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Editor's Choice
  • Mustafa HJ
  • Sambatur EV
  • Pagani G
  • D'Antonio F
  • Maisonneuve E
  • et al.
Am J Obstet Gynecol. 2024 Apr 7; doi: 10.1016/j.ajog.2024.03.044.
POPULATION:

Pregnancies with red blood cell alloimmunization (9 studies, n= 194).

INTERVENTION:

Intravenous immunoglobulin (IVIG) at <17 weeks of gestation (n= 97).

COMPARISON:

No IVIG (n= 97).

OUTCOME:

The primary outcome was gestational age (GA) at the first intrauterine transfusion (IUT). Individual patient data analysis included eight studies comprising 97 cases and 97 controls. IVIG was associated with prolonged delta GA at first IUT (GA of current pregnancy - GA at prior pregnancy) (mean difference (MD) 3.19 weeks; 95% CrI [1.28, 5.05]), prolonged GA at first IUT (MD 1.32 weeks; 95% CrI [0.08, 2.5]), reduced risk of fetal hydrops at time of first IUT (incidence rate ratio (IRR) 0.19; 95% CrI [0.07, 0.45]), reduced risk of fetal demise (IRR 0.23; 95% CrI [0.10, 0.47]), higher chances of live birth ≥28 weeks, ≥32 weeks, and survival at birth (IRR 1.88; 95% CrI [1.31, 2.69]; IRR 1.93; 95% CrI [1.32, 2.83]; IRR 1.82; 95% CrI [1.30 to 2.61], respectively). There were no significant differences in numbers of IUT, haemoglobin level at birth, bilirubin level at birth, or survival at hospital discharge for live births.

OBJECTIVE:

This study aimed to investigate the outcomes associated with the administration of maternal intravenous immunoglobulin in high-risk red blood cell-alloimmunized pregnancies.

DATA SOURCES:

Medline, Embase, and Cochrane Library were systematically searched until June 2023.

STUDY ELIGIBILITY CRITERIA:

This review included studies reporting on pregnancies with severe red blood cell alloimmunization, defined as either a previous fetal or neonatal death or the need for intrauterine transfusion before 24 weeks of gestation in the previous pregnancy as a result of hemolytic disease of the fetus and newborn.

METHODS:

Cases were pregnancies that received intravenous immunoglobulin, whereas controls did not. Individual patient data meta-analysis was performed using the Bayesian framework.

RESULTS:

Individual patient data analysis included 8 studies consisting of 97 cases and 97 controls. Intravenous immunoglobulin was associated with prolonged delta gestational age at the first intrauterine transfusion (gestational age of current pregnancy - gestational age at previous pregnancy) (mean difference, 3.19 weeks; 95% credible interval, 1.28-5.05), prolonged gestational age at the first intrauterine transfusion (mean difference, 1.32 weeks; 95% credible interval, 0.08-2.50), reduced risk of fetal hydrops at the time of first intrauterine transfusion (incidence rate ratio, 0.19; 95% credible interval, 0.07-0.45), reduced risk of fetal demise (incidence rate ratio, 0.23; 95% credible interval, 0.10-0.47), higher chances of live birth at ≥28 weeks (incidence rate ratio, 1.88; 95% credible interval, 1.31-2.69;), higher chances of live birth at ≥32 weeks (incidence rate ratio, 1.93; 95% credible interval, 1.32-2.83), and higher chances of survival at birth (incidence rate ratio, 1.82; 95% credible interval, 1.30-2.61). There was no substantial difference in the number of intrauterine transfusions, hemoglobin level at birth, bilirubin level at birth, or survival at hospital discharge for live births.

CONCLUSION:

Intravenous immunoglobulin treatment in pregnancies at risk of severe early hemolytic disease of the fetus and newborn seems to have a clinically relevant beneficial effect on the course and severity of the disease.