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dc.contributor.authorErnstsen, Siw Leiknes
dc.contributor.authorAhlen, Maria Therese
dc.contributor.authorJohansen, Tiril
dc.contributor.authorBertelsen, eirin listau
dc.contributor.authorKjeldsen-Kragh, Jens
dc.contributor.authorTiller, Heidi
dc.date.accessioned2022-11-22T09:50:47Z
dc.date.available2022-11-22T09:50:47Z
dc.date.issued2022-04-29
dc.description.abstractBACKGROUND: Maternal alloantibodies to human platelet antigen-1a can cause severe intracranial hemorrhage in a fetus or newborn. Although never evaluated in placebo-controlled clinical trials, most Western countries use off-label weekly administration of high-dosage intravenous immunoglobulin in all pregnant women with an obstetrical history of fetal and neonatal alloimmune thrombocytopenia. In Norway, antenatal intravenous immunoglobulin is only recommended in pregnancies wherein a previous child had intracranial hemorrhage (high-risk) and is generally not given in other human platelet antigen-1a alloimmunized pregnancies (lowrisk).<p> <p>OBJECTIVE: To compare the frequency of anti-human platelet antigen1a-induced intracranial hemorrhage in pregnancies at risk treated with intravenous immunoglobulin vs pregnancies not receiving this treatment as a part of a different management program. <p>STUDY DESIGN: This was a retrospective comparative study where the neonatal outcomes of 71 untreated human platelet antigen1a-alloimmunized pregnancies in Norway during a 20-year period was compared with 403 intravenous-immunoglobulin-treated pregnancies identified through a recent systematic review. We stratified analyses on the basis of whether the mothers belonged to high- or lowrisk pregnancies. Therefore, only women who previously had a child with fetal and neonatal alloimmune thrombocytopenia were included. <p>RESULTS: Two neonates with brain bleeds were identified from 313 treated low-risk pregnancies (0.6%; 95% confidence interval, 0.2e2.3). There were no neonates born with intracranial hemorrhage of 64 nontreated, low-risk mothers (0.0%; 95% confidence interval, 0.0e5.7). Thus, no significant difference was observed in the neonatal outcome between immunoglobulin-treated and untreated low-risk pregnancies. Among high-risk mothers, 5 of 90 neonates from treated pregnancies were diagnosed with intracranial hemorrhage (5.6%; 95% confidence interval, 2.4e12.4) compared with 2 of 7 neonates from nontreated pregnancies (29%; 95% confidence interval, 8.2e64.1; P¼.08). <p>CONCLUSION: The most reliable data hitherto for the evaluation of intravenous immunoglobulins treatment in low-risk pregnancies is shown herein. We did not find evidence that omitting antenatal intravenous immunoglobulin treatment in low-risk pregnancies increases the risk of neonatal intracranial hemorrhage.en_US
dc.identifier.citationErnstsen, Ahlen, Johansen, Bertelsen, Kjeldsen-Kragh, Tiller. Antenatal intravenous immunoglobulins in pregnancies at risk of fetal and neonatal alloimmune thrombocytopenia: comparison of neonatal outcome in treated and nontreated pregnancies. American Journal of Obstetrics and Gynecology. 2022;27(3):506.e1-506.e12en_US
dc.identifier.cristinIDFRIDAID 2047941
dc.identifier.doi10.1016/j.ajog.2022.04.044
dc.identifier.issn0002-9378
dc.identifier.issn1097-6868
dc.identifier.urihttps://hdl.handle.net/10037/27455
dc.language.isoengen_US
dc.publisherElsevieren_US
dc.relation.journalAmerican Journal of Obstetrics and Gynecology
dc.rights.accessRightsopenAccessen_US
dc.rights.holderCopyright 2022 The Author(s)en_US
dc.rights.urihttps://creativecommons.org/licenses/by/4.0en_US
dc.rightsAttribution 4.0 International (CC BY 4.0)en_US
dc.titleAntenatal intravenous immunoglobulins in pregnancies at risk of fetal and neonatal alloimmune thrombocytopenia: comparison of neonatal outcome in treated and nontreated pregnanciesen_US
dc.type.versionpublishedVersionen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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Attribution 4.0 International (CC BY 4.0)
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