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Fetus

Poster Session 4

(1092) Postponing Early Intrauterine Transfusion with IVIG Treatment in Severe Hemolytic Disease: Individual Patient Data Meta-Analysis

Wednesday, February 14, 2024

1:00 PM – 2:30 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Hiba J. Mustafa, MD (she/her/hers)

Assistant Professor of Fetal Surgery and Maternal-Fetal Medicine
Indiana University, Riley Children's Hospital
Carmel, IN, United States

Coauthor(s)

GP

Giorgio Pagani, MD, MSc

Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, ASST-Papa Giovanni XXIII
Bergamo, Lombardia, Italy
ES

Enaja Sambatur, MD

Maternal-Fetal Care Center, Boston Children’s hospital
Boston, MA, United States
FD

Francesco D'Antonio, MD, PhD, FRCOG, MBBS, MSc

McMaster University
Hamilton, ON, Canada
EM

Emeline Maisonneuve, MD

Materno-Fetal and Obstetrics Research Unit, Woman-Mother-Child Department, Lausanne University Hospital
Lausanne, Bern, Switzerland
PM

Paul Maurice, MD

Fetal Medicine Department and French Referral National Centre for Perinatal Hmobiology Armand Trousseau Hospital. APHP Sorbonne University
Paris, Lorraine, France
CZ

Carolien Zwiers, MD

Leiden University Medical Center
Leiden, Flevoland, Netherlands
JV

Joanne Verweij, MD

Leiden University Medical Center
Leiden, Gelderland, Netherlands
Alireza A. Shamshirsaz, MD (he/him/his)

Department Director, Professor of Surgery
Maternal Fetal Care Center (MFCC), Boston Children's Hospital, Harvard Medical School
Boston, MA, United States
JJ

Jean-Marie Jouannic, MD, PhD

Fetal Medecine Department, Armand Trousseau Hospital, APHP, Sorbonne Université
Paris, Ile-de-France, France
Asma Khalil, MD, MSc (she/her/hers)

Professor of Maternal Fetal Medicine
Fetal Medicine Unit, St. George's Hospital, St. George's University of London
London, England, United Kingdom

Objective: To determine whether maternal administration of intravenous immunoglobulin (IVIG) in high-risk red blood cell alloimmunized pregnancies is effective in delaying the gestational age (GA) at the first intrauterine transfusion (IUT) and the onset of severe hemolytic disease of fetus and newborn (HDFN).

Study Design: We systematically searched Medline, Embase and Cochrane Library until June 2023. We included studies reporting on pregnancies with severe Rhesus alloimmunization which was defined as either a previous fetal or neonatal death as a result of HDFN or the need for IUT prior to 24 weeks’ gestation in the previous pregnancy. Cases included pregnancies receiving IVIG aiming to delay IUT, while controls were pregnancies receiving IUT only. Following inclusion, individual patient data (IPD) were obtained and authors were contacted for missing data. Primary outcome was GA at first IUT. IPD Meta-Analysis was performed using the Bayesian framework.

Results: 11 studies were included in the systematic review of which IPD were obtained for 9 studies. Data were available for 90 controls and 97 cases. GA at first IUT mean difference was significantly earlier in the IUT only group compared to IVIG group (MD -1.29, 95% CI -2.49, -0.13). Hemoglobin level was significantly lower in the IUT only group compared to IVIG at time of first IUT (MD -2.19, 95% CI -3.18, -1.24). GA at delivery was also significantly different between groups reflecting earlier GA in the IUT only group compared to IVIG (MD -4.99, 95% CI -6.79, -3.23). There were no significant differences in numbers of IUTs, hemoglobin level at birth, or bilirubin level at birth between groups.

Conclusion: IVIG treatment in pregnancies at risk of severe early HDFN seems to have a potential clinically relevant beneficial effect on the course and severity of the disease.