title: Associations of Rhesus and non-Rhesus maternal red blood cell alloimmunization with stillbirth and preterm birth.
abstract: BACKGROUND
  Although the risks of adverse pregnancy outcomes associated with anti-D antibodies are well-recognized, much less is known concerning alloimmunization with other red blood cell antibodies detected during routine maternal screening. To date, most reports of adverse pregnancy outcomes associated with non-anti-D antibodies have been from small case studies. The aim of this study was to examine the associations of maternal alloimmunization with specific red blood cell antibodies and the risks of preterm birth and stillbirth in the Swedish population.
  
  
  METHODS
  All antibody screening, outcome and covariate data were obtained through linkages of Swedish national health and data registers. Follow-up in these population-based registers was available up to 31 December 2002. The final study sample consisted of 1,022,569 singleton births from 668,952 mothers during 1987-2002.
  
  
  RESULTS
  In total, 1.3% of the 1,022,569 study pregnancies were alloimmunized. In adjusted logistic regression models, compared with having no antibodies, alloimmunization with anti-D, anti-E, anti-C and anti-c was associated with increased risk of both stillbirth and preterm birth. In addition, anti-Kell was associated with increased risk of preterm birth and anti-Lea with increased risk of stillbirth. Compared with firstborn children, risk of preterm birth associated with alloimmunization was greater in subsequent births
  
  
  CONCLUSIONS
  In the largest study to date, alloimmunization with Rhesus, K- and -Lea red blood cell antibodies increased the risk of preterm birth and/or stillbirth. The association of anti-Lea with stillbirth was an unexpected finding. Further study of the consequences of non-anti-D alloimmunization is warranted.
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden, Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA 19102, USA, Department of Laboratory Medicine, Karolinska Institutet and Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, S-14183 Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet and Department of Neonatology, Sachs' Children and Youth Hospital, 118 83 Stockholm, Sweden.
authors.forename: Jing
authors.initials: J
authors.lastname: Fan
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden, Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA 19102, USA, Department of Laboratory Medicine, Karolinska Institutet and Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, S-14183 Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet and Department of Neonatology, Sachs' Children and Youth Hospital, 118 83 Stockholm, Sweden.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Lee
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden, Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA 19102, USA, Department of Laboratory Medicine, Karolinska Institutet and Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, S-14183 Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet and Department of Neonatology, Sachs' Children and Youth Hospital, 118 83 Stockholm, Sweden.
authors.forename: Agneta T
authors.initials: AT
authors.lastname: Wikman
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden, Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA 19102, USA, Department of Laboratory Medicine, Karolinska Institutet and Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, S-14183 Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet and Department of Neonatology, Sachs' Children and Youth Hospital, 118 83 Stockholm, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Johansson
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden, Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA 19102, USA, Department of Laboratory Medicine, Karolinska Institutet and Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, S-14183 Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet and Department of Neonatology, Sachs' Children and Youth Hospital, 118 83 Stockholm, Sweden marie.reilly@ki.se.
authors.forename: Marie
authors.initials: M
authors.lastname: Reilly
mesh_terms: D000328:Adult; D001787:Blood Group Incompatibility / Q000453:epidemiology / Q000276:immunology; D004912:Erythrocytes / Q000276:immunology; D005260:Female; D006801:Humans; D007518:Isoantibodies / Q000276:immunology; D016015:Logistic Models; D008297:Male; D008562:Membrane Glycoproteins / Q000276:immunology; D008666:Metalloendopeptidases / Q000276:immunology; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology*; D012203:Rh Isoimmunization / Q000453:epidemiology* / Q000276:immunology; D018029:Rho(D) Immune Globulin; D050497:Stillbirth / Q000453:epidemiology*; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
chemical_list: D007518:Isoantibodies; D008562:Membrane Glycoproteins; C061961:RHO(D) antibody; D018029:Rho(D) Immune Globulin; C051138:anti-c antibody; C585978:KEL protein, human; D008666:Metalloendopeptidases
keywords: Kell system; Lewis system; alloimmunisation; erythrocyte antibodies; maternal screening