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American Academy of Pediatrics
Article

Update on the Use of Intravenous Immunoglobulin in Pregnancy

Rahul J. D’Mello, Chaur-Dong Hsu, Puangphaka Chaiworapongsa and Tinnakorn Chaiworapongsa
NeoReviews January 2021, 22 (1) e7-e24; DOI: https://doi.org/10.1542/neo.22-1-e7
Rahul J. D’Mello
*Department of Obstetrics and Gynecology, Detroit Medical Center, Detroit, MI
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Chaur-Dong Hsu
†Department of Obstetrics and Gynecology and
‡Department of Physiology, Wayne State University School of Medicine, Detroit, MI
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Puangphaka Chaiworapongsa
§Department of Pharmacy, Henry Ford Hospital, Detroit, MI
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Tinnakorn Chaiworapongsa
†Department of Obstetrics and Gynecology and
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  • Abbreviations:
    ACOG:
    American College of Obstetricians and Gynecologist
    aPL:
    antiphospholipid antibodies
    APS:
    antiphospholipid syndrome
    CAPS:
    catastrophic antiphospholipid syndrome
    ET:
    exchange transfusion
    FBS:
    fetal blood sampling
    FDA:
    Food and Drug Administration
    GALD:
    gestational alloimmune liver disease
    HDFN:
    hemolytic disease of the fetus and newborn
    HLA:
    human leukocyte antigen
    HPA:
    human platelet antigen
    ICH:
    intracranial hemorrhage
    Ig:
    immunoglobulin
    ITP:
    immune thrombocytopenia
    IUPT:
    intrauterine platelet transfusion
    IUT:
    intrauterine transfusion
    IVIG:
    intravenous immunoglobulin
    MCA:
    middle cerebral artery
    NAIT:
    neonatal alloimmune thrombocytopenia
    NH:
    neonatal hemochromatosis
    PI:
    primary immunodeficiency
    PSV:
    peak systolic velocity
    RCT:
    randomized controlled trial
    RPL:
    recurrent pregnancy loss
    TRALI:
    transfusion-related acute lung injury
  • Abstract

    Intravenous immunoglobulin (IVIG) was first administered to humans in the 1980s. The mechanism of action of IVIG is still a subject of debate but the pharmacokinetics have been well characterized, albeit outside of pregnancy. IVIG has been used in pregnancy to treat several nonobstetrical and obstetrical-related conditions. However, current evidence suggests that IVIG use during pregnancy can be recommended for 1) in utero diagnosis of neonatal alloimmune thrombocytopenia; 2) gestational alloimmune liver disease; 3) hemolytic disease of the fetus and newborn for early-onset severe intrauterine disease; 4) antiphospholipid syndrome (APS) when refractory to or contraindicated to standard treatment, or in catastrophic antiphospholipid syndrome; and 5) immune thrombocytopenia when standard treatment is ineffective or rapid increase of platelet counts is needed. All recommendations are based on case series and cohort studies without randomized trials usually because of the rare prevalence of the conditions, the high incidence of adverse outcomes if left untreated, and ethical concerns. In contrast, IVIG therapy cannot be recommended for recurrent pregnancy loss, and the use of IVIG in subgroups of those with recurrent pregnancy loss requires further investigations. For non–obstetrical-related conditions, we recommend using IVIG as indicated for nonpregnant patients. In conclusion, the use of IVIG during pregnancy is an effective treatment in some obstetrical-related conditions with rare serious maternal side effects. However, the precise mechanisms of action and the long-term immunologic effects on the fetus and neonate are poorly understood and merit further investigations.

    • Copyright © 2021 by the American Academy of Pediatrics

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    NeoReviews
    Vol. 22, Issue 1
    1 Jan 2021
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    Update on the Use of Intravenous Immunoglobulin in Pregnancy
    Rahul J. D’Mello, Chaur-Dong Hsu, Puangphaka Chaiworapongsa, Tinnakorn Chaiworapongsa
    NeoReviews Jan 2021, 22 (1) e7-e24; DOI: 10.1542/neo.22-1-e7

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    Update on the Use of Intravenous Immunoglobulin in Pregnancy
    Rahul J. D’Mello, Chaur-Dong Hsu, Puangphaka Chaiworapongsa, Tinnakorn Chaiworapongsa
    NeoReviews Jan 2021, 22 (1) e7-e24; DOI: 10.1542/neo.22-1-e7
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      • Abstract
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