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What You Need to Know About Low Titer Pregnancies
S3E2: Low Titer Alloimmunized Pregnancies
Over half of alloimmunized pregnancies begin with a low antibody titer, and a portion stay low throughout the pregnancy. Others begin low and later rise to critical levels. This episode is dedicated to management of the low titer pregnancy and how to anticipate a potential change in disease trajectory if titers increase.
Bethany and Molly include management recommendations and stories submitted by low titer moms before transitioning to a special interview with allo mom Amanda, whose pregnancy began as a low titer pregnancy before taking a surprising turn. We meet Amanda in this episode before resuming the second half of her HDFN journey in this season’s final episode, Incredible HDFN Survival Stories.
Key aspects of low titer disease management:
- Determine baby’s antigen status if possible. If not possible, monitor as if antigen positive. If the baby is certainly antigen negative, the pregnancy proceeds as normal and there is no need to do anything further beyond standard pregnancy care
- Establish care with an MFM and determine up front if this MFM is able to do IUTs on your baby if your disease progresses. If not, have a referral plan set up
- Check titers every 4 weeks in the first and second trimester, then every 2 in the third trimester
- Weekly fetal assessment beginning at 32 weeks (Nonstress tests and biophysical profiles).
- Delivery at 37-38 weeks
- Follow all neonatal recommendations (establish a plan with pediatrician in advance if possible b/c they are likely to be doing the follow-up care) - bilirubin consistent with AAP guidelines which may include daily testing after discharge for a week or more, and hemoglobin/hematocrit weekly for the first six weeks and until hemoglobin/hematocrit increases or is in stable normal range for two consecutive weeks
Delivery timing 37-38 weeks: ACOG Medically Indicated Late Term and Early Preterm Deliveries. ACOG Early Delivery Guidlines
AAP guidelines for hyperbilirubinemia after birth: AAP on Hyperbilirubinemia
Undetectable antibodies progressing to severe disease: Dajak S, Stefanović V, Čapkun V. Severe hemolytic disease of fetus and newborn caused by red blood cell antibodies undetected at first‐trimester screening (CME). Transfusion. 2011 Jul;51(7):1380-8. Undetected Antibodies Research
Amanda’s video blog of her alloimmunized pregnancy journey: Amanda's Video Blog
Donate to AHF: https://allohopefoundation.org/get-involved/donate/
AHF Merch: https://allo-hope-foundation.myspreadshop.com/
Watch this episode on YouTube: https://youtu.be/AA9J1pHPNUA
Join the AHF patient support group:
https://www.facebook.com/groups/antibodiesinpregnancy
View all episodes
By Allo Hope FoundationS3E2: Low Titer Alloimmunized Pregnancies
Over half of alloimmunized pregnancies begin with a low antibody titer, and a portion stay low throughout the pregnancy. Others begin low and later rise to critical levels. This episode is dedicated to management of the low titer pregnancy and how to anticipate a potential change in disease trajectory if titers increase.
Bethany and Molly include management recommendations and stories submitted by low titer moms before transitioning to a special interview with allo mom Amanda, whose pregnancy began as a low titer pregnancy before taking a surprising turn. We meet Amanda in this episode before resuming the second half of her HDFN journey in this season’s final episode, Incredible HDFN Survival Stories.
Key aspects of low titer disease management:
- Determine baby’s antigen status if possible. If not possible, monitor as if antigen positive. If the baby is certainly antigen negative, the pregnancy proceeds as normal and there is no need to do anything further beyond standard pregnancy care
- Establish care with an MFM and determine up front if this MFM is able to do IUTs on your baby if your disease progresses. If not, have a referral plan set up
- Check titers every 4 weeks in the first and second trimester, then every 2 in the third trimester
- Weekly fetal assessment beginning at 32 weeks (Nonstress tests and biophysical profiles).
- Delivery at 37-38 weeks
- Follow all neonatal recommendations (establish a plan with pediatrician in advance if possible b/c they are likely to be doing the follow-up care) - bilirubin consistent with AAP guidelines which may include daily testing after discharge for a week or more, and hemoglobin/hematocrit weekly for the first six weeks and until hemoglobin/hematocrit increases or is in stable normal range for two consecutive weeks
Delivery timing 37-38 weeks: ACOG Medically Indicated Late Term and Early Preterm Deliveries. ACOG Early Delivery Guidlines
AAP guidelines for hyperbilirubinemia after birth: AAP on Hyperbilirubinemia
Undetectable antibodies progressing to severe disease: Dajak S, Stefanović V, Čapkun V. Severe hemolytic disease of fetus and newborn caused by red blood cell antibodies undetected at first‐trimester screening (CME). Transfusion. 2011 Jul;51(7):1380-8. Undetected Antibodies Research
Amanda’s video blog of her alloimmunized pregnancy journey: Amanda's Video Blog
Donate to AHF: https://allohopefoundation.org/get-involved/donate/
AHF Merch: https://allo-hope-foundation.myspreadshop.com/
Watch this episode on YouTube: https://youtu.be/AA9J1pHPNUA
Join the AHF patient support group:
https://www.facebook.com/groups/antibodiesinpregnancy