A Real-world Prospective Study to Evaluate the Geographical Distribution, Isoimmunization Rate, and Utilization of Prophylactic Treatment of Rh-negative Pregnant Women in India (RhYTHM Study)
Citation Information :
Shah P, Pawar SH, Naik SN, Sivjyothi T, Kakkar A. A Real-world Prospective Study to Evaluate the Geographical Distribution, Isoimmunization Rate, and Utilization of Prophylactic Treatment of Rh-negative Pregnant Women in India (RhYTHM Study). J South Asian Feder Obs Gynae 2023; 15 (5):594-600.
Aim and background: There is a lack of comprehensive and recent data on rhesus (Rh)-negative pregnancies in India. The aim of this study is to examine the demographics, isoimmunization status, usage of prophylactic treatment, and complications associated with Rh-negative pregnancies in India.
Materials and methods: This is an interim analysis of an ongoing real-world observational study targeting the recruitment of 20,000 Rh-negative pregnant women throughout India. This article presents data from 1,421 participants who were followed prospectively for 3 months. Participants’ demographics, obstetrics history, usage of prophylactic treatment, and pregnancy-related complications were recorded. Data were analyzed using descriptive statistics for all the outcome variables.
Results: The maximum number of participants belonged to the West region (47.4%). The mean gestational age of the participants was 37.7 weeks. There was an equal representation of primigravida and multigravida participants in the study population. The available indirect Coombs test data showed that most of the participants (116 of 125) were negative for circulating antiglobulin in the current pregnancy. However, isoimmunization during the current pregnancy occurred in 9 participants (9 of 125; 7.2%). Overall, 25.7% of the participants received anti-D prophylaxis during their current pregnancy.
Conclusion: This real-world evidence study demonstrates that most Rh-negative women carrying Rh-positive fetus are at risk of becoming sensitized to the Rh antigen. Despite the availability of prophylactic treatment, there are women who are getting sensitized. Hence, there is a need to create awareness among the Indian population about the Rh-disease-associated risks and available preventive measures to reduce the mortality rates.
Clinical significance: Anti-D prophylaxis is the most effective method to prevent sensitization in Rh-negative pregnant women. Anti-Rh (O) D immunoglobulin is a must administered drug both in antenatal and postnatal phases of pregnancy to prevent Rh-negative pregnant women from getting sensitized. Thus, further reducing the burden of Rh-sensitization in India and having healthy motherhood.
Pinapothu S, Guvvada T, Sowjanya MN, et al. Prevalence of rhesus negative pregnancy and comparison to its prevalence in previous decade. Int Arch Integr Med 2019;6(12):10–14.
Nagamuthu E, Mudavath P, Prathima P, et al. Prevalence of rhesus negativity among pregnant women. Int J Res Med Sci 2017;4(8): 3305–3309. DOI: 10.18203/2320-6012.ijrms20162284.
Sarwar A, Citla Sridhar D. Rh-hemolytic disease. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing, 2023. PMID: 32809323.
Costumbrado J, Mansour T, Ghassemzadeh S. Rh incompatibility. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing, 2022. PMID: 29083656.
Neamţu SD, Novac MB, Neamţu AV, et al. Fetal-maternal incompatibility in the Rh system. Rh isoimmunization associated with hereditary spherocytosis: Case presentation and review of the literature. Rom J Morphol Embryol 2022;63(1):229–235. DOI: 10.47162/rjme.63.1.26.
Ayenew AA. Prevalence of rhesus D-negative blood type and the challenges of rhesus D immunoprophylaxis among obstetric population in Ethiopia: A systematic review and meta-analysis. Matern Health Neonatol Perinatol 2021;7(1):8. DOI: 10.1186/s40748-021-00129-3.
Bi SH, Jiang LL, Dai LY, et al. Rh-incompatible hemolytic disease of the newborn in Hefei. World J Clin Cases 2019;7(20):3202–3207. DOI: 10.12998/wjcc.v7.i20.3202.
Pegoraro V, Urbinati D, Visser GHA, et al. Hemolytic disease of the fetus and newborn due to Rh(D) incompatibility: A preventable disease that still produces significant morbidity and mortality in children. PLoS One 2020;15(7):e0235807. DOI: 10.1371/journal.pone.0235807.
Visser GHA, Thommesen T, Di Renzo GC, et al. FIGO/ICM guidelines for preventing rhesus disease: A call to action. Int J Gynaecol Obstet 2021;152(2):144–147. DOI: 10.1002/ijgo.13459. Epub 2021 Jan 9.
Agarwal S, Seema S, Sharma S, et al. Rh negative pregnancy: Maternal and perinatal outcome in Bundelkhand region. J Evol Med Dent Sci 2016;5(71):5165–5168. DOI: 10.14260/jemds/2016/1171.
Aljuhaysh RM, El-Fetoh NMA, Alanazi MI, et al. Maternal-fetal rhesus (Rh) factor incompatibility in Arar, northern Saudi Arabia. Elect Phys 2017;9(12):5908–5913. DOI: 10.19082/5908. eCollection 2017 Dec.
Bhutani VK, Zipursky A, Blencowe H, et al. Neonatal hyperbilirubinemia and rhesus disease of the newborn: Incidence and impairment estimates for 2010 at regional and global levels. Pediatr Res 2013;74(Suppl 1):86–100. DOI: 10.1038/pr.2013.208.
Mayekar RV, Paradkar GV, Bhosale AA, et al. Recombinant anti-D for prevention of maternal-foetal Rh(D) alloimmunization: A randomized multi-centre clinical trial. Obstet Gynecol Sci 2020;63(3):315–322. DOI: 10.5468/ogs.2020.63.3.315.
Pahuja S, Gupta SK, Pujani M, et al. The prevalence of irregular erythrocyte antibodies among antenatal women in Delhi. Blood Transfus 2011;9(4):388–93. DOI: 10.2450/2011.0050-10. Epub 2011 May 31.
Sahoo T, Sahoo M, Gulla KM, et al. Rh alloimmunisation: Current updates in antenatal and postnatal management. Indian J Pediatr 2020;87(12):1018–1028. DOI: 10.1007/s12098-020-03366-0. Epub 2020 Jul 1.