I first learned about my anti-Fya antibodies in February 2020 when I suffered an ectopic pregnancy. As part of that blood work, they ran an antibody screen which came back positive. I had previously had two healthy, term pregnancies without issue, so this was a surprise. I must have become sensitized either during the c-section for my second child or during the ectopic pregnancy itself. During the ectopic only the antibody screen was run (not a titer), so the anti-Fya antibodies were just brought up in passing. There was a brief mention that if I had a future pregnancy I may need additional monitoring.
Fast forward to November 2020 when I was again pregnant, with what was initially a twin pregnancy. One of the twins passed away between 6 and 8 weeks and was reabsorbed. At this time my antibody screen was repeated and my titer came back critically high for anti-Fya, at 512.
I transferred care to a wonderful MFM group around 14 weeks. They walked me through the monitoring that my pregnancy would require. Starting at 18 weeks I had MCA dopplers every 2 weeks, until 28 weeks. This was when I had my first scan with an MOM elevated above 1.5. I was given steroids and scheduled for an IUT with repeat dopplers beforehand- however the next day my baby’s MoM had decreased back down to 1.47. Over the next several weeks she stayed just under the threshold for an IUT, and I had scans at least 2x a week. Starting at 32 weeks, I had NSTs as well. At 34 weeks and 4 days my baby’s MoM was elevated, and after some close monitoring Ellie was delivered at 35 weeks and 1 day.
At birth her hemoglobin was 9 and bilirubin 4.6. She immediately underwent two blood transfusions and started phototherapy. Ellie has been doing well and progressing through her NICU stay so far (as I’m writing this she is 4 days old).
I wanted to share this story because I had never heard of anti-Fya prior to this pregnancy despite being a family medicine physician Assistant that cares for newborns after birth! There are very few stories available online for people to read. Even my experienced MFM doctors had not dealt with this particular antibody before. I didn’t know what to expect, but I am so glad to be through the pregnancy. I hope that sharing this story is helpful for families out there who may be going through a similar struggle.
How can health care providers help?
I appreciated how transparent my providers were about the uncertainty and variability of patient experiences with HDFN.
How can scientists help?
It would be wonderful if there was a RhoGAM-like preventative for other antibodies, or if maternal and paternal antigen typing became part of pre-conception counseling!
What would you tell other parents?
Your pregnancy will be scary and stressful, but with good care you can still have a happy outcome!