This study aimed to investigate the outcomes associated with the administration of maternal intravenous immunoglobulin in high-risk red blood cell–alloimmunized pregnancies. Medline, Embase, and Cochrane Library were systematically searched until June 2023. This review included studies reporting on pregnancies with severe red blood cell alloimmunization, defined as either a previous fetal or neonatal death or the need for intrauterine transfusion before 24 weeks of gestation in the previous pregnancy as a result of hemolytic disease of the fetus and newborn. Cases were pregnancies that received intravenous immunoglobulin, whereas controls did not. Individual patient data meta-analysis was performed using the Bayesian framework. Individual patient data analysis included 8 studies consisting of 97 cases and 97 controls. Intravenous immunoglobulin was associated with prolonged delta gestational age at the first intrauterine transfusion (gestational age of current pregnancy − gestational age at previous pregnancy) (mean difference, 3.19 weeks; 95% credible interval, 1.28–5.05), prolonged gestational age at the first intrauterine transfusion (mean difference, 1.32 weeks; 95% credible interval, 0.08–2.50), reduced risk of fetal hydrops at the time of first intrauterine transfusion (incidence rate ratio, 0.19; 95% credible interval, 0.07–0.45), reduced risk of fetal demise (incidence rate ratio, 0.23; 95% credible interval, 0.10–0.47), higher chances of live birth at ≥28 weeks (incidence rate ratio, 1.88; 95% credible interval, 1.31–2.69;), higher chances of live birth at ≥32 weeks (incidence rate ratio, 1.93; 95% credible interval, 1.32–2.83), and higher chances of survival at birth (incidence rate ratio, 1.82; 95% credible interval, 1.30–2.61). There was no substantial difference in the number of intrauterine transfusions, hemoglobin level at birth, bilirubin level at birth, or survival at hospital discharge for live births. Intravenous immunoglobulin treatment in pregnancies at risk of severe early hemolytic disease of the fetus and newborn seems to have a clinically relevant beneficial effect on the course and severity of the disease.

中文翻译：

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静脉注射免疫球蛋白治疗严重孕产妇同种免疫：个体患者数据荟萃分析

本研究旨在调查高危红细胞同种免疫妊娠中母体静脉注射免疫球蛋白的相关结果。系统检索了 Medline、Embase 和 Cochrane 图书馆，直至 2023 年 6 月。该综述包括报告严重红细胞同种免疫妊娠的研究，定义为既往胎儿或新生儿死亡或在妊娠 24 周之前需要宫内输血因胎儿和新生儿溶血病而导致的前次妊娠。病例是接受静脉注射免疫球蛋白的妊娠，而对照组则没有。使用贝叶斯框架进行个体患者数据荟萃分析。个体患者数据分析包括 8 项研究，其中包括 97 例病例和 97 例对照。静脉注射免疫球蛋白与首次宫内输血时胎龄延长相关（本次妊娠的胎龄 - 前次妊娠的胎龄）（平均差，3.19 周；95% 可信区间，1.28-5.05），首次宫内输血时胎龄延长宫内输血（平均差，1.32周；95%可信区间，0.08-2.50），首次宫内输血时胎儿水肿的风险降低（发生率比，0.19；95%可信区间，0.07-0.45），风险降低胎儿死亡的可能性（发生率比，0.23；95%可信区间，0.10–0.47），≥28周时活产的机会较高（发生率比，1.88；95%可信区间，1.31–2.69；），胎儿死亡的机会较高≥32周时活产（发生率比，1.93；95%可信区间，1.32-2.83），出生时存活机会较高（发生率比，1.82；95%可信区间，1.30-2.61）。宫内输血次数、出生时血红蛋白水平、出生时胆红素水平或活产出院存活率没有显着差异。对于有胎儿和新生儿严重早期溶血病风险的妊娠，静脉注射免疫球蛋白治疗似乎对疾病的病程和严重程度具有临床相关的有益作用。