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    IV drug abuse linked to alloimmunization

    Women with a history of intravenous (IV) drug abuse appear to be at increased risk of having a pregnancy complicated by red cell alloimmunization, according to results of a recently published retrospective study. Appearing March 17, 2016, online in the American Journal of Obstetrics and Gynecology, the study’s findings are relevant and concerning considering that opioid addiction and heroin abuse are a growing epidemic in the United States, said lead author Justin Lappen, MD.

    “An association between intravenous drug abuse and alloimmunization has been previously described in published case reports and small case series. Our study, however, represents the first study to explore this issue in a large obstetric cohort using an appropriate comparison group,” said Dr. Lappen, Maternal Fetal Medicine Fellow and Assistant Professor, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.

    “Our research has some limitations relating to its relatively small sample size and retrospective design, and certainly further investigation is warranted to confirm our results. Nevertheless, we believe that our findings support intensified efforts towards establishing prenatal care early for women with a history of intravenous drug abuse and increasing screening for alloantibodies, whose presence has implications for hemolytic disease as well as transfusion medicine, both of which can impact maternal and neonatal outcomes”

    For the study information about alloimmunization and IV drug abuse among pregnant women was extracted from MetroHealth Medical Center’s blood bank, perinatal, and Mother and Child Dependency Program databases for the years 2008 to 2014. The analyses included 305 women with a history of IV drug abuse and 16,022 women without such a history. Relative to the control population, the IV drug abuse group had a two-fold higher relative risk of alloimmunization (3.6% vs 1.8%), which was statistically significant. The women who were IV drug abusers were also significantly more likely to be Rh-negative than the control group (45.5% vs 9.4%; P = .003) and to have antibodies against Rh group antigens (72.7% vs 29.2%; P = .004). Other analyses identified trends for the IV drug abusers to more often have multiple alloantibodies (27.2% vs 8.0%; P = .06), a critical titer (50.0% vs 19.2%; P = .06), and a newborn infant with hemolytic disease (25% vs 6.7%; P = .012). Inadequate study power may explain failure to achieve a statistically significant difference between groups in those outcomes, said Dr. Lappen.



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