Antenatal IVIG in Gestational Alloimmune Liver Disease
Supervisor / Principle Investigator:
MD Class of 2019
Objective: Gestational alloimmune liver disease (GALD) is one of the most common causes of neonatal liver failure, associated with high mortality and morbidity. Antenatal intravenous immunoglobulin (IVIG) has become a promising treatment option. The objective of this study is to evaluate the efficacy of antenatal IVIG therapy for GALD in reducing perinatal and neonatal morbidity and mortality.
Methods: Electronic databases (MEDLINE, Scopus, PROSPERO, Cochrane, CINAHL) were searched from inception until January 1, 2017 with the terms: "gestational alloimmune liver disease", "neonatal hemochromatosis", and "treatment or therapy or intervention." Outcomes were perinatal and neonatal mortality, liver transplantation, and iatrogenic preterm delivery.
Results: Sixteen studies were included with n=73 matched pregnancies. Out of the 73 pregnancies treated with antenatal IVIG all of them had live births, surviving to discharge. Among control pregnancies all but 6 resulted in neonatal death (55/73) or intrauterine fetal demise (12/73). Of live births 10/67 liver transplants were reported of which 3 survived to discharge. None of the infants from treatment pregnancies required liver transplants. Gestational age of treatment pregnancies was 37.2 ± 2.3 weeks, only 11/73 control pregnancies reported gestational age.
Conclusion: Antenatal IVIG treatment significantly reduces perinatal and neonatal mortality in GALD and should be offered to all women with previously affected child(ren).