Pregnancy in women who are Rh negative

About half of all pregnant women who are Rh negative are expecting a baby who is also Rh negative. That shouldn’t be a problem because their blood will be compatible.

But if a woman who is Rh negative is expecting a baby who is Rh positive, the mother’s blood might produce anti-D antibodies against the baby’s rhesus factor. That can happen if some of the baby's blood mixes with the mother’s blood – for instance, following minor injuries to the placenta or umbilical cord during birth. It can also happen during pregnancy, either without any outside influence or as a result of testing such as an amniotic fluid test (amniocentesis).

Anti-D antibodies don’t usually harm the baby if it is the woman’s first pregnancy. But in later pregnancies, these antibodies can negatively affect the development of a baby that is Rh positive. Anti-D injections are given to the mother with the aim of preventing that from happening. These injections contain anti-D immunoglobulin. They can usually stop the production of the antibodies.

Current use of anti-D injections in Germany

In Germany there are maternity guidelines outlining prenatal and postnatal care. Doctors and midwives generally follow these recommendations. The screening tests recommended for pregnant women include a blood test to determine their Rh factor.

If a woman is found to be Rh negative, she is given an anti-D injection. But at that point, nobody knows whether the baby is Rh positive or Rh negative. The baby’s blood type is only identified using blood taken from the umbilical cord after the birth. Only then do doctors know whether the baby’s blood is compatible with the mother's.

If the baby is Rh positive, the mother is given another injection of the anti-D immunoglobulins within 72 hours. The aim of giving this second dose is to quickly get rid of any blood cells that have traveled from the baby to the mother’s blood in order to prevent antibodies from forming.

When this procedure is followed, about half of all women who are Rh negative are unnecessarily given an anti-D injection. The mother's immune system will only produce antibodies if she is carrying a baby that is Rh positive – and only then can the injection have a benefit.

Use of anti-D injections with prenatal testing

A blood test that can already determine the Rh factor of the baby before the birth has been available for several years. This prenatal test aims to prevent women who are Rh negative from getting an unnecessary anti-D injection during their pregnancy: The injection is given only if the test shows that the baby has Rh positive blood.

This prenatal test involves taking a sample of the woman's blood. The mother's blood contains cell-free DNA of the child that can be used to determine the baby’s Rh factor.

Research on prenatal testing

The Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into the advantages and disadvantages of using the prenatal test for Rh negative pregnant women compared to the standard approach. The current standard approach involves giving all Rh negative women an anti-D injection during the pregnancy as a precaution. When the prenatal test is used, Rh negative women are only given an anti-D injection if the test shows that the unborn baby is Rh positive.

The IQWiG researchers didn’t find any good-quality studies comparing the two approaches. So they looked into a different important issue: Can the prenatal test reliably determine the unborn baby’s Rh factor?

To answer this question, the researchers analyzed eleven studies. They confirmed that the test is reliable. The accuracy of the test for a multiple pregnancy (twins or triplets, etc.) remains unclear, though.

Current research findings indicate that the prenatal test doesn't have any known disadvantages for the pregnant women or for their children. But in Rh negative pregnant women who are expecting an Rh negative baby, the test can prevent the unnecessary use of the anti-D injection (containing immunoglobulins). Side effects of the anti-D injection are extremely rare.

Sources

• Gemeinsamer Bundesausschuss (G-BA). Richtlinien des Gemeinsamen Bundesausschusses über die ärztliche Betreuung während der Schwangerschaft und nach der Entbindung („Mutterschafts-Richtlinien“). April 21, 2016.
• Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Non-invasive determination of the fetal rhesus factor to prevent maternal rhesus sensitization: Final report; Commission D16-01. March 20, 2018. (IQWiG Reports; Volume 607).

• IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.