MOTHER AND CHILD HEALTH

Our Mother and Child Health area focuses on Hemolytic Disease of the Fetus and Newborn and on vertical (mother to child) transmission of Hepatitis B.

These are serious and debilitating diseases, which represent a real threat to the fetus or newborn and, in the most severe cases, can lead to death.

Nowadays both diseases are easily preventable through the screening of all pregnant women – to detect situations at risk – and the eventual administration of a correct prophylaxis.

However, despite the existence of an effective and non-invasive treatment, access to therapy is still scarce or lacking in many countries worldwide.

HEMOLYTIC DISEASE OF THE FETUS AND NEWBORN

Maternal-fetal red cell antigen incompatibility can lead to alloimmunization, maternal Immunoglobulin transplacental transfer, and Hemolytic Disease of the Fetus and Newborn (HDFN).

Hemolytic Disease of the Fetus and Newborn (HDFN), also called Erythroblastosis Fetalis, is a condition that can arise when a mother and her unborn child have different and incompatible blood types. If even a few of the fetus’s red blood cells cross over the placenta and get into the mother’s circulation during the pregnancy, they are recognized by her immune system as “foreign” and it will produce antibodies to attack them. If these antibodies cross back over into the fetus, they will begin to destroy fetal red blood cells.

Since it takes time for antibodies to develop, the first child might not be seriously affected, but the mother’s immune system will now be sensitized to these incompatible red blood cells and subsequent pregnancies involving similar incompatibility will be seriously threatened.
The most serious type of HDFN is the one caused by Rh incompatibility in which the mother has Type Rh Negative blood and the fetus, Rh Positive. Although HDFN can be extremely serious, it is rare and preventable.

Passive Immunization with anti-D antigen Immune Globulin protects Rh(D)-negative women from sensitization against Rh(D)-positive red blood cells.

The use of Routine Antenatal Anti-D Prophylaxis (RAADP) has sharply decreased the incidence of and mortality from HDFN due to RhD allosensitization. However, despite the advent of anti-Rh(D) immunoglobulin prophylaxis, severe morbidity and death because of Rh disease have only been reduced by approximately 50% globally during the last 50 years.

References
Visser et al. The continuing burden of Rh disease 50 years after the introduction of anti-Rh(D) immunoglobin prophylaxis: call to action. Am J Obstet Gynecol. 2019 Sep;221(3):227
Liumbruno et al. The role of antenatal immunoprophylaxis in the prevention of maternal-foetal anti-Rh(D) alloimmunisation. Blood Transfus 2010; 8:8-16
Bowman JM. Controversies in Rh prophylaxis: who needs Rh immune globulin and when should it be given? Am J Obstet Gynecol 1985; 151: 289-94
Clarke CA, Donohoe WTA, McConnell RB, et al. Further experimental studies on the prevention of Rh haemolytic disease. Br Med J 1963; 1: 979-84

VERTICAL TRANSMISSION (MOTHER TO CHILD) OF HEPATITIS B

Women HBV positive can transmit HBV to their babies. In areas endemic for HBV, such as Western Pacific Region and Africa, up to 20% of the general population is chronically infected, with perinatal/neonatal and childhood infections existing as a primary route for expanding the reservoir of carriers.

Chronic HBV infection, even if asymptomatic for decades, can result in eventual death from cirrhosis and hepatocellular carcinoma (HCC). Mother-to-child transmission of HBV has been associated with an increased risk of HCC. Consequently, in Asian and African countries with a high incidence of perinatal and early childhood infection, death from cirrhosis or HCC (more than half due to HBV infection) is common, among the top ten causes of death. Thus, from the outset, prevention of chronic infection in children has been a key component of HBV immunization strategies.

The currently recommended practice to reduce mother-to-child HBV vertical transmission relies on the administration of HBV vaccine and concurrent administration of hepatitis B immune globulin (HBIG) at the time of or shortly after birth. A small but growing body of data suggests that maternal treatment with NA therapy in the third trimester of pregnancy in addition to vaccine and HBIG for the infant may also reduce HBV transmission to the infant.

References
Silverman, N, Glob. libr. women’s med.,ISSN: 1756-2228) 2008; DOI 10.3843/GLOWM.10181
Lee C., Gong Y., Brok J. et al. Effect of hepatitis B immunization in newborn infants of mothers positive for HBsAg: systematic review and meta-analysis, BMJ 2006;332:328-336
Beasley R.P. Rocks along the road to the control of HBV and HCC. Ann Epidemiology 2009;19:231-234 Red Book, current version 2018-2021
Guidelines For The Prevention, Care And Treatment Of Persons With Chronic Hepatitis B Infection, Who, March 2015