Immunoglobulins

Immunoglobulin solutions contain primarily immunoglobulin-G (IgG) antibodies, and are produced from pooled human plasma. The extent to which IgG antibodies pass through the placenta is dependent on the gestational age, the dosage, the length of treatment, and the kind of preparation given. However, Fab fragments do not pass (Miller et al. 2003). Immunoglobulins are used for different maternal or fetal indications - for example, in cases of antibody deficiency or infectious diseases (especially as a preventive measure), to improve the symptoms of some maternal autoimmune diseases, or to treat the symptoms of some fetal conditions (such as, for instance, heart block in the fetuses of mothers with lupus erythematosus).

Both immunoglobulins and hyperimmune sera against specific infections arc not, as far as we know today, cmbryotoxic (review in Briggs 2005).

Non-specific risks via human blood products, such as the transfer of virus infections and anaphylaxis, cannot be ruled out completely, and can indirectly endanger the fetus.

A study of 93 children whose mothers had been given - globulin prophylaxis against hepatitis during pregnancy on known gestational dates showed significant dermatoglyphic changes on the fingertips of the children exposed prenatally (Ross 1996). This effect, which can hardly be considered to be a birth defect, only occurred when "pglobulin had been administered in the first 163 days of pregnancy. This anecdotal report docs not modify the recommendation.

Recommendation. Immunoglobulins - standard ^-globulin and hyperimmune sera - may be used in pregnancy for appropriate indications.

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