PDF icon Download PDF
Open Access
CC BY 4.0 · Am J Perinatol
DOI: 10.1055/a-2558-7891
Original Article

Hemolytic Disease of the Fetus and Newborn in an Integrated Health Care System

Michael J. Fassett
1   Department of Obstetrics and Gynecology, Kaiser Permanente West Los Angeles Medical Center, Los Angeles, California
2   Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
,
Nehaa Khadka
3   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Fagen Xie 
3   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Jiaxiao Shi
3   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Vicki Y. Chiu
3   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Theresa M. Im
3   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Sunhea Kim
3   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Nana A. Mensah
3   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Daniella Park
3   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
,
Carol Mao
4   Janssen Global Services, LLC, Horsham, Pennsylvania
,
Matthew Molaei
4   Janssen Global Services, LLC, Horsham, Pennsylvania
,
Iris Lin
5   Janssen Scientific Affairs, LLC, Horsham, Pennsylvania
,
Darios Getahun 
3   Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
6   Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
› Author Affiliations
Funding This study was supported by Johnson & Johnson, PA.
› Further Information
Also available ateRefHebammen
  Permissions and Reprints
Preview

Abstract

Objective

Hemolytic disease of the fetus and newborn (HDFN) is associated with significant infant morbidity and mortality. Characteristics of pregnancies impacted by HDFN are not well understood. Therefore, this study examines maternal and infant characteristics based on HDFN status in a large, integrated health care system in the United States.

Study Design

This was a population-based, retrospective cohort study of 464,711 pregnancies that received care at Kaiser Permanente Southern California (KPSC) hospitals from January 2008 to June 2022. HDFN cases were ascertained using a validated algorithm of structured and unstructured data elements. HDFN due to ABO alloimmunization alone was excluded. Adjusted odds ratios (aORs) derived from logistic regression were used to describe the association between maternal and infant characteristics and HDFN diagnosis as well as adverse perinatal outcomes. For rare events, Firth's bias-reduced logistic regression was applied.

Results

A total of 136 HDFN pregnancies with 138 HDFN births (live births = 137; stillbirth = 1) were observed in the study. Of three twin pregnancies, all but one fetus had an HDFN diagnosis. HDFN diagnosis was associated with a maternal age of ≥35 years (aOR: 1.74; 95% confidence interval [CI]: 1.13–2.67), hypertension (2.07; 0.96–4.50), renal disease (3.43; 1.75–6.70), and multiparity (4.95; 2.73–8.95). Furthermore, HDFN diagnosis was associated with birth at 33 to 34 weeks (aOR: 5.72; 95% CI: 2.78–11.78) and 35 to 36 weeks (3.76; 2.38–5.94), and neonatal jaundice (3.11; 2.20–4.41). Birth weight ≥4,000 g was associated with lower HDFN diagnosis odds than normal weight (2,500–3,999 g; aOR: 0.36; 95% CI: 0.14–0.90). Hispanic race/ethnicity was associated with a lower HDFN diagnosis risk than non-Hispanic White (aOR: 0.63; 95% CI: 0.43–0.93).

Conclusion

This study identified clinical and demographic factors linked with HDFN diagnosis, including specific maternal characteristics, medical/obstetrical factors, and neonatal factors, within a large, integrated health care system that can help inform management plans.

Key Points

  • Characteristics of HDFN are not well understood.

  • This study examined HDFN characteristics in the United States.

  • HDFN risk is linked to medical/obstetric factors.

  • Increased risk of prematurity associated with HDFN.

Keywords

adverse perinatal outcomes - chronic maternal hypertension - HDFN - hemolytic disease - neonatal jaundice - obstetrical care - preterm birth

Authors' Contributions

M.J.F., D.G., and C.M.: Study concept and design.

D.G., V.Y.C., and F.X.: Acquisition of data.

M.J.F., N.K., and D.G.: Drafting of the manuscript.

D.G., J.M.S., V.Y.C., and N.K.: Statistical analysis.

D.G., T.M.I., S.K., and D.P.: Administrative, technical, and material support.

D.G. and M.J.F.: Study supervision.

All authors: Analysis and interpretation of data and critical revision of the manuscript for important intellectual content.


Supplementary Material



Publication History

Received: 23 December 2024

Accepted: 10 March 2025

Article published online:
17 April 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA