I have had 3 successful pregnancies with anti-E antibodies. My first immunized pregnancy, my levels stayed at less than 1. That baby was born Coombs negative and unaffected by my antibodies. During the next pregnancy, my titres rose at the very end to 8. At 37 weeks, I was induced due to cholestasis. My son was affected by my anti-E antibodies (Coombs positive) and had to be readmitted to hospital on day 5 due to high bilirubin. After 2 days of phototherapy, he was perfectly fine.
My last baby was monitored closely with MCA scans even though my titres stayed at 8. Medical literature recommends MCA scans over titers if you have had a previous baby affected by HDFN. We had a scare and almost had to travel to a bigger center for a cordocentesis (PUBS), but the repeat scan was normal.
“For a woman with a history of a previously affected fetus or neonate, serial titer assessment is inadequate for surveillance of fetal anemia”. – ACOG Practice Bulletin No. 192: Management of Alloimmunization During Pregnancy. Obstet Gynecol. 2018 Mar;131(3):e82-e90. doi: 10.1097/AOG.0000000000002528. PMID: 29470342.
I was induced at 35 weeks because of all the issues: cholestasis (again), anti-E antibodies, and a possible heart defect. My induction ended in an emergency c-section but the baby was surprisingly perfect. He was Coombs negative and had no prematurity issues. He came home with me 2 days later. I was so lucky to have 2 of my 4 kids be E antigen negative.
Do you have any advice or tips for other families going through this?
I would advise any families trying to navigate pregnancy with antibodies to do your research. It’s important to know what should happen and when to keep your baby safe.
Do you have any things that your health care providers did (or that you wish they did) that helped you?
My doctors may not have been the most knowledgeable when it comes to antibodies, but they were very receptive when I brought articles to them or suggested more monitoring. As long as my requests were reasonable, they were usually happy to accommodate me and to do extra research if it was required.
Is there anything that you would ask the scientific community to do or to research related to our antibodies/HDFN?
I wish there was a way to prevent antibodies from forming. If we could prevent antibodies from forming during pregnancies or transfusions, it would help people who need future transfusions as well and have a pretty broad application. It would be great if we could do this by using a synthetic drug similar to RhoGAM, but that would blanket protection against all antibodies. Another option would be to find a way to tone down our immune system so that antibodies aren’t produced in response to exposure to foreign antigens.