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Meta-Analysis
. 2015 Sep 3;2015(9):CD000020.
doi: 10.1002/14651858.CD000020.pub3.

Anti-D administration in pregnancy for preventing Rhesus alloimmunisation

Rosemary D McBain  1 , Caroline A Crowther, Philippa Middleton
Affiliations
Meta-Analysis

Anti-D administration in pregnancy for preventing Rhesus alloimmunisation

Rosemary D McBain et al. Cochrane Database Syst Rev. .

Abstract

Background: During pregnancy, a Rhesus negative (Rh-negative) woman may develop antibodies when her fetus is Rhesus positive (Rh-positive). These antibodies may harm Rh-positive babies.

Objectives: To assess the effects of antenatal anti-D immunoglobulin on the incidence of Rhesus D alloimmunisation when given to Rh-negative women without anti-D antibodies.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2015) and reference lists of retrieved studies.

Selection criteria: Randomised trials in Rh-negative women without anti-D antibodies given anti-D after 28 weeks of pregnancy, compared with no treatment, placebo or a different regimen of anti-D.

Data collection and analysis: Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.

Main results: We included two trials involving over 4500 women, comparing anti-D prophylaxis with no anti-D during pregnancy in this review. Overall, the trials were judged to be at moderate to high risk of bias. The quality of the evidence for pre-specified outcomes was also assessed using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach.In regards to primary review outcomes, there did not appear to be a clear difference in the risks of immunisation when women who received anti-D at 28 and 34 weeks' gestation were compared with women who were not given antenatal anti-D: risk ratio (RR) for incidence of Rhesus D alloimmunisation during pregnancy was 0.42 (95% confidence interval (CI) 0.15 to 1.17, two trials, 3902 women; GRADE: low quality evidence); at birth of a Rh-positive infant the RR was 0.42 (95% CI 0.15 to 1.17, two trials, 2297 women); and within 12 months after birth of a Rh-positive infant the average RR was 0.39 (95% CI 0.10 to 1.62, two trials, 2048 women; Tau²: 0.47; I²: 39%; GRADE: low quality evidence). Neither of the trials reported on incidence of Rhesus D alloimmunisation in subsequent pregnancies.Considering secondary outcomes, in one trial, women receiving anti-D during pregnancy were shown to be less likely to register a positive Kleihauer test (which detects fetal cells in maternal blood) in pregnancy (at 32 to 25 weeks) (RR 0.60, 95% CI 0.41 to 0.88; 1884 women; GRADE: low quality evidence) and at the birth of a Rh-positive infant (RR 0.60, 95% CI 0.46 to 0.79; 1189 women; GRADE: low quality evidence). No clear differences were seen for neonatal jaundice (RR 0.26, 95% CI 0.03 to 2.30; 1882 infants; GRADE: very low quality evidence). Neither of the trials reported on adverse effects associated with anti-D treatment.

Authors' conclusions: Existing studies do not provide conclusive evidence that the use of anti-D during pregnancy benefits either mother or baby in terms of incidence of Rhesus D alloimmunisation during the pregnancy or postpartum, or the incidence of neonatal morbidity (jaundice) (low to very low quality evidence). However women receiving anti-D may be less likely to register a positive Kleihauer test in pregnancy and at the birth of a Rh-positive infant (low quality evidence). Fewer women who receive anti-D during pregnancy may have Rhesus D antibodies in a subsequent pregnancy, with benefits for the baby, however this needs to be tested in studies of robust design.

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Conflict of interest statement

None known.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Anti‐D administration in pregnancy, Outcome 1 Incidence of Rhesus D alloimmunisation during pregnancy.
1.2
1.2. Analysis
Comparison 1 Anti‐D administration in pregnancy, Outcome 2 Incidence of Rhesus D alloimmunisation postpartum (at birth of Rh‐positive infant).
1.3
1.3. Analysis
Comparison 1 Anti‐D administration in pregnancy, Outcome 3 Incidence of Rhesus D alloimmunisation postpartum (at birth of Rh‐positive infant and follow‐up, up to 12 months).
1.4
1.4. Analysis
Comparison 1 Anti‐D administration in pregnancy, Outcome 4 Incidence of Rhesus D alloimmunisation postpartum (after birth of Rh‐positive infant at 2 to 12 months): primigravidae.
1.5
1.5. Analysis
Comparison 1 Anti‐D administration in pregnancy, Outcome 5 Incidence of positive Kleihauer test (32 to 35 weeks' gestation).
1.6
1.6. Analysis
Comparison 1 Anti‐D administration in pregnancy, Outcome 6 Incidence of positive Kleihauer test (at birth of Rh‐positive infant).
1.7
1.7. Analysis
Comparison 1 Anti‐D administration in pregnancy, Outcome 7 Incidence of positive Kleihauer test (Kleihauer > 1/10,000, Rh‐positive infant).
1.8
1.8. Analysis
Comparison 1 Anti‐D administration in pregnancy, Outcome 8 Neonatal morbidity (jaundice).
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Update of

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