Does high body mass index (>25 kg/m²) or weight (>80 kg) reduce the effectiveness of anti-D prophylaxis in Rh(D)-negative pregnant women? A systematic review and meta-analysis.

IF 1.8 4区医学 Q3 HEMATOLOGY Vox Sanguinis Pub Date : 2024-09-01 Epub Date: 2024-06-18 DOI:10.1111/vox.13693

C B M Ngan, R Kaur, Denise E Jackson

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Abstract

Background and objectives: Haemolytic disease of the foetus and newborn (HDFN) occurs when maternal antibodies, often triggered by foetal antigens, destroy foetal and neonatal red blood cells. Factors like antibody strength, quantity and gestational age influence HDFN severity. Routine antenatal anti-D prophylaxis (RAADP) has significantly reduced HDFN cases. However, the effect of overweight/obesity (body mass index [BMI] > 25/30 kg/m²) on anti-D prophylaxis efficacy remains unclear. This systematic review will examine the impact of BMI on anti D prophylaxis effectiveness in Rh(D) negative pregnant women.

Materials and methods: We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocols. We searched databases from 1996 to 2023, focusing on studies exploring the link between high BMI/weight and anti-D serum levels in Rh(D)-negative pregnant women with Rh(D)-positive foetuses. Ten eligible studies were included, three suitable for meta-analysis. Study quality was assessed using the Strengthening the Reporting Observation Studies in Epidemiology (STROBE) checklist. Statistical analyses included Pearson correlation coefficients and risk differences.

Results: Our meta-analysis revealed a significant negative correlation (r = -0.59, 95% confidence interval [CI]: -0.83 to -0.35, p = 0.007) between high BMI/weight and serial anti-D levels in in Rh(D)-negative pregnant women with Rh(D)-positive foetuses. High BMI/weight had lower odds of serial anti-D level exceeding 30 ng/mL (arcsine risk difference [ARD] = 0.376, 95% CI: 0.143-0.610, p = 0.002). Heterogeneity among studies was low (I² = 0).

Conclusion: While our analysis suggests a potential linkage between high BMI/weight and reduced efficacy of anti-D prophylaxis, caution is warranted due to study limitations. Variability in study design and confounding factors necessitate careful interpretation. Further research is needed to confirm these findings and refine clinical recommendations.

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高体重指数（>25 kg/m2）或体重（>80 kg）是否会降低 Rh（D）阴性孕妇的抗 D 预防效果？系统回顾和荟萃分析。

背景和目的：胎儿和新生儿溶血病（HDFN）是指母体抗体（通常由胎儿抗原引发）破坏胎儿和新生儿红细胞。抗体强度、数量和胎龄等因素会影响 HDFN 的严重程度。常规产前抗 D 预防（RAADP）可显著减少 HDFN 病例。然而，超重/肥胖（体重指数 [BMI] > 25/30 kg/m2）对抗原预防效果的影响仍不清楚。本系统综述将研究 BMI 对 Rh(D) 阴性孕妇抗 D 预防效果的影响：我们按照系统综述和荟萃分析的首选报告项目（Preferred Reporting Items for Systematic Review and Meta-Analysis，PRISMA）协议进行了系统综述和荟萃分析。我们检索了 1996 年至 2023 年的数据库，重点关注探讨 Rh（D）阴性孕妇高 BMI/体重与 Rh（D）阳性胎儿抗 D 血清水平之间联系的研究。共纳入十项符合条件的研究，其中三项适合进行荟萃分析。研究质量采用加强流行病学观察研究报告（STROBE）核对表进行评估。统计分析包括皮尔逊相关系数和风险差异：我们的荟萃分析显示，在Rh（D）阴性孕妇和Rh（D）阳性胎儿中，高BMI/体重与序列抗-D水平之间存在显著负相关（r = -0.59，95% 置信区间[CI]：-0.83 至 -0.35，p = 0.007）。高体重指数/体重降低了连续抗-D水平超过30纳克/毫升的几率（arcsine风险差异[ARD] = 0.376，95% CI：0.143-0.610，p = 0.002）。研究之间的异质性较低（I2 = 0）：尽管我们的分析表明高体重指数/体重与抗 D 预防疗效降低之间存在潜在联系，但由于研究的局限性，仍需谨慎。由于研究设计和混杂因素存在差异，因此有必要进行谨慎解释。需要进一步的研究来证实这些发现并完善临床建议。

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来源期刊

Vox Sanguinis 医学-血液学

CiteScore

4.40

自引率

11.10%

发文量

156

审稿时长

6-12 weeks

期刊介绍： Vox Sanguinis reports on important, novel developments in transfusion medicine. Original papers, reviews and international fora are published on all aspects of blood transfusion and tissue transplantation, comprising five main sections: 1) Transfusion - Transmitted Disease and its Prevention: Identification and epidemiology of infectious agents transmissible by blood; Bacterial contamination of blood components; Donor recruitment and selection methods; Pathogen inactivation. 2) Blood Component Collection and Production: Blood collection methods and devices (including apheresis); Plasma fractionation techniques and plasma derivatives; Preparation of labile blood components; Inventory management; Hematopoietic progenitor cell collection and storage; Collection and storage of tissues; Quality management and good manufacturing practice; Automation and information technology. 3) Transfusion Medicine and New Therapies: Transfusion thresholds and audits; Haemovigilance; Clinical trials regarding appropriate haemotherapy; Non-infectious adverse affects of transfusion; Therapeutic apheresis; Support of transplant patients; Gene therapy and immunotherapy. 4) Immunohaematology and Immunogenetics: Autoimmunity in haematology; Alloimmunity of blood; Pre-transfusion testing; Immunodiagnostics; Immunobiology; Complement in immunohaematology; Blood typing reagents; Genetic markers of blood cells and serum proteins: polymorphisms and function; Genetic markers and disease; Parentage testing and forensic immunohaematology. 5) Cellular Therapy: Cell-based therapies; Stem cell sources; Stem cell processing and storage; Stem cell products; Stem cell plasticity; Regenerative medicine with cells; Cellular immunotherapy; Molecular therapy; Gene therapy.