Department of Obstetrics and Gynaecology, University Hospital North Norway, Tromsø, Norway.
Immunology Research Group, Department of Medical Biology, The Artic University of Norway, Tromsø, Norway.
BJOG. 2016 Apr;123(5):738-44. doi: 10.1111/1471-0528.13343. Epub 2015 Mar 9.
To assess neonatal platelet counts by comparing alloimmunised pregnancies from a Norwegian screening and intervention study with subsequent pregnancies from the same women.
Prospective observational follow-up study.
A university hospital.
HPA-1a immunised women from a large Norwegian screening study that gave birth to one or more children after the screening study ended (2004-2012).
Follow-up of maternal anti-HPA-1a antibody levels and neonatal platelet counts from the screening pregnancies were compared with subsequent pregnancies. None of the women received antenatal intravenous immunoglobulin (IVIG) treatment and neonatal platelet counts were therefore comparable.
Change in neonatal platelet counts from one HPA-1a incompatible pregnancy to the next. Maternal anti-HPA-a1 antibody levels from one HPA-1a incompatible pregnancy to the next.
Forty-five incompatible subsequent pregnancies were identified. Overall, the neonatal platelet count in the subsequent pregnancy was improved (18%), unchanged (52%), or worse (30%), compared with the corresponding screening pregnancy. There was one case of fetal intracranial haemorrhage (ICH) identified in the screening (intrauterine fetal death detected at 30 weeks of gestation) and no ICH cases recorded for the subsequent pregnancies. In cases where the platelet count was lower in the subsequent pregnancy, the maternal anti-HPA-1a antibody level was higher compared with the screening pregnancy. In comparison, the maternal antibody level was lower in subsequent pregnancies where the platelet count improved.
In contrast to what is often stated, we found that the neonatal platelet count was increased or unchanged in the majority of subsequent pregnancies of HPA-1a-immunised women.
通过比较挪威筛查和干预研究中的同种免疫妊娠与同一女性随后的妊娠，评估新生儿血小板计数。
前瞻性观察随访研究。
一所大学医院。
来自挪威大型筛查研究的 HPA-1a 免疫妇女，该研究在筛查研究结束后（2004-2012 年）生育了一个或多个孩子。
比较了筛查妊娠中的母体抗 HPA-1a 抗体水平和新生儿血小板计数，并与随后的妊娠进行了随访。没有妇女接受产前静脉内免疫球蛋白（IVIG）治疗，因此新生儿血小板计数是可比的。
从一次 HPA-1a 不相容妊娠到下一次妊娠的新生儿血小板计数变化。从一次 HPA-1a 不相容妊娠到下一次妊娠的母体抗 HPA-a1 抗体水平。
确定了 45 次不相容的后续妊娠。总体而言，与相应的筛查妊娠相比，随后妊娠的新生儿血小板计数有所改善（18%）、不变（52%）或恶化（30%）。在筛查中发现了一例胎儿颅内出血（ICH）（宫内胎儿死亡在 30 周时被发现），而随后的妊娠中没有记录到 ICH 病例。在随后的妊娠中血小板计数较低的情况下，母体抗 HPA-1a 抗体水平较筛查妊娠更高。相比之下，在血小板计数改善的后续妊娠中，母体抗体水平较低。
与通常所说的相反，我们发现 HPA-1a 免疫妇女的大多数随后妊娠中，新生儿血小板计数增加或不变。
