Optimizing RhD Immune Globulin Use in Pregnancy

The global shortage of RhD immune globulin, formally acknowledged by the Food and Drug Administration in 2023, is ongoing but has improved in recent months. This shortage prompted the need to re-evaluate prevention strategies for hemolytic disease of the fetus and newborn (HDFN) due to RhD incompatibility. In response, the American College of Obstetricians and Gynecologists (ACOG) issued guidance in March 2024 on alternative strategies to conserve RhD immune globulin supplies. These strategies include targeted RhD immune globulin administration based on non-invasive fetal RhD genotyping, alternatives options to Rhogam, and selective withholding of Rh immune globulin in cases of pregnancy loss under 12 weeks’ gestation. ACOG guidance on the administration of Rh immune globulin in pregnancy differs from many countries worldwide, as well as the World Health Organization and the American Society of Family Planning. This clinical opinion reviews the risks, benefits, and cost-effectiveness of different strategies to optimize RhD immune globulin use. Targeted administration and the use of non-invasive cell-free DNA (cfDNA) testing for fetal RhD status have shown promising accuracy and reliability in studies across multiple countries, leading to reduced unnecessary prophylaxis and potential cost savings. Additionally, withholding RhD immune globulin in select early pregnancy losses could further conserve resources without increasing alloimmunization risk. This review underscores the need for evidence-based approaches to manage limited RhD immune globulin supplies effectively and suggests that targeted prophylaxis could benefit both patient outcomes and healthcare resource allocation in the face of global shortages.

Publication History

Received: 18 November 2024

Accepted after revision: 03 March 2025

Accepted Manuscript online:
04 March 2025