Antenatal Treatment with Intravenous Immunoglobulin to Prevent Gestational Alloimmune Liver Disease: Comparative Effectiveness of 14-Week versus 18-Week Initiation

Peter F. Whitington, Susan Kelly, Sarah A. Taylor*, Sara Nóbrega, Richard A. Schreiber, Etienne M. Sokal, Judith U. Hibbard

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Antenatal therapy with high-dose intravenous immunoglobulin (IVIG) may prevent gestational alloimmune liver disease (GALD). Objective: The objective of this study was to determine the effectiveness of this approach in a large cohort of women at risk for poor pregnancy outcome due to GALD. Methods: Women with a history of affected offspring were provided antenatal IVIG treatment and data were acquired prospectively from 1997 to 2015. The outcomes of treated pregnancies were compared to those of untreated pregnancies, and the effectiveness of starting at 14 weeks was compared to that of starting at 18 weeks. Results: A total of 188 treated pregnancies in 151 women were analyzed. Only 30% (n = 105) of untreated gestations resulted in healthy offspring as compared to 94% (n = 177) of treated pregnancies (p < 0.0001). Treated gestations of both the 14-week (n = 108) and the 18-week (n = 80) start cohort showed a decreased rate of fetal loss relative to untreated gestations (p < 0.0001). Equivalent outcomes were recorded in the 18-week versus the 14-week start cohort (p > 0.05). Few adverse events or complications of antenatal therapy were recorded. Conclusion: Antenatal therapy with high-dose IVIG initiated at either 18 or 14 gestational weeks effectively prevents poor outcome of pregnancies at risk for GALD.

Original languageEnglish (US)
Pages (from-to)218-225
Number of pages8
JournalFetal Diagnosis and Therapy
Volume43
Issue number3
DOIs
StatePublished - Apr 1 2018

Fingerprint

Intravenous Immunoglobulins
Liver Diseases
Pregnancy Outcome
Pregnancy
Therapeutics

Keywords

  • Antenatal therapy
  • Gestational alloimmune liver disease
  • Neonatal hemochromatosis
  • Stillbirth

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Embryology
  • Radiology Nuclear Medicine and imaging
  • Obstetrics and Gynecology

Cite this

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title = "Antenatal Treatment with Intravenous Immunoglobulin to Prevent Gestational Alloimmune Liver Disease: Comparative Effectiveness of 14-Week versus 18-Week Initiation",
abstract = "Background: Antenatal therapy with high-dose intravenous immunoglobulin (IVIG) may prevent gestational alloimmune liver disease (GALD). Objective: The objective of this study was to determine the effectiveness of this approach in a large cohort of women at risk for poor pregnancy outcome due to GALD. Methods: Women with a history of affected offspring were provided antenatal IVIG treatment and data were acquired prospectively from 1997 to 2015. The outcomes of treated pregnancies were compared to those of untreated pregnancies, and the effectiveness of starting at 14 weeks was compared to that of starting at 18 weeks. Results: A total of 188 treated pregnancies in 151 women were analyzed. Only 30{\%} (n = 105) of untreated gestations resulted in healthy offspring as compared to 94{\%} (n = 177) of treated pregnancies (p < 0.0001). Treated gestations of both the 14-week (n = 108) and the 18-week (n = 80) start cohort showed a decreased rate of fetal loss relative to untreated gestations (p < 0.0001). Equivalent outcomes were recorded in the 18-week versus the 14-week start cohort (p > 0.05). Few adverse events or complications of antenatal therapy were recorded. Conclusion: Antenatal therapy with high-dose IVIG initiated at either 18 or 14 gestational weeks effectively prevents poor outcome of pregnancies at risk for GALD.",
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Antenatal Treatment with Intravenous Immunoglobulin to Prevent Gestational Alloimmune Liver Disease : Comparative Effectiveness of 14-Week versus 18-Week Initiation. / Whitington, Peter F.; Kelly, Susan; Taylor, Sarah A.; Nóbrega, Sara; Schreiber, Richard A.; Sokal, Etienne M.; Hibbard, Judith U.

In: Fetal Diagnosis and Therapy, Vol. 43, No. 3, 01.04.2018, p. 218-225.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Antenatal Treatment with Intravenous Immunoglobulin to Prevent Gestational Alloimmune Liver Disease

T2 - Comparative Effectiveness of 14-Week versus 18-Week Initiation

AU - Whitington, Peter F.

AU - Kelly, Susan

AU - Taylor, Sarah A.

AU - Nóbrega, Sara

AU - Schreiber, Richard A.

AU - Sokal, Etienne M.

AU - Hibbard, Judith U.

PY - 2018/4/1

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N2 - Background: Antenatal therapy with high-dose intravenous immunoglobulin (IVIG) may prevent gestational alloimmune liver disease (GALD). Objective: The objective of this study was to determine the effectiveness of this approach in a large cohort of women at risk for poor pregnancy outcome due to GALD. Methods: Women with a history of affected offspring were provided antenatal IVIG treatment and data were acquired prospectively from 1997 to 2015. The outcomes of treated pregnancies were compared to those of untreated pregnancies, and the effectiveness of starting at 14 weeks was compared to that of starting at 18 weeks. Results: A total of 188 treated pregnancies in 151 women were analyzed. Only 30% (n = 105) of untreated gestations resulted in healthy offspring as compared to 94% (n = 177) of treated pregnancies (p < 0.0001). Treated gestations of both the 14-week (n = 108) and the 18-week (n = 80) start cohort showed a decreased rate of fetal loss relative to untreated gestations (p < 0.0001). Equivalent outcomes were recorded in the 18-week versus the 14-week start cohort (p > 0.05). Few adverse events or complications of antenatal therapy were recorded. Conclusion: Antenatal therapy with high-dose IVIG initiated at either 18 or 14 gestational weeks effectively prevents poor outcome of pregnancies at risk for GALD.

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KW - Stillbirth

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