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. 2024 May;131(6):769-776.
doi: 10.1111/1471-0528.17674. Epub 2023 Sep 24.

Severity of haemolytic disease of the fetus and newborn in patients with a history of intrauterine transfusions in a previous pregnancy: A nationwide retrospective cohort study

Renske M Van't Oever  1   2 , Carolien Zwiers  1 , Masja de Haas  2   3 , Saskia le Cessie  4   5 , Enrico Lopriore  6 , Dick Oepkes  1 , E J T Joanne Verweij  1
Affiliations

Severity of haemolytic disease of the fetus and newborn in patients with a history of intrauterine transfusions in a previous pregnancy: A nationwide retrospective cohort study

Renske M Van't Oever et al. BJOG. 2024 May.

Abstract

Objective: Pregnant women who received at least one intrauterine transfusion (IUT) for haemolytic disease of the fetus and newborn (HDFN) in the preceding pregnancy are presumed to have a high likelihood of requiring IUTs again, often starting at an earlier gestational age. Our aim was to quantify these risks in a large national cohort.

Design: Retrospective cohort study of a nationwide Dutch database.

Setting: The Netherlands.

Population: All women treated in The Netherlands with IUTs for Rhesus D (RhD)- or Kell-mediated HDFN between 1999 and 2017 and their follow-up pregnancies were included. Pregnancies with an antigen-negative fetus were excluded.

Methods: Electronic patient files were searched for the number and gestational age of each IUT, and analysed using descriptive statistics and linear regression.

Main outcome measures: Percentage of women requiring one or more IUTs again in the subsequent pregnancy, and gestational age at first IUT in both pregnancies.

Results: Of the 321 women in our study population, 21% (69) had a subsequent ongoing pregnancy at risk. IUTs were administered in 86% (59/69) of cases. In subsequent pregnancies, the median gestational age at first IUT was 3 weeks earlier (interquartile range -6.8 to 0.4) than in the preceding pregnancy.

Conclusions: Our study shows that pregnant women with a history of IUTs in the previous pregnancy are highly likely to require IUTs again, and on average 3 weeks earlier. Clinicians need to be aware of these risks and ensure timely referral, and close surveillance from early pregnancy onwards. Additionally, for women with a history of IUT and their caregivers, this information is essential to enable adequate preconception counselling.

Keywords: alloimmunisation; fetal anaemia; fetal therapy; haemolytic disease of the fetus and newborn.

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References

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