Antenatal intravenous immunoglobulins in pregnancies at risk of fetal and neonatal alloimmune thrombocytopenia : comparison of neonatal outcome in treated and nontreated pregnancies
(2022) In American Journal of Obstetrics and Gynecology 227(3). p.1-506- Abstract
Background: Maternal alloantibodies to human platelet antigen-1a can cause severe intracranial hemorrhage in a fetus or newborn. Although never evaluated in placebo-controlled clinical trials, most Western countries use off-label weekly administration of high-dosage intravenous immunoglobulin in all pregnant women with an obstetrical history of fetal and neonatal alloimmune thrombocytopenia. In Norway, antenatal intravenous immunoglobulin is only recommended in pregnancies wherein a previous child had intracranial hemorrhage (high-risk) and is generally not given in other human platelet antigen-1a alloimmunized pregnancies (low-risk). Objective: To compare the frequency of anti-human platelet antigen-1a-induced intracranial hemorrhage... (More)
Background: Maternal alloantibodies to human platelet antigen-1a can cause severe intracranial hemorrhage in a fetus or newborn. Although never evaluated in placebo-controlled clinical trials, most Western countries use off-label weekly administration of high-dosage intravenous immunoglobulin in all pregnant women with an obstetrical history of fetal and neonatal alloimmune thrombocytopenia. In Norway, antenatal intravenous immunoglobulin is only recommended in pregnancies wherein a previous child had intracranial hemorrhage (high-risk) and is generally not given in other human platelet antigen-1a alloimmunized pregnancies (low-risk). Objective: To compare the frequency of anti-human platelet antigen-1a-induced intracranial hemorrhage in pregnancies at risk treated with intravenous immunoglobulin vs pregnancies not receiving this treatment as a part of a different management program. Study Design: This was a retrospective comparative study where the neonatal outcomes of 71 untreated human platelet antigen-1a-alloimmunized pregnancies in Norway during a 20-year period was compared with 403 intravenous-immunoglobulin-treated pregnancies identified through a recent systematic review. We stratified analyses on the basis of whether the mothers belonged to high- or low-risk pregnancies. Therefore, only women who previously had a child with fetal and neonatal alloimmune thrombocytopenia were included. Results: Two neonates with brain bleeds were identified from 313 treated low-risk pregnancies (0.6%; 95% confidence interval, 0.2–2.3). There were no neonates born with intracranial hemorrhage of 64 nontreated, low-risk mothers (0.0%; 95% confidence interval, 0.0–5.7). Thus, no significant difference was observed in the neonatal outcome between immunoglobulin-treated and untreated low-risk pregnancies. Among high-risk mothers, 5 of 90 neonates from treated pregnancies were diagnosed with intracranial hemorrhage (5.6%; 95% confidence interval, 2.4–12.4) compared with 2 of 7 neonates from nontreated pregnancies (29%; 95% confidence interval, 8.2–64.1; P=.08). Conclusion: The most reliable data hitherto for the evaluation of intravenous immunoglobulins treatment in low-risk pregnancies is shown herein. We did not find evidence that omitting antenatal intravenous immunoglobulin treatment in low-risk pregnancies increases the risk of neonatal intracranial hemorrhage.
(Less)
- author
- Ernstsen, Siw L. ; Ahlen, Maria T. ; Johansen, Tiril ; Bertelsen, Eirin L. ; Kjeldsen-Kragh, Jens LU and Tiller, Heidi
- organization
- publishing date
- 2022
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- alloimmunization, antenatal management, human platelet antigen 1a, intracranial hemorrhage, intravenous immunoglobulins, neonatal alloimmune thrombocytopenia, newborn
- in
- American Journal of Obstetrics and Gynecology
- volume
- 227
- issue
- 3
- pages
- 1 - 506
- publisher
- Elsevier
- external identifiers
-
- pmid:35500612
- scopus:85130934086
- ISSN
- 0002-9378
- DOI
- 10.1016/j.ajog.2022.04.044
- language
- English
- LU publication?
- yes
- id
- 3c296dd3-6ff0-47ce-b3fe-29a96cc06fe2
- date added to LUP
- 2022-08-25 11:24:18
- date last changed
- 2024-04-16 02:49:19
@article{3c296dd3-6ff0-47ce-b3fe-29a96cc06fe2,
abstract = {{<p>Background: Maternal alloantibodies to human platelet antigen-1a can cause severe intracranial hemorrhage in a fetus or newborn. Although never evaluated in placebo-controlled clinical trials, most Western countries use off-label weekly administration of high-dosage intravenous immunoglobulin in all pregnant women with an obstetrical history of fetal and neonatal alloimmune thrombocytopenia. In Norway, antenatal intravenous immunoglobulin is only recommended in pregnancies wherein a previous child had intracranial hemorrhage (high-risk) and is generally not given in other human platelet antigen-1a alloimmunized pregnancies (low-risk). Objective: To compare the frequency of anti-human platelet antigen-1a-induced intracranial hemorrhage in pregnancies at risk treated with intravenous immunoglobulin vs pregnancies not receiving this treatment as a part of a different management program. Study Design: This was a retrospective comparative study where the neonatal outcomes of 71 untreated human platelet antigen-1a-alloimmunized pregnancies in Norway during a 20-year period was compared with 403 intravenous-immunoglobulin-treated pregnancies identified through a recent systematic review. We stratified analyses on the basis of whether the mothers belonged to high- or low-risk pregnancies. Therefore, only women who previously had a child with fetal and neonatal alloimmune thrombocytopenia were included. Results: Two neonates with brain bleeds were identified from 313 treated low-risk pregnancies (0.6%; 95% confidence interval, 0.2–2.3). There were no neonates born with intracranial hemorrhage of 64 nontreated, low-risk mothers (0.0%; 95% confidence interval, 0.0–5.7). Thus, no significant difference was observed in the neonatal outcome between immunoglobulin-treated and untreated low-risk pregnancies. Among high-risk mothers, 5 of 90 neonates from treated pregnancies were diagnosed with intracranial hemorrhage (5.6%; 95% confidence interval, 2.4–12.4) compared with 2 of 7 neonates from nontreated pregnancies (29%; 95% confidence interval, 8.2–64.1; P=.08). Conclusion: The most reliable data hitherto for the evaluation of intravenous immunoglobulins treatment in low-risk pregnancies is shown herein. We did not find evidence that omitting antenatal intravenous immunoglobulin treatment in low-risk pregnancies increases the risk of neonatal intracranial hemorrhage.</p>}},
author = {{Ernstsen, Siw L. and Ahlen, Maria T. and Johansen, Tiril and Bertelsen, Eirin L. and Kjeldsen-Kragh, Jens and Tiller, Heidi}},
issn = {{0002-9378}},
keywords = {{alloimmunization; antenatal management; human platelet antigen 1a; intracranial hemorrhage; intravenous immunoglobulins; neonatal alloimmune thrombocytopenia; newborn}},
language = {{eng}},
number = {{3}},
pages = {{1--506}},
publisher = {{Elsevier}},
series = {{American Journal of Obstetrics and Gynecology}},
title = {{Antenatal intravenous immunoglobulins in pregnancies at risk of fetal and neonatal alloimmune thrombocytopenia : comparison of neonatal outcome in treated and nontreated pregnancies}},
url = {{http://dx.doi.org/10.1016/j.ajog.2022.04.044}},
doi = {{10.1016/j.ajog.2022.04.044}},
volume = {{227}},
year = {{2022}},
}