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Int J Epidemiol. 2014 Aug;43(4):1123-31. doi: 10.1093/ije/dyu079. Epub 2014 May 5.

Associations of Rhesus and non-Rhesus maternal red blood cell alloimmunization with stillbirth and preterm birth.

Author information

1
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.
2
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.

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.

KEYWORDS:

Kell system; Lewis system; alloimmunisation; erythrocyte antibodies; maternal screening

PMID:
24801308
PMCID:
PMC4258779
DOI:
10.1093/ije/dyu079
[Indexed for MEDLINE]
Free PMC Article
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