Targeted antenatal anti-D prophylaxis for RhD-negative pregnant women: a systematic review
Abstract Background All non-sensitized Rhesus D (RhD)-negative pregnant women in Germany receive antenatal anti-D prophylaxis without knowledge of fetal RhD status. Non-invasive prenatal testing (NIPT) of cell-free fetal DNA in maternal plasma could avoid unnecessary anti-D administration. In this p...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-02-01
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| Series: | BMC Pregnancy and Childbirth |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12884-020-2742-4 |
| _version_ | 1818969431331569664 |
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| author | Britta Runkel Gregor Bein Wiebke Sieben Dorothea Sow Stephanie Polus Daniel Fleer |
| author_facet | Britta Runkel Gregor Bein Wiebke Sieben Dorothea Sow Stephanie Polus Daniel Fleer |
| author_sort | Britta Runkel |
| collection | DOAJ |
| description | Abstract Background All non-sensitized Rhesus D (RhD)-negative pregnant women in Germany receive antenatal anti-D prophylaxis without knowledge of fetal RhD status. Non-invasive prenatal testing (NIPT) of cell-free fetal DNA in maternal plasma could avoid unnecessary anti-D administration. In this paper, we systematically reviewed the evidence on the benefit of NIPT for fetal RhD status in RhD-negative pregnant women. Methods We systematically searched several bibliographic databases, trial registries, and other sources (up to October 2019) for controlled intervention studies investigating NIPT for fetal RhD versus conventional anti-D prophylaxis. The focus was on the impact on fetal and maternal morbidity. We primarily considered direct evidence (from randomized controlled trials) or if unavailable, linked evidence (from diagnostic accuracy studies and from controlled intervention studies investigating the administration or withholding of anti-D prophylaxis). The results of diagnostic accuracy studies were pooled in bivariate meta-analyses. Results Neither direct evidence nor sufficient data for linked evidence were identified. Meta-analysis of data from about 60,000 participants showed high sensitivity (99.9%; 95% CI [99.5%; 100%] and specificity (99.2%; 95% CI [98.5%; 99.5%]). Conclusions NIPT for fetal RhD status is equivalent to conventional serologic testing using the newborn’s blood. Studies investigating patient-relevant outcomes are still lacking. |
| first_indexed | 2024-12-20T14:20:28Z |
| format | Article |
| id | doaj.art-ade17ae94a164aaa877bc33777430dd8 |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-20T14:20:28Z |
| publishDate | 2020-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-ade17ae94a164aaa877bc33777430dd82022-12-21T19:37:56ZengBMCBMC Pregnancy and Childbirth1471-23932020-02-0120111010.1186/s12884-020-2742-4Targeted antenatal anti-D prophylaxis for RhD-negative pregnant women: a systematic reviewBritta Runkel0Gregor Bein1Wiebke Sieben2Dorothea Sow3Stephanie Polus4Daniel Fleer5Institute for Quality and Efficiency in Health Care (IQWiG)Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig-UniversityInstitute for Quality and Efficiency in Health Care (IQWiG)Institute for Quality and Efficiency in Health Care (IQWiG)Institute for Research in Operative Medicine, Witten/Herdecke UniversityInstitute for Quality and Efficiency in Health Care (IQWiG)Abstract Background All non-sensitized Rhesus D (RhD)-negative pregnant women in Germany receive antenatal anti-D prophylaxis without knowledge of fetal RhD status. Non-invasive prenatal testing (NIPT) of cell-free fetal DNA in maternal plasma could avoid unnecessary anti-D administration. In this paper, we systematically reviewed the evidence on the benefit of NIPT for fetal RhD status in RhD-negative pregnant women. Methods We systematically searched several bibliographic databases, trial registries, and other sources (up to October 2019) for controlled intervention studies investigating NIPT for fetal RhD versus conventional anti-D prophylaxis. The focus was on the impact on fetal and maternal morbidity. We primarily considered direct evidence (from randomized controlled trials) or if unavailable, linked evidence (from diagnostic accuracy studies and from controlled intervention studies investigating the administration or withholding of anti-D prophylaxis). The results of diagnostic accuracy studies were pooled in bivariate meta-analyses. Results Neither direct evidence nor sufficient data for linked evidence were identified. Meta-analysis of data from about 60,000 participants showed high sensitivity (99.9%; 95% CI [99.5%; 100%] and specificity (99.2%; 95% CI [98.5%; 99.5%]). Conclusions NIPT for fetal RhD status is equivalent to conventional serologic testing using the newborn’s blood. Studies investigating patient-relevant outcomes are still lacking.https://doi.org/10.1186/s12884-020-2742-4Genotyping techniquesRh-Hr blood-group systemFetusBenefit assessmentSystematic review |
| spellingShingle | Britta Runkel Gregor Bein Wiebke Sieben Dorothea Sow Stephanie Polus Daniel Fleer Targeted antenatal anti-D prophylaxis for RhD-negative pregnant women: a systematic review BMC Pregnancy and Childbirth Genotyping techniques Rh-Hr blood-group system Fetus Benefit assessment Systematic review |
| title | Targeted antenatal anti-D prophylaxis for RhD-negative pregnant women: a systematic review |
| title_full | Targeted antenatal anti-D prophylaxis for RhD-negative pregnant women: a systematic review |
| title_fullStr | Targeted antenatal anti-D prophylaxis for RhD-negative pregnant women: a systematic review |
| title_full_unstemmed | Targeted antenatal anti-D prophylaxis for RhD-negative pregnant women: a systematic review |
| title_short | Targeted antenatal anti-D prophylaxis for RhD-negative pregnant women: a systematic review |
| title_sort | targeted antenatal anti d prophylaxis for rhd negative pregnant women a systematic review |
| topic | Genotyping techniques Rh-Hr blood-group system Fetus Benefit assessment Systematic review |
| url | https://doi.org/10.1186/s12884-020-2742-4 |
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