The continuing burden of Rh disease 50 years after the introduction of anti-Rh(D) immunoglobin prophylaxis: call to action

Visser, Gerard H.A.; Renzo, Gian Carlo Di; Spitalnik, Steven L.; Ayres‐de‐Campos, Diogo; Escobar, María Fernanda; Barnea, Eytan R.; Shah, Pooja; Nasser, A; Bernis, Luc de; Sun, Lei; Nicholson, Wanda K; Lloyd, Isabel; Walani, Salimah R.; Theron, Gerhard; Stones, William

doi:10.1016/j.ajog.2019.05.019

Cited by 19 publications

(11 citation statements)

References 7 publications

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“…Nevertheless, recent data have shown that, in approximately 50% of eligible cases worldwide, anti‐Rh(D) immunoglobulin is not administered 4,5 . The reasons vary but include insufficient supply, cost considerations, ignorance (e.g., simply forgot to administer anti‐Rh[D]), lack of access, and use of products that have not been tested for therapeutic efficacy 6 . It has been estimated that Rh disease still results in more than 160 000 perinatal deaths and 100 000 cases of disability annually, representing only a 50% reduction relative to the era before immunoglobulin administration 4 .…”

Section: Introductionmentioning

confidence: 99%

FIGO/ICM guidelines for preventing Rhesus disease: A call to action

Visser

Thommesen²,

Renzo³

et al. 2021

Intl J Gynecology & Obste

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The introduction of anti‐Rh(D) immunoglobulin more than 50 years ago has resulted in only a 50% decrease in Rhesus disease globally owing to a low uptake of this prophylactic approach. The International Federation of Gynecology and Obstetrics, International Confederation of Midwives, and Worldwide Initiative for Rhesus Disease Eradication have reviewed current evidence regarding the utility of anti‐Rh(D) immunoglobulin. Taking into account the effectiveness anti‐Rh(D), the new guidelines propose adjusting the dose for different indications and prioritizing its administration by indication.

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Section: Introductionmentioning

confidence: 99%

FIGO/ICM guidelines for preventing Rhesus disease: A call to action

Visser

Thommesen²,

Renzo³

et al. 2021

Intl J Gynecology & Obste

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“…The reasons for the continuing burden of Rh disease vary widely, but discussions with representatives from many countries identified some important factors [25]. For example, in Africa, ABO and Rh blood group typing is not routinely performed in many regions, and the cost of IgG anti-Rh(D) may be 4-8 times higher than in high income countries, primarily due to the privatization of pharmacies.…”

Section: Discussionmentioning

confidence: 99%

Hemolytic disease of the fetus and newborn due to Rh(D) incompatibility: A preventable disease that still produces significant morbidity and mortality in children

Pégoraro¹,

Urbinati²,

Visser

et al. 2020

PLoS ONE

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In the mid-20 th century, Hemolytic Disease of the Fetus and Newborn, caused by maternal alloimmunization to the Rh(D) blood group antigen expressed by fetal red blood cells (i.e., "Rh disease"), was a major cause of fetal and neonatal morbidity and mortality. However, with the regulatory approval, in 1968, of IgG anti-Rh(D) immunoprophylaxis to prevent maternal sensitization, the prospect of eradicating Rh disease was at hand. Indeed, the combination of antenatal and post-partum immunoprophylaxis is~99% effective at preventing maternal sensitization to Rh(D). To investigate global compliance with this therapeutic intervention, we used an epidemiological approach to estimate the current annual number of pregnancies worldwide involving an Rh(D)-negative mother and an Rh(D)-positive fetus. The annual number of doses of anti-Rh(D) IgG required for successful immunoprophylaxis for these cases was then calculated and compared with an estimate of the annual number of doses of anti-Rh(D) produced and provided worldwide. Our results suggest that~50% of the women around the world who require this type of immunoprophylaxis do not receive it, presumably due to a lack of awareness, availability, and/or affordability, thereby putting hundreds of thousands of fetuses and neonates at risk for Rh disease each year. The global failure to provide this generally acknowledged standard-of-care to prevent Rh disease, even 50 years after its availability, contributes to an enormous, continuing burden of fetal and neonatal disease and provides a critically important challenge to the international health care system.

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“…Hemolytic disease of the fetus and newborn due to Rh incompatibility remains a significant contributor to perinatal mortality and morbidity in low and middle income countries, in particular those where medical infrastructure is rudimentary, costs and supply of RhIg are prohibitive, delivery systems are underdeveloped, and population and family sizes are larger. An international call to action has been issued to address this global concern and inequity [1]. To date, these populations are underrepresented in the current comparative literature.…”

Section: Plos Onementioning

confidence: 99%

“…Rhesus D (Rh D) alloimmunization leading to hemolytic disease in the fetus and newborn, a preventable condition, carries a global burden of infirmity, resulting in some 50,000 fetal deaths annually, primarily in low and middle income countries in Asia and Sub-Saharan Africa [1]. In the developed world, however, the introduction of Rh immunoprophylaxis (RhIg) in the 1960s into routine obstetrical care for Rh negative women at risk lead to a dramatic fall in the number of Rh affected babies and is considered an immunological success story in the conquest of hemolytic disease of the fetus and newborn in these countries [2].…”

Section: Introductionmentioning

confidence: 99%

Antenatal and postpartum prevention of Rh alloimmunization: A systematic review and GRADE analysis

et al. 2020

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Background Existing systematic reviews of Rh immunoprophylaxis include only data from randomized controlled trials, have dated searches, and some do not report on all domains of risk of bias or evaluate the certainty of the evidence. Our objective was to perform an updated review, by including new trials, any comparative observational studies, and assessing the certainty of the evidence using the GRADE framework. Methods We searched MEDLINE, Embase and the Cochrane Library from 2000 to November 26, 2019. Relevant websites and bibliographies of systematic reviews and guidelines were searched for studies published before 2000. Outcomes of interest were sensitization and adverse events. Risk of bias was evaluated with the Cochrane tool and ROBINS-I. The certainty of the evidence was performed using the GRADE framework. Results Thirteen randomized trials and eight comparative cohort studies were identified, evaluating 12 comparisons. Although there is some evidence of beneficial treatment effects (e.g., at 6months postpartum, fewer women who received RhIg at delivery compared to no RhIg became sensitized [70 fewer sensitized women per 1,000 (95%CI: 67 to 71 fewer); I 2 = 73%]), due to very low certainty of the evidence, the magnitude of the treatment effect may be overestimated. The certainty of the evidence was very low for most outcomes often due to high risk of bias (e.g., randomization method, allocation concealment, selective reporting) and imprecision (i.e., few events and small sample sizes). There is limited evidence on prophylaxis for invasive fetal procedures (e.g. amniocentesis) in the comparative literature, and few studies reported adverse events.

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The continuing burden of Rh disease 50 years after the introduction of anti-Rh(D) immunoglobin prophylaxis: call to action

Cited by 19 publications

References 7 publications

FIGO/ICM guidelines for preventing Rhesus disease: A call to action

FIGO/ICM guidelines for preventing Rhesus disease: A call to action

Hemolytic disease of the fetus and newborn due to Rh(D) incompatibility: A preventable disease that still produces significant morbidity and mortality in children

Antenatal and postpartum prevention of Rh alloimmunization: A systematic review and GRADE analysis

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