy performed <20 weeks' gestation is associated with a higher fetal death rate. Intravenous immunoglobulins may prevent hemolysis and could therefore be a noninvasive alternative for early transfusions. OBJECTIVE: We evaluated whether maternal treatment with intravenous immunoglobulins defers the development of severe fetal anemia and its consequences in a retrospective cohort to which 12 fetal therapy centers contributed. STUDY DESIGN: We included consecutive pregnancies of alloimmunized women with a history of severe hemolytic disease and by propensity analysis compared index pregnancies treated with intravenous immunoglobulins (n = 24) with pregnancies managed without intravenous immunoglobulins (n = 28). RESULTS: In index pregnancies with intravenous immunoglobulin treatment, fetal anemia developed on average 15 days later compared to previous pregnancies (8% less often <20 weeks' gestation). In pregnancies without intravenous immunoglobulin treatment anemia developed 9 days earlier compared to previous pregnancies (10% more <20 weeks), an adjusted 4-day between-group difference in favor of the immunoglobulin group (95% confidence interval, -10 to +18; P = .564). In the subcohort in which immunoglobulin treatment was started <13 weeks, anemia developed 25 days later and 31% less <20 weeks' gestation (54% compared to 23%) than in the previous pregnancy. Fetal hydrops occurred in 4% of immunoglobulin-treated pregnancies and in 24% of those without intravenous immunoglobulin treatment (odds ratio, 0.03; 95% confidence interval, 0-0.5; P = .011). Exchange transfusions were given to 9% of neonates born from pregnancies with and in 37% without immunoglobulin treatment (odds ratio, 0.1; 95% confidence interval, 0-0.5; P = .009). CONCLUSION: Intravenous immunoglobulin treatment in mothers pregnant with a fetus at risk for hemolytic disease seems to have a potential clinically relevant, beneficial effect on the course and severity of the disease. Confirmation in a multicenter randomized trial is needed.
BACKGROUND:Intrauterine transfusion for severe alloimmunization in pregnancy performed <20 weeks' gestation is associated with a higher fetal death rate. Intravenous immunoglobulins may prevent hemolysis and could therefore be a noninvasive alternative for early transfusions. OBJECTIVE: We evaluated whether maternal treatment with intravenous immunoglobulins defers the development of severe fetal anemia and its consequences in a retrospective cohort to which 12 fetal therapy centers contributed. STUDY DESIGN: We included consecutive pregnancies of alloimmunized women with a history of severe hemolytic disease and by propensity analysis compared index pregnancies treated with intravenous immunoglobulins (n = 24) with pregnancies managed without intravenous immunoglobulins (n = 28). RESULTS: In index pregnancies with intravenous immunoglobulin treatment, fetal anemia developed on average 15 days later compared to previous pregnancies (8% less often <20 weeks' gestation). In pregnancies without intravenous immunoglobulin treatment anemia developed 9 days earlier compared to previous pregnancies (10% more <20 weeks), an adjusted 4-day between-group difference in favor of the immunoglobulin group (95% confidence interval, -10 to +18; P = .564). In the subcohort in which immunoglobulin treatment was started <13 weeks, anemia developed 25 days later and 31% less <20 weeks' gestation (54% compared to 23%) than in the previous pregnancy. Fetal hydrops occurred in 4% of immunoglobulin-treated pregnancies and in 24% of those without intravenous immunoglobulin treatment (odds ratio, 0.03; 95% confidence interval, 0-0.5; P = .011). Exchange transfusions were given to 9% of neonates born from pregnancies with and in 37% without immunoglobulin treatment (odds ratio, 0.1; 95% confidence interval, 0-0.5; P = .009). CONCLUSION: Intravenous immunoglobulin treatment in mothers pregnant with a fetus at risk for hemolytic disease seems to have a potential clinically relevant, beneficial effect on the course and severity of the disease. Confirmation in a multicenter randomized trial is needed.
Authors: Isabelle M C Ree; Anne M de Grauw; Vincent Bekker; Masja de Haas; Arjan B Te Pas; Dick Oepkes; Annemieke J M Middeldorp; Enrico Lopriore Journal: Vox Sang Date: 2019-12-19 Impact factor: 2.144
Authors: Shuwen Huang; Lin Liu; Guanglei Qian; Wenxue Liu; Jialiang Wang; Ming Li; Guang Yang Journal: Iran J Public Health Date: 2020-05 Impact factor: 1.429