Prevalence of Rhesus D negativity among reproductive age women in Southern Ethiopia: a cross-sectional study

Does high body mass index (>25 kg/m2) or weight (>80 kg) reduce the effectiveness of anti-D prophylaxis in Rh(D)-negative pregnant women? A systematic review and meta-analysis

BACKGROUND AND OBJECTIVES

Haemolytic disease of the foetus and newborn (HDFN) occurs when maternal antibodies, often triggered by foetal antigens, destroy foetal and neonatal red blood cells. Factors like antibody strength, quantity and gestational age influence HDFN severity. Routine antenatal anti-D prophylaxis (RAADP) has significantly reduced HDFN cases. However, the effect of overweight/obesity (body mass index [BMI] > 25/30 kg/m2) on anti-D prophylaxis efficacy remains unclear. This systematic review will examine the impact of BMI on anti D prophylaxis effectiveness in Rh(D) negative pregnant women.

MATERIALS AND METHODS

We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocols. We searched databases from 1996 to 2023, focusing on studies exploring the link between high BMI/weight and anti-D serum levels in Rh(D)-negative pregnant women with Rh(D)-positive foetuses. Ten eligible studies were included, three suitable for meta-analysis. Study quality was assessed using the Strengthening the Reporting Observation Studies in Epidemiology (STROBE) checklist. Statistical analyses included Pearson correlation coefficients and risk differences.

RESULTS

Our meta-analysis revealed a significant negative correlation (r = -0.59, 95% confidence interval [CI]: -0.83 to -0.35, p = 0.007) between high BMI/weight and serial anti-D levels in in Rh(D)-negative pregnant women with Rh(D)-positive foetuses. High BMI/weight had lower odds of serial anti-D level exceeding 30 ng/mL (arcsine risk difference [ARD] = 0.376, 95% CI: 0.143-0.610, p = 0.002). Heterogeneity among studies was low (I2 = 0).

CONCLUSION

While our analysis suggests a potential linkage between high BMI/weight and reduced efficacy of anti-D prophylaxis, caution is warranted due to study limitations. Variability in study design and confounding factors necessitate careful interpretation. Further research is needed to confirm these findings and refine clinical recommendations.

Predeposit Autologous Blood Donation in Rh(D)-Negative Pregnant Women: A Single-Center Study

Objective  The primary purpose of this study was to assess the practicability of predeposit autologous blood donation (PABD) in the practice of Rh(D)-negative pregnant women. Materials and Methods  A cohort of 405 Rh(D)-negative pregnant women who had a delivery in the comprehensive tertiary hospital in Nanjing was analyzed retrospectively, over 10 years. Results  After PABD, 203 women experienced a slight drop in mean hemoglobin of 5.32 ± 0.5 g/L (PABD-associated anemia was not featured in our study). Thirteen women who received allogeneic blood might benefit from PABD practically. Conclusion  PABD is applicable for Rh(D)-negative pregnant women, as it ensures the availability of the patient's blood in the event of perinatal hemorrhage, thus minimizing the need for transfusion from external sources. Despite the autologous blood reinfusion of low proportion, PABD could still serve as an alternative when allogeneic blood resources are scarce. However, one challenge in the future is to identify candidates who may benefit most from PABD. Also, more attention is needed to raise awareness of patient blood management. Recommended strategies include early screening and treatment of anemia, hemostasis promotion, and blood loss reduction. Replacement of allogeneic transfusion with autotransfusion could be referred to where feasible. We believe that PABD still has a promising potential for application in Rh(D)-negative pregnant women.

Prevalence and determinants of RH alloimmunization in Rh-negative women in teaching hospitals of Addis Ababa, Ethiopia: a hospital-based cross-sectional study

Background

Despite the implementation of immunization with an anti-D antigen for pregnant women, adverse pregnancy outcomes continue to occur in Ethiopia and most Sub-Saharan African countries. Consequently, the woman's obstetric care is compromised, and there is an increase in perinatal morbidity and mortality. In Ethiopia, the burden of the disease is not well understood, and no research has been conducted in the study area. Therefore, this study aims to determine the prevalence and determinants of Rh alloimmunization in Rh-negative women receiving care at Addis Ababa teaching hospitals.

Methods

An institutional-based cross-sectional study was conducted from 5 October 2020 to 5 May 2021, among 328 Rh-negative pregnant women who received antenatal care and delivery services at Teaching Hospitals under Addis Ababa University. Face-to-face interviews were used to gather data using a pre-tested structured questionnaire, and a chart review was performed using a checklist. The data were entered into Epidata version 3.1 and analyzed using SPSS version 22. Multivariable analysis and logistic regression were used to evaluate the predictors, and the results were presented as an adjusted odds ratio (AOR) with a 95% confidence interval. Statistical significance was declared at a p-value < 0.05.

Results

Among Rh-D negative individuals, 56(17.1%) were alloimunized with 95% CI (15.1%, 19.23%). The prevalence of Rh-D negative was 2.1% with 95% CI (1.56%, 2.76%). Factors such as unemployment [AOR = 2.28, 95% CI: 1.21, 4.28], failure to use anti-D prophylaxis in previous pregnancy [AOR = 2.08, 95% CI: 1.10, 3.92), and the presence of sensitizing events [AOR = 0.52, 95% CI: 0.27, 0.84] were statistically significant with the outcome variables.

Conclusions

This study pointed out that the prevalence of Rh was relatively large and that almost one in every five pregnant women was alloimunized. Factors such as unemployment and failure to use anti-D prophylaxis in a previous pregnancy were found to be associated with outcome variables. Therefore, all stakeholders and concerned entities should prioritize enhancing access and affordability to anti-D prophylaxis to prevent the occurrence of Rh alloimmunization and its associated adverse outcomes.