Routine administration of Anti-D: The ethical case for offering pregnant women fetal RHD genotyping and a review of policy and practice

Kent, Julie; Farrell, Anne Maree; Soothill, Peter

Abstract

Background: Since its introduction in the 1960s Anti-D immunoglobulin (Anti-D Ig) has been highly successful in reducing the incidence of haemolytic disease of the fetus and newborn (HDFN) and achieving improvements to maternal and fetal health. It has protected women from other invasive interventions during pregnancy and prevented deaths and damage amongst newborns and is a technology which has been adopted worldwide. Currently about one third of pregnant women with the blood group Rhesus D (RhD) negative in the UK (approximately 40,000 women per year in England and Wales), receive antenatal Anti-D Ig in pregnancy when they do not require it because they are carrying a RhD negative fetus. Since 1997, a test using cell free fetal DNA (cffDNA) in maternal blood has been developed to identify the genotype of the fetus and can be used to predict the fetal RhD blood group.Discussion: This paper considers whether it is ethically acceptable to continue administering antenatal Anti-D Ig to all RhD negative women when fetal RHD genotyping using maternal blood could identify those women who do not need this product.Summary: The antenatal administration of Anti-D Ig to a third of RhD negative pregnant women who carry a RhD negative fetus and therefore do not need it raises important ethical issues. If fetal RHD genotyping using maternal blood was offered to all RhD negative pregnant women it would assist them to make an informed choice about whether or not to have antenatal Anti-D Ig. © 2014 Kent et al.; licensee BioMed Central Ltd.

Citation

Kent, J., Farrell, A. M., & Soothill, P. (2014). Routine administration of Anti-D: The ethical case for offering pregnant women fetal RHD genotyping and a review of policy and practice. BMC Pregnancy and Childbirth, 14(1), https://doi.org/10.1186/1471-2393-14-87

• Journal Article Type: Article
• Publication Date: Feb 25, 2014
• Deposit Date: Sep 24, 2014
• Publicly Available Date: Apr 6, 2017
• Journal: BMC Pregnancy and Childbirth
• Electronic ISSN: 1471-2393
• Publisher: BioMed Central
• Peer Reviewed: Peer Reviewed
• Volume: 14
• Issue: 1
• DOI: https://doi.org/10.1186/1471-2393-14-87
• Keywords: anti-D, pregnant women, fetal RHD genotyping
• Public URL: https://uwe-repository.worktribe.com/output/821587
• Publisher URL: http://dx.doi.org/10.1186/1471-2393-14-87