ANTENATAL INTRAVENOUS IMMUNOGLOBULIN TREATMENT FOR GESTATIONAL ALLOIMMUNE LIVER DISEASE: A SYSTEMATIC REVIEW

Objectives Gestational alloimmune liver disease (GALD) is one of the most common causes of neonatal liver failure, associated with high mortality and morbidity. Antenatal intravenous immunoglobulin (IVIG) has become a promising treatment option. The objective of this study is to evaluate the efficacy of antenatal IVIG therapy for GALD in reducing perinatal and neonatal morbidity and mortality. Methods Electronic databases (MEDLINE, Scopus, PROSPERO, Cochrane, CINAHL) were searched from inception until January 1, 2017 with the terms: "gestational alloimmune liver disease", "neonatal hemochromatosis", and "treatment or therapy or intervention." Outcomes were perinatal and neonatal mortality, liver transplantation, and iatrogenic preterm delivery. Results Sixteen studies were included with n=73 matched pregnancies. Out of the 73 pregnancies treated with antenatal IVIG all of them had live births, surviving to discharge. Among control pregnancies all but 6 resulted in neonatal death (55/73) or intrauterine fetal demise (12/73). Of live births 10/67 liver transplants were reported of which 3 survived to discharge. None of the infants from treatment pregnancies required liver transplants. Gestational age of treatment pregnancies was 37.2 ± 2.3 weeks, only 11/73 control pregnancies reported gestational age. Conclusions Antenatal IVIG treatment significantly reduces perinatal and neonatal mortality in GALD and should be offered to all women with previously affected child(ren).