Correlation between maternal parity and ABO hemolytic disease of the fetus and newborn
10.13303/j.cjbt.issn.1004-549x.2025.12.010
- VernacularTitle:妊娠胎次与ABO胎儿新生儿溶血病相关性分析
- Author:
Li YANG
1
;
Wei LIU
1
;
Yuan ZHAO
1
;
Daihong LI
1
Author Information
1. Department of blood transfusion, Tianjin First Central Hospital, Tianjin 300192, China
- Publication Type:Journal Article
- Keywords:
parity;
antibody titer;
direct Coombs test;
IVIG therapy
- From:
Chinese Journal of Blood Transfusion
2025;38(12):1713-1719
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To investigate the correlation between maternal parity and ABO hemolytic disease of the fetus and newborn (ABO-HDFN). Methods: A total of 244 neonates diagnosed with ABO-HDFN who were admitted to the neonatology department of of our hospital from January 2021 to December 2024 were selected as the research subjects. According to maternal parity, the neonates were divided into the first- (n=139), second- (n=79), and third-parity group (n=26). Statistical analyses were performed on the maternal IgG anti-A (B) antibody titer, results of the three hemolysis tests, hemolysis-related indicators, and treatment regimens among the three groups. Binary logistic multivariate regression analysis was applied to identify the risk factors for intravenous immunoglobulin (IVIG) therapy in neonates. Results: The proportions of mothers with IgG anti-A (B) titers <64 and ≥64 in each group were as follows: first parity group: 86.33% vs 13.67%; second parity group: 70.89% vs 29.11%; third parity group: 53.85% vs 46.15%. Compared with the first parity group, both the second and third parity group showed statistically significant differences (P
=0.005, P
<0.001), while no statistically significant difference was observed between the second and the third parity group (P
=0.110). The positive rates of direct Coombs test in the first, second and third parity groups were 19.42%, 34.18% and 42.31%, respectively. Compared with the first parity group, the second and third parity group showed statistically significant differences (P
=0.015, P
=0.011), whereas the difference between the second and third parity group was not statistically significant (P
=0.454). The absolute values of reticulocytes (RET#) (×10
/L) in the first, second and third parity groups were 197.02±66.16, 225.69±67.42 and 227.74±64.03, the reticulocyte percentages (RET%) were 4.80±1.83, 5.81±2.07 and 5.90±1.84, and the immature reticulocyte fractions (IRF%) were 38.35±8.06, 40.76±6.63 and 43.25±5.86, respectively. There were statistically significant differences in RET# and RET% between the first and second parity group (RET#: P
=0.002; RET%: P
<0.001), but no statistically significant difference in IRF% (P
=0.022). There were statistically significant differences in RET% and IRF% between the first and third parity group (RET%: P
=0.008; IRF%: P
=0.002), while no statistically significant difference was found in RET# (P
=0.031). No statistically significant differences were observed between the second and the third parity group (RET#: P
=0.891, RET%: P
=0.825, IRF%: P
=0.139). The proportions of neonatal patients with normal hemoglobin (HGB) levels (>144 g/L), mild anemia (120-144 g/L) and moderate anemia (90-120 g/L) were 72.66%, 25.90% and 1.44% in the first parity group; 51.90%, 35.44% and 12.66% in the second parity group; and 46.15%, 38.46% and 15.38% in the third parity group. Compared with the first parity group, the second and third parity group showed statistically significant differences (P
=0.001, P
=0.009). However, there was no statistically significant difference between the second and third parity group (P
=0.594). The proportions of neonatal patients receiving phototherapy alone and phototherapy combined with IVIG treatment in the three groups were as follows: first parity group: 84.17% and 15.83%; second parity group: 63.29% and 36.71%; third parity group: 61.54% and 38.46%. Compared with the first parity group, the second and third parity group showed statistically significant differences (P
<0.001, P
=0.007), while no statistically significant difference was detected between the second and third parity group (P
=0.873). Conclusion: When the maternal parity is ≥ 2, the titers of maternal IgG anti-A (B) antibody increase, and the neonates present with elevated positive rate of direct Coombs test and reticulocyte count, along with changes in the degree of anemia and clinical treatment strategies. Positive direct Coombs test and low 24-hour hemoglobin level are the risk factors for clinical administration of IVIG therapy.
