Immunoglobulin in pregnancy

In some cases, it is necessary to administer immunoglobulin during pregnancy. This is a specific drug, the action of which is aimed at improving the quality of the body's natural defense. This drug is synthesized from donor blood plasma.

With the onset of pregnancy, a natural decrease in the level of immune protection occurs, which is an extremely necessary process for the safety of the fetus. If this process does not occur, the woman's immunity will direct all its efforts to terminating the pregnancy, since it will consider the fetus a foreign agent. There are a number of known cases in which a woman requires the introduction of immunoglobulin.

Is immunoglobulin necessary during pregnancy?

Pregnancy is always associated with many risks - both for the female body and for the growing fetus. The first indicator of changes associated with this period is a decrease in immune protection. It is important to understand that the body of the expectant mother independently launches this mechanism, intentionally and purposefully. This need is associated with the successful bearing of the child, because our immunity is configured in such a way that it can perceive the fetus as a foreign organism and reject it.

Immunoglobulin is often used as a supportive measure if a woman has problems that prevent her from carrying a baby. In such a situation, the drug is administered by injection or intravenously by drip.

The direct action of immunoglobulin is based on the properties of the active substance, extracted from plasma, purified and concentrated. The main focus of the drug is the correction of immunity, assistance in resisting infectious agents, and restoration of the level of IgG antibodies. This allows the body to protect itself from infectious diseases in case of primary or secondary immunity deficiency.

Immunoglobulin during pregnancy: pros and cons

During pregnancy, the introduction of immunoglobulin will help preserve the fetus and prevent the termination of the gestation process. However, its effect on the baby and the expectant mother has not yet been fully studied, although no negative consequences have been registered so far. It follows that the drug can be used only when it is really necessary, and the risk from such treatment will be less than the existing danger of pathology. [ 1 ]

It is not recommended to use immunoglobulin during pregnancy without appropriate indications.

At what week of pregnancy is immunoglobulin administered?

During planned prenatal preventive measures in the period from 28 to 30 weeks of gestation, the doctor sends the woman for an injection of immunoglobulin. Repeated administration should be carried out within 3 days after the birth of the child.

If a woman did not undergo prophylaxis during pregnancy, then when a Rh-positive baby is born, an injection of immunoglobulin is given after birth for 72 hours.

In case of abdominal trauma or amniocentesis, immunoglobulin is used at any stage.

Indications immunoglobulin in pregnancy

There are different types of immunoglobulin, each of which has its own indications and can only be prescribed in cases of extreme necessity.

The basic indications are:

• critically weakened immunity of the woman;
• serious injuries to the abdominal area during pregnancy;
• conducting a study of amniotic fluid (amniocentesis);
• carrying out any procedures that may involve mixing of fetal and maternal blood;
• real threat of spontaneous abortion;
• threat of fetal rejection;
• infectious diseases that can harm both the unborn child and the expectant mother;
• risk of rhesus conflict;
• termination of ectopic pregnancy.

Features of application

Pharmacists have many types of immunoglobulin, but only two are used during pregnancy: Anti-D and human normal immunoglobulin. All of them are antibodies, a special type of protein produced by human beta lymphocytes to provide protection against foreign attack, such as viral or bacterial. The most commonly used immunoglobulin during pregnancy is Rh-negative: this is the so-called anti-Rhesus immunoglobulin, or Anti-D, which is produced from the donor blood of a Rh-immunized person. The basic composition of the drug is antibodies to the protein substances of the Rh factor, which provoke a reaction of rejection of the fetus. This drug is used during pregnancy if the expectant mother is Rh-negative and there is a risk of Rh-conflict. [ 2 ]

In what cases is it necessary to administer immunoglobulin during pregnancy?

When a woman learns of her pregnancy and comes to the antenatal clinic for the first time, she is offered to take a blood test to determine her Rh factor. The future father of the child must also take the same test. If the woman's blood is Rh-negative and the man's blood is Rh-positive, the pregnancy is monitored in a special way: now the future mother will have to take a blood test twice a month to determine the concentration of antibodies. [ 3 ]

Is immunoglobulin necessary during the first pregnancy? As a rule, a negative Rh factor of the mother with a positive Rh factor of the baby does not pose a danger if such a pregnancy is the first, since the strength of the immune response is not yet sufficient for the development of a conflict. However, already during the second pregnancy, such a response is several times stronger, which is associated with the massive appearance of antibodies in the bloodstream. A large number of antibodies enter the fetal circulatory system, which leads to a serious hemolytic disorder, which is the Rh conflict. Why is this dangerous? In fact, various complications can develop, from premature birth to spontaneous abortion or stillbirth. [ 4 ]

And, although immunoglobulin preparations are not used in many cases during the first pregnancy, it is necessary to monitor the antibody content throughout the entire period of gestation. If they are determined in dangerous concentrations, then a decision to administer the preparation can be made. This is a safety measure that will help save the child.

Here are some women with a negative Rh factor who are especially recommended to receive immunoglobulin:

• during the second pregnancy;
• if a woman has previously had abortions, spontaneous miscarriages, or ectopic pregnancies;
• if the patient has previously received a blood transfusion.

Immunoglobulin can be prescribed in different situations when planning a pregnancy, and first of all, when there are problems with bearing a fetus. Frequent miscarriages, frozen pregnancies in the anamnesis are indications for the use of the drug. However, immunoglobulin for miscarriage is not the only indication. In addition, the administration of the drug is successfully practiced in the presence of herpes or cytomegalovirus infection in the body of the expectant mother, with any infections that can harm the health of the fetus, as well as for immune correction. Before planning a baby, doctors always recommend undergoing a number of important diagnostic tests in order to be able to identify and eliminate possible problems for normal conception and pregnancy in advance. Thus, a woman should donate blood for antibodies - protein structures of immunity produced by the lymphatic system. They are able to attach to red blood cells and become aggressively configured with respect to "foreign" organisms. [ 5 ]

Immunoglobulin G during pregnancy, as well as when planning it, is an important marker for assessing the state of immunity - after all, it is the main serum immunoglobulin that takes part in the formation of the immune response.

Immunoglobulin E also becomes quite indicative during pregnancy. It is a basic marker of allergic processes and helminthiasis, therefore it is prescribed for screening in determining these pathologies.

Immunoglobulin during pregnancy for a tick bite is administered no later than 96 hours after the insect bite. We are talking about a specific drug against tick-borne encephalitis. Such an injection can be done at a trauma center, a special vaccination center or even a hospital.

Another pathology that can occur, including during pregnancy, is chickenpox. The virus - the causative agent of this disease - can cause quite serious complications, so it is important to prevent them. Immunoglobulin during pregnancy for chickenpox can be administered at any time, and in case of contact with a sick person, this injection is even performed for preventive purposes. A specific drug is administered intramuscularly, no later than 72 hours after contact with a sick person, in an amount of 125 U / 10 kg of body weight.

Anti-Rhesus immunoglobulin must be administered again after pregnancy - within 72 hours after the birth of the child (or after a miscarriage, placental abruption, ectopic pregnancy). Such administration is necessary, since during subsequent pregnancies the woman's immune system will begin to produce antibodies in huge quantities. There is no need to be afraid of this medication: there is no need to stop breastfeeding after the injection. Multiple studies have demonstrated the complete safety of immunoglobulin for a nursing baby.

Release form

• Human normal immunoglobulin is prescribed relatively often during pregnancy: the medicine in the form of a solution is released in ampoules of 1.5 ml, which corresponds to one dose. The recalculation of this dose for the content of protein substance is 150 mg. Sodium chloride, glycine, and water for injection are present as auxiliary components. The solution should be transparent, colorless, or slightly yellowish.
• Anti D immunoglobulin is prescribed during pregnancy to prevent the development of Rhesus conflict: the injection solution is represented by specific antibodies to anti-Rh ₀ (D), as well as glycine and sodium chloride. One dose of the drug contains 300 mcg, with a titer of antibodies to anti-Rh ₀ (D) 1:2000. The solution is transparent, slightly yellowish or colorless.

Pharmacodynamics

The active base of anti-Rhesus immunoglobulin is a substance specific to the D antigen. In one dose of the drug, the antibody titer is less than 1:2000, which can be determined using the Coombs reaction.

Anti-Rhesus immunoglobulin prevents Rh sensitization of Rh-negative patients, which can occur when Rh-positive fetal blood enters the mother's circulatory system. The danger of such a development is especially high when a Rh-negative woman gives birth to a Rh-positive child, when a pregnancy is terminated, when amniocentesis is performed, or when there is traumatic abdominal injury during pregnancy.

Normal human immunoglobulin has immunomodulatory and immunostimulating properties, includes neutralizing and opsonizing antibodies that allow to resist viral, bacterial infections, etc. In addition, the product compensates for the numerical deficiency of IgG antibodies, successfully replaces and supplements the amount of natural antibodies in the woman's serum.

The effect of immunoglobulin on the fetus

Both human normal and anti-Rhesus immunoglobulin are considered absolutely safe for the fetus, the newborn baby, and the patient herself. Of course, there is a possibility of developing some side effects. But this happens extremely rarely, and the benefit from the introduction of these medications is often much higher than the existing risk of adverse effects.

In any case, if the doctor prescribes immunoglobulin, then there is no need to panic and worry about this issue. This is just a necessary measure that will allow you to carry and give birth to a healthy baby.

Immunoglobulin effects during pregnancy

I would like to clarify that adverse reactions in the body against the background of taking immunoglobulin develop very rarely. Treatment with the drug occurs with strict adherence to the dosage and rate of administration, and only if there are indications.

In some cases, minor side effects are possible, which are detected during the first 50-60 minutes after the injection of the drug. As a rule, they are expressed in a general deterioration in well-being, headache, weakness, and a slight increase in temperature.

In isolated patients, breathing difficulties, nausea, diarrhea, short-term dry cough, hypersalivation, abdominal pain, peripheral circulatory disorders, sleep disorders, skin rashes, and nagging pain in muscles and joints occur.

Pharmacokinetics

The active components of the drug are immunoglobulins – different specific antibodies with different kinetic properties, the content of which in the bloodstream reaches its maximum concentration within 24 hours after administration.

With intravenous infusion, the bioavailability of immunoglobulin is equal to 100%. Redistribution of the active component occurs gradually between the plasma and the extravascular space, with equilibrium being found after approximately 1 week. The half-life of antibodies in the bloodstream can be 4-5 weeks.

Dosing and administration

The use of immunoglobulin is carried out taking into account the following points:

• the woman must be Rh negative, without sensitization to the D antigen;
• the newborn baby must be Rh positive, with a negative direct antiglobulin test result;
• the introduction of immunoglobulin during pregnancy should be accompanied by repeated introduction of the drug after childbirth – during the first 72 hours after the birth of a Rh-positive baby;
• If the baby's father is also Rh negative, then the administration of immunoglobulin is not necessary.

The medication is administered in a quantity of 300 mcg, which corresponds to one ampoule, once, deep intramuscularly.

If there is a risk of miscarriage, then IV drips and injections of immunoglobulin are administered at any stage of pregnancy.

When performing amniocentesis or when there is abdominal trauma in the second or third trimester of pregnancy, one dose of immunoglobulin is administered. If such situations occurred in the period from 13-18 weeks, then another dose of the drug should be administered again at 26-28 weeks.

Contraindications

Immunoglobulin is not used during pregnancy:

• in case of hypersensitivity to the drug;
• with a tendency to severe allergic processes that develop in response to the administration of protein blood products;
• hemostatic disorders, severe thrombocytopenia.

Anti-Rhesus immunoglobulin is not administered if Rhesus sensitization is already present - that is, antibodies are detected in the bloodstream of the expectant mother. In such a situation, preventive measures are no longer appropriate: treatment of the Rhesus conflict should be started in hospital conditions.

Side effects immunoglobulin in pregnancy

Cases of side effects after the introduction of immunoglobulin during pregnancy are rarely recorded. The frequency of such manifestations depends, first of all, on the individual sensitivity of the organism.

Common side effects sometimes include fever, mild back pain, and soreness at the injection site.

Additional undesirable signs include:

• nausea, vomiting;
• allergy;
• joint pain;
• headaches;
• hypotension.

Overdose

As a rule, immunoglobulin during pregnancy is administered in strictly calculated dosages and is never used for self-medication - this is strictly prohibited. Perhaps this is why no cases of drug overdose have been recorded so far.

Interactions with other drugs

During pregnancy, immunoglobulin may be used in combination with other medications and solutions, provided that it is administered by separate injection: mixing several medications in one syringe or drip system is prohibited.

Vaccination with live viral serums can be carried out no earlier than 12 weeks after the last administration of immunoglobulin.

Storage conditions

Ampoules with immunoglobulin are stored only under certain conditions: in a dark place with an ambient temperature of no lower than +2 and no higher than +8°C. Freezing and heating the drug is strictly prohibited.

Storage areas should be kept out of reach of children and mentally ill people.

Shelf life

Ampoules with immunoglobulin can be stored for up to two years under appropriate conditions.

An opened ampoule is used immediately: it is prohibited to store it. If the drug is not used, it is immediately disposed of.

Analogues

An analogue of anti-Rhesus immunoglobulin can be a solution of identical composition, Resonativ, which is produced in the UK by the pharmaceutical company Amaxa Pharma Ltd.

Normal human immunoglobulin can be represented by the following similar preparations:

• Gamanorm, Kiovig are Austrian-made drugs;
• Bioven, Bioven mono, Venoimun are Ukrainian-made drugs;
• Octagam - made in Great Britain;
• Phlebogamma – made in Spain.

The question of the possibility of using immunoglobulin analogues should be decided directly with the attending physician.

Reviews

Immunoglobulins are not prescribed to everyone and not always during pregnancy, but only for specific diseases, disorders or conditions. Such means are necessary to support the immune system, and in case of a negative Rh factor in women, they allow to maintain pregnancy and give birth to a healthy baby.

Injections are carried out exclusively under the supervision of the attending physician. As a rule, this is the doctor who is monitoring the pregnancy.

Based on numerous positive reviews from women, we can conclude that immunoglobulin can be administered during pregnancy without any concerns - of course, if there are appropriate indications. Such drugs are safe, and in return can prevent a lot of troubles - from termination of pregnancy and stillbirth to the occurrence of health problems in the future baby. There is also no need to be afraid of side effects: as a rule, they occur rarely and do not last long.