{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T21:20:05Z","timestamp":1791494405001,"version":"4.3.4"},"reference-count":19,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,5,21]],"date-time":"2024-05-21T00:00:00Z","timestamp":1716249600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012023","name":"Stichting Sanquin Bloedvoorziening","doi-asserted-by":"publisher","award":["L2181"],"award-info":[{"award-number":["L2181"]}],"id":[{"id":"10.13039\/501100012023","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vox Sanguinis"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Objectives<\/jats:title><jats:p>To evaluate the severity of haemolytic disease of the foetus and newborn (HDFN) in subsequent pregnancies with RhD immunization and to identify predictive factors for severe disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>Nationwide prospective cohort study, including all pregnant women with RhD antibodies. All women with at least two pregnancies with RhD antibodies and RhD\u2010positive foetuses were selected. The main outcome measure was the severity of HDFN in the first and subsequent pregnancy at risk. A subgroup analysis was performed for the group of women where RhD antibodies developed after giving birth to an RhD\u2010positive child and thus after receiving anti\u2010D at least twice (group A) or during the first pregnancy at risk for immunization (group B).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty\u2010two RhD immunized women with a total of 150 RhD\u2010positive children were included. The severity of HDFN increased for the whole group significantly in the subsequent pregnancy (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), although it remained equal or even decreased in 44% of women. When antibodies were already detected at first trimester screening in the first immunized pregnancy, after giving birth to an RhD\u2010positive child (group A), severe HDFN in the next pregnancy was uncommon (22%). Especially when no therapy or only non\u2010intensive phototherapy was indicated during the first immunized pregnancy (6%) or if the antibody\u2010dependent cell\u2010mediated cytotoxicity result remained &lt;10%. Contrarily, women with a negative first trimester screening and RhD antibodies detected later during the first pregnancy of an RhD\u2010positive child (group B), often before they had ever received anti\u2010D prophylaxis, were most prone for severe disease in a subsequent pregnancy (48%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>RhD\u2010mediated HDFN in a subsequent pregnancy is generally more severe than in the first pregnancy at risk and can be estimated using moment of antibody detection and severity in the first immunized pregnancy. Women developing antibodies in their first pregnancy of an RhD\u2010positive child are at highest risk of severe disease in the next pregnancy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/vox.13651","type":"journal-article","created":{"date-parts":[[2024,5,22]],"date-time":"2024-05-22T02:40:19Z","timestamp":1716345619000},"page":"859-866","source":"Crossref","is-referenced-by-count":13,"title":["Disease severity in subsequent pregnancies with <scp>RhD<\/scp> immunization: A nationwide cohort"],"prefix":"10.1111","volume":"119","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5844-6142","authenticated-orcid":false,"given":"Carolien","family":"Zwiers","sequence":"first","affiliation":[{"name":"Department of Obstetrics Leiden University Medical Center  Leiden the Netherlands"},{"name":"Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center University of Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8209-7237","authenticated-orcid":false,"given":"Yolentha M.","family":"Slootweg","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Leiden University Medical Center  Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joke M.","family":"Koelewijn","sequence":"additional","affiliation":[{"name":"Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center University of Amsterdam  Amsterdam the Netherlands"},{"name":"Department of Immunohematology Sanquin Diagnostic Services  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C.","family":"Ligthart","sequence":"additional","affiliation":[{"name":"Department of Immunohematology Sanquin Diagnostic Services  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9095-2475","authenticated-orcid":false,"given":"Johanna G.","family":"van der Bom","sequence":"additional","affiliation":[{"name":"Center for Clinical Transfusion Research, Sanquin Research  Leiden the Netherlands"},{"name":"Department of Clinical Epidemiology Leiden University Medical Center  Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inge L.","family":"van Kamp","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Leiden University Medical Center  Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3513-5066","authenticated-orcid":false,"given":"Enrico","family":"Lopriore","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Leiden University Medical Center  Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8065-3540","authenticated-orcid":false,"given":"C. Ellen","family":"van der Schoot","sequence":"additional","affiliation":[{"name":"Department of Experimental Immunohematology, Sanquin Research and Landsteiner Laboratory, Academic Medical Center University of Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dick","family":"Oepkes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Leiden University Medical Center  Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7044-0525","authenticated-orcid":false,"given":"Masja","family":"de Haas","sequence":"additional","affiliation":[{"name":"Department of Immunohematology Sanquin Diagnostic Services  Amsterdam the Netherlands"},{"name":"Department of Hematology Leiden University Medical Center  Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,5,21]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.5355"},{"key":"e_1_2_9_3_1","unstructured":"Centraal Begeleidings Orgaan.Richtlijn Bloedtransfusie.2011. 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Last accessed April 2024."},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1423-0410.1984.tb00093.x"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1067\/mob.2001.112970"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.17118"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12193"},{"key":"e_1_2_9_14_1","first-page":"410","article-title":"The importance of antenatal prevention of RhD immunisation in the first pregnancy","volume":"12","author":"Dajak S","year":"2014","journal-title":"Blood Transfus"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/trf.12624"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2004-04-1554"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-05-716365"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.1999.tb08304.x"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.14438"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.12965"}],"container-title":["Vox Sanguinis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/vox.13651","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,13]],"date-time":"2024-08-13T08:50:49Z","timestamp":1723539049000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/vox.13651"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,21]]},"references-count":19,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2024,8]]}},"alternative-id":["10.1111\/vox.13651"],"URL":"https:\/\/doi.org\/10.1111\/vox.13651","archive":["Portico"],"relation":{},"ISSN":["0042-9007","1423-0410"],"issn-type":[{"value":"0042-9007","type":"print"},{"value":"1423-0410","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,21]]}}}