Should cell-free DNA testing be used to target antenatal rhesus immune globulin administration?

Kimberly K. Ma, Maria I. Rodriguez, Yvonne W. Cheng, Mary E. Norton, Aaron B. Caughey

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Objective: To compare the rates of alloimmunization with the use of cell-free DNA (cfDNA) screening to target antenatal rhesus immune globulin (RhIG) prenatally, versus routine administration of RhIG in rhesus D (RhD)-negative pregnant women in a theoretic cohort using a decision-analytic model. Methods: A decision-analytic model compared cfDNA testing to routine antenatal RhIG administration. The primary outcome was maternal sensitization to RhD antigen. Sensitivity and specificity of cfDNA testing were assumed to be 99.8% and 95.3%, respectively. Univariate and bivariate sensitivity analyses, Monte Carlo simulation, and threshold analyses were performed. Results: In a cohort of 10 000 RhD-negative women, 22.6 sensitizations would occur with utilization of cfDNA, while 20 sensitizations would occur with routine RhIG. Only when the sensitivity of the cfDNA test reached 100%, the rate of sensitization was equal for both cfDNA and RhIG. Otherwise, routine RhIG minimized the rate of sensitization, especially given RhIG is readily available in the United States. Conclusions: Adoption of cfDNA testing would result in a 13.0% increase in sensitization among RhD-negative women in a theoretical cohort taking into account the ethnic diversity of the United States population.

Original languageEnglish (US)
Pages (from-to)1866-1870
Number of pages5
JournalJournal of Maternal-Fetal and Neonatal Medicine
Volume29
Issue number11
DOIs
StatePublished - Jun 2 2016

Keywords

  • Cell-free DNA
  • Rh alloimmunization
  • RhIG

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

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