prenatal rhogam injection

[newbie716]

I am O- and struggling to decide whether to take the prenatal rhogam. DH is being tested this week for his blood type. I have seen a lot of differing opinions (mostly on the internet) and am looking for current info on the topic.

It is my understanding that thimerosal was taken out in 2001 and that the current injections on the market are thimerosal free. any reason to believe this is inaccurate?

I have seen on numerous sites that while RH- mothers constitute roughly 15% of the ppopulation they account for over half of mother of children of autism. However, I have not seen anywhere where this statistic comes from. Is this accurate? Also, does it take into account the removal of thimerosal?

As I understand it Rhogam injects a limited number of IGG antibodies into your blood stream so that your body does not produce much larger immune response in the event that there is blood mixing between the mother and child. Is there any evidence that the level of IGG antibodies from the rhogam can cause harm to the fetus?

I am a first time mother and am obviously very torn on this issue as I do plan to have more children. The risks of not taking the prenatal rhogam are frightening but I am also very concerned about unknown risks from the shot.

Any help is much much appreciated!

[laurendecorrea]

re: prenatal rogham injection

Hi there,
I ran across your posting and wanted to reply. My blood type is A-. During my pregnancy I received prenatal care from a homebirth midwife. When I was in my last trimester she tested my blood for the presence of antibodies and found none, so I did not have to get a prenatal Rogham injection. I did receive an injection after dd's birth.

I haven't come across any statistics like the ones you mentioned, but if you're concerned and your provider feels it's important to receive an injection without testing your blood for antibodies, I would do some more research!

Hope this helps.

[amnesiac]

Moving since this isn't vaccine related.

[is it puppies?]

I found quite a bit of info on the forums here, if you search it you will find some good stuff.
I am also O- and will not plan on getting the shot, but MAY consider after the birth depending on baby's rh.

[Cetan Luta]

I am also O- with an O+ husband. With my first child I had the prenatal Rhogam shot, and did not need one after birth because of my baby's blood type. With my second child, I chose to not recieve the prenatal shot, but did get one after birth since baby was RH+. There has been no noticeable difference between the two kids as far as effects of timing of the shots. The prenatal shot is not usually neccessary unless you have reason to think your blood may have mixed (car accidents, bad falls, etc.), and can be administered soon afterward if you do have some kind of accident. I am otherwise totally against shots/vax if at all avoidable, but I would DEFINATELY get the post partum one if your baby's blood type requires it. If you don't, the chances of miscarrying all future RH+ babies is pretty high, so why risk it. I hope this helps.

[AustinMom]

I am O- as well and hubby is B+ I didn't get the Rhogam prenatally, but baby was B+ so I did after birth.

The reason they give you the shot prenatally is if you, by some strange instance get injured and the baby's blood mixes with yours, it MAY cause a problem with the next pregnancy if the next baby is + blood type.

I would not get the shot, but if you are in a really really bad accident, or have a situation where the blood may have mixed, you have 72 to get the shot.

[is it puppies?]

One point that I am considering, the chances even without having the shot of developing antibodies isn't actually all that huge, especially if you have a baby who is a different blood type from you. It is only something like a 2% chance if the baby is A+ or B+ type to your O (vs. approx 1% if you get the shot) and apparently it's about 12% if the baby is O+ (vs approx 1% if you get the shot). If the baby is anything with neg RH you have 0 chance of developing antibodies anyways and if there's no blood mixing (which is fairly unlikely other than accidents or traumatic birth) there's pretty much 0 chance. What mostly concerns me about the shot is that it is a blood product made from many different people and has transmitted disease in the past. It has also never been proven safe during pregnancy, and they don't give it prenatally in most countries. There are also instances of the shot not helping at all. Of course, it's always a risk not to take it, but there's also a risk to take it (albeit a smaller one).

[Belle]

I'm O- and my dh is O+.

For my first I got the prenatal Rhogam because I was seeing an OB and didn't question the routine as much. I didn't need it after the birth because Dd1 was also O-.

For my second I questioned it a bit more. I saw HB midwives so they didn't give me any guff about declining it. I would have gotten the postpartum one if Dd2 was positive. My reasoning for declining it was that the difference in risk of being sensitized from just getting the postpartum one and declining the prenatal was neglegible. If I'd had some sort of prenatal trauma or bleeding episodes I'd have gotten the prenatal one.

[japonica]

If you don't, the chances of miscarrying all future RH+ babies is pretty high, so why risk it. I hope this helps.

I'm not convinced there's a higher m/c rate. I know lots of sensitized women who go on to deliver their babies near term (or as close as the peris can get them). Likewise, both of my sensitized pregnancies did not end in m/c. The issue is more of dealing with hydrops and HDN than m/c. And if the antibodies are going to affect the baby, it's generally more likely after the placenta is fully formed...

[japonica]

Originally Posted by is it puppies?

One point that I am considering, the chances even without having the shot of developing antibodies isn't actually all that huge, especially if you have a baby who is a different blood type from you. It is only something like a 2% chance if the baby is A+ or B+ type to your O (vs. approx 1% if you get the shot) and apparently it's about 12% if the baby is O+ (vs approx 1% if you get the shot). If the baby is anything with neg RH you have 0 chance of developing antibodies anyways and if there's no blood mixing (which is fairly unlikely other than accidents or traumatic birth) there's pretty much 0 chance. What mostly concerns me about the shot is that it is a blood product made from many different people and has transmitted disease in the past. It has also never been proven safe during pregnancy, and they don't give it prenatally in most countries. There are also instances of the shot not helping at all. Of course, it's always a risk not to take it, but there's also a risk to take it (albeit a smaller one).

I still think this is fascinating and my own experience corroborates this (I'm O-)--pg with a O+ fetus and my antibody titers rose throughout the pg, yet pg with a B+ fetus and the titers flatlined and stay constant. Too bad I'm still not seeing any peris, I'd love to talk to them about it. I posted this ABO/Rh phenomenon on the iso moms' board and no one commented on it.

[Lauren31]

I would not get the shot again. I felt almost bullied into it by my German OB. I just moved here, do not speak German, and he looked at me like I was crazy for declining it. Then my husband was like, just do it there is no thimeresol in it which we specifically asked about. The German OB seemed pretty confident in the shot and I know they do things more naturally here and all that but still... I think I might have refused it unless I had trauma. This baby is WILD though and is always kicking, punching, etc so who knows, maybe it's a good thing to get it prenatally. :

[hapersmion]

I haven't seen any reason to doubt that the thimerosal is really out of the shots. Even the doses that had it would have expired by now.

I had never heard the autism thing - like you, I'd really want to see a study before I'd worry too much. My immediate assumption would be that it was based on studies from back when there was thimerosal, if it was based on anything.

I do know my son is anything but autistic, and I ended up getting two prenatal doses of rhogam with him (in 2005/6), one routine and one for an external version. *shrug* That doesn't really mean anything statistics-wise, of course.

There is no evidence that the antibodies can harm the baby - there's no evidence that they don't. There just aren't any good studies out there, so there's really no info, sadly.

There are a couple of tests you might be able to have done, if you can track down someone who will do them for you. (I had no luck with this, grr.) One is the Kleihauer-Betke test, which can detect fetal blood cells in your bloodstream, and thus let you know you DO need the shot if there's been blood mixing. Also, if it detects a really big amount of blood cells, you might need more than the standard Rhogam dose. Sadly, the test can miss tiny bleeds, so a negative result isn't a guarantee that you're safe.

The other test is new - it detects fetal DNA in your bloodstream and can determine if the baby is rh-positive or -negative. http://www.lenetix.com/html/rhd___sry_genotyping.html

I had a lot of trouble with this decision too, this pregnancy. In the end, I decided to get the shot again, but only by a narrow margin. My midwife doesn't even give it routinely. I think both decisions are viable, and whatever you decide, odds are you and your baby will be just fine.

[Lauren31]

Originally Posted by hapersmion

I haven't seen any reason to doubt that the thimerosal is really out of the shots. Even the doses that had it would have expired by now.

I had never heard the autism thing - like you, I'd really want to see a study before I'd worry too much. My immediate assumption would be that it was based on studies from back when there was thimerosal, if it was based on anything.

The studies are definitely outdated and the rhogam is very different now then prior to 2001. I think people will blame ANYTHING on causing Autism. I really think it is a genetic disease that has some environmental factors. If you are not comfortable taking the shot do not take it prenatally unless you HAVE to, ie bleeding, amnio, etc. I would still type the baby and take it afterwards if it's a positive baby.

Had I stood up for myself a bit more I would have done this. It is interesting that my doctor was ADAMANT that I not take the H1n1 or Flu vaccine but he said I DEFINITELY should take the Rhogam. Germans are definitely not vaccine happy so it swayed me more then I think it would have had it been my OB in the US.

[is it puppies?]

There are studies published in I think The Journal of Autism and Developmental Disorders that concluded there was a much higher prevalence of autism in children whose mother's were RH negative. I honestly don't know when the studies were from, and I can't find a link now, but it was poking around on the forums here. I also don't know if it concluded what the prevalence was from but I believe that the thoughts were either from the shot or simply due to something related to the blood type. There is just so much that is still unknown about the shot and I think that many mothers would rather only have it if necessary and at proper doses (which may be more or less I guess depending on the situation) just like with any drug or herb that may have effects on the baby or pregnancy.
In my "research" I have also never found anything stating that there was a higher likelihood of miscarriage with RH incompatible couples or mothers who have antibodies (I don't think a fetus even has a detectable RH status until something like 10 weeks), but once I did find a study pointing to a higher infertility rate amongst couples who were ABO incompatible (where there are no other known factors).

[jsh7809]

I don't know if this will reassure you as it does me, but the Rhogam shot has been around and I think very standard/ safe (with the exception of risk of AIDS in the 80s) since 1968. My mom got it with all 3 of her children, we are all very healthy, but I understand the concern.

[jsh7809]

Also, I found this article (written by a mom who didn't get the prenatal Rhogam shot) very informative and helpful, even though I think I will still get it. I highly recommend reading it:
http://www.vegfamily.com/vegan-pregn...tal-rhogam.htm

[newbie716]

thanks for all of the replies/info so far. it is really a tough decision and there is so much conflicting information out there!