Yesterday the BBC produced an article on a new test just to get on my wick. I have lots of issues with blanket policy of any kind.

There are two things unclear in this article:

1. How do they get the DNA of the baby? I couldn’t work it out.
2. It’s not a perfect test and you get an occasional false negative, so the question is can you justify not treating all women. Looks like they would want to keep treating women anyway. Totally pointless because we will have to give you the stuff anyway.

So is antenatal anti D anything more than an arse covering big pharmaceutical conspiracy?

I myself am O-neg but wasn’t even offered anti D in the antenatal period. Is that because nobody had realised the money making potential of approx 15% of the population succoming to at least 2 injections during their pregnancy? 40% of who’s baby will be neg and didn’t even need to entertain the thought of it let alone try and make a sound decision after the baby is born.

One of the main arguments for the routine giving of anti D antenatally was that the majority of isoimmunised infants were due to failure in recognising an antenatal event, from threatened miscarriage to abdominal trauma. It seems terrible to introduce a blanket practice of a potentially harmful product when giving it if really necessary would actually solve the issue. Or at least offering the woman the choice.

There have been numerous studies which have been for and against and even the cochrane database (good solid obstetric research base) says:

Women whose blood group is Rh-negative sometimes form Rh-antibodies when carrying a Rh-positive baby. This is more likely during birth, but occasionally happens in late pregnancy. It can cause anaemia, and sometimes death, for a Rh-positive baby in a subsequent pregnancy. Giving the mother anti-D after the first birth does reduce the problems, but giving anti-D during pregnancy is likely to help as well, although more research is required to confirm these possible benefits and identify possible harms.

If they are suggesting more research there must be a potential harm.

It’s a human blood product for a start. So there is a big problem with getting the anti D especially with the extra needed over the last few years to support the antenatal demand. ( see the drug companies rubbing hands together with glee)

I can’t really find any significant research on the affect of anti D on the newborn but there has been many calls for caution. Gaskin (1989) shows several factors indicating potential risks, to newborn girls and their later fertility and to immune system problems.

And the fantastic Sara Wickham says that augmentation, or enhanced anti D immunisations where a woman who is given passive anti D antenatally could if exposed to a fetomaternal bleed have an immune response.

So rather than accepting routine administration of antenatal anti D midwives and women alike need to look at the facts, check the research and decide whether they are even in the risk category before jumping in blindly to an unresearched intervention.

Postnatal Anti D

This seems almost a whole other debate to me as being a negative group myself I initially stepped up to the mark after finding I had a postive baby without a second thought.

I could try and explain all the reasons to look more closely and think about the real risks involved but Sara Wickham’s book Anti D paradox or panacea is a must for rhesus neg women and is by far the the most pragmatic on this subject says it so much better.

The results of the trials showed that, on a population basis, anti-D was effective in preventing rhesus isoimmunisation. However, a closer look at the data shows that anti-D may not be necessary for all women: between 1.96% (3/153)and 13.39% (15/112) of women in the control groups were isoimmunised at 6 months postpartum. Overall, the average rate of isoimmunisation of women in the control groups was 7.5%, which implies that around 90% of woman may not need
anti-D.

Her conclusion that Anti D needs further investigatation even though it is effective is a must read.

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