PT  - JOURNAL ARTICLE
AU  - D’Mello, Rahul J.
AU  - Hsu, Chaur-Dong
AU  - Chaiworapongsa, Puangphaka
AU  - Chaiworapongsa, Tinnakorn
TI  - Update on the Use of Intravenous Immunoglobulin in Pregnancy
AID  - 10.1542/neo.22-1-e7
DP  - 2021 Jan 01
TA  - NeoReviews
PG  - e7--e24
VI  - 22
IP  - 1
4099  - http://neoreviews.aappublications.org/content/22/1/e7.short
4100  - http://neoreviews.aappublications.org/content/22/1/e7.full
SO  - NeoReviews2021 Jan 01; 22
AB  - Abbreviations:ACOG: American College of Obstetricians and GynecologistaPL: antiphospholipid antibodiesAPS: antiphospholipid syndromeCAPS: catastrophic antiphospholipid syndromeET: exchange transfusionFBS: fetal blood samplingFDA: Food and Drug AdministrationGALD: gestational alloimmune liver diseaseHDFN: hemolytic disease of the fetus and newbornHLA: human leukocyte antigenHPA: human platelet antigenICH: intracranial hemorrhageIg: immunoglobulinITP: immune thrombocytopeniaIUPT: intrauterine platelet transfusionIUT: intrauterine transfusionIVIG: intravenous immunoglobulinMCA: middle cerebral arteryNAIT: neonatal alloimmune thrombocytopeniaNH: neonatal hemochromatosisPI: primary immunodeficiencyPSV: peak systolic velocityRCT: randomized controlled trialRPL: recurrent pregnancy lossTRALI: transfusion-related acute lung injuryIntravenous 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.