title: Consequences of being Rhesus D immunized during pregnancy and how to optimize new prevention strategies.
abstract: OBJECTIVE
  To analyze the timing of Rhesus D (RhD) immunization in pregnancy and the consequences for the index pregnancy and for subsequent pregnancies to be able to optimize the design of antenatal screening and prevention programs.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Stockholm county, Sweden.
  
  
  METHODS
  All RhD immunized pregnant women 1990-2008 before the introduction of routine antenatal anti-D prophylaxis.
  
  
  METHODS
  Data were collected from transfusion medicine registers and databases, medical records, the Swedish Medical Birth Register and the National Perinatal Quality Register and entered into a standardized database before analysis.
  
  
  METHODS
  The order of pregnancy and trimester when immunization occurred and treatment of hemolytic disease of the fetus and newborn.
  
  
  RESULTS
  A total of 290 RhD immunized women were included in the study. In 147/290 (51%) of the women, sensitization occurred with their first-born child and in 96/290 (33%) it occurred with their second-born child. Anti-D antibodies developed during the second or third trimester in 212/290 (73%) and in 61/290 (21%) at term or after delivery. In subsequent pregnancies 56% (144/259) of the neonates required treatment for hemolytic disease of the fetus and newborn.
  
  
  CONCLUSIONS
  Based on our study, at least half of the cases could potentially have been avoided by routine antenatal anti-D prophylaxis in the beginning of the third trimester. To optimize the beneficial effects of new prevention programs, we propose providing anti-D prophylaxis in gestational week 28-30 selectively to all RhD-negative women with RhD-positive fetuses.
authors.affiliation: Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden. eleonor.tiblad@karolinska.se
authors.forename: Eleonor
authors.initials: E
authors.lastname: Tiblad
authors.forename: Magnus
authors.initials: M
authors.lastname: Westgren
authors.forename: Dharmintra
authors.initials: D
authors.lastname: Pasupathy
authors.forename: Anita
authors.initials: A
authors.lastname: Karlsson
authors.forename: Agneta T
authors.initials: AT
authors.lastname: Wikman
mesh_terms: D000328:Adult; D004899:Erythroblastosis, Fetal / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000517:prevention & control; D011263:Pregnancy Trimester, Third; D011295:Prenatal Care; D011296:Prenatal Diagnosis; D012042:Registries; D012189:Retrospective Studies; D012203:Rh Isoimmunization / Q000517:prevention & control*; D018029:Rho(D) Immune Globulin / Q000627:therapeutic use*
chemical_list: D018029:Rho(D) Immune Globulin
keywords: Rhesus immunization; Rhesus prophylaxis; hemolytic disease of the newborn; prevention; red cell alloimmunization