Immune Globulin Intravenous in Pregnancy and Breastfeeding
Fetal Risk Summary
Immune globulin IV (IGIV) is a solution of immunoglobulin, primarily immunoglobulin G (IgG), prepared from pooled plasma that, in contrast to the IM preparation, provides immediate serum concentrations of antibodies (1).
IgG administered IV was shown to cross the human placenta in significant amounts only if the gestational age was greater than 32 weeks (2). Placental transfer was also a function of dose, as well as gestational age. Four subclasses of IgG and two different antibodies in the preparation also crossed to the fetus in a similar manner (2). Others have found that the placental transfer of exogenous IgG is dependent on the dose and duration of treatment and, possibly, on the method of IgG preparation (3).
A 1988 review of IGIV summarized the clinical indications for the product in pregnancy (4). The indications included hypogammaglobulinemia such as common variable immunodeficiency, autoimmune diseases such as chronic immune thrombocytopenic purpura, and alloimmune disorders such as severe Rh-immunization disease and alloimmune thrombocytopenia. Recent reports have described the use of IGIV for the prevention of intracranial hemorrhage in fetal alloimmune thrombocytopenia (5, 6), recurrent abortions caused by antiphospholipid antibodies (7,8), neonatal congenital heart block caused by maternal antibodies to Ro (SS-A) and La (SS-B) autoantigens (9), and severe isoimmunization with either Rh or Kell antibodies (10). No adverse effects were observed in the fetus or newborns in any of the above reports, but caution has been advised in its use to prevent spontaneous abortion (11).
Breast Feeding Summary
No data are available.
- Product information. Gamimune N. Miles, Inc., 1993.
- Sidiropoulos D, Herrmann U Jr, Morell A, von Muralt G, Barandun S. Transplacental passage of intravenous immunoglobulin in the last trimester of pregnancy. J Pediatr 1986;109:5058.
- Smith CIE, Hammarstrm SL. Intravenous immunoglobulin in pregnancy. Obstet Gynecol 1985;66(Suppl):39S40S.
- Sacher RA, King JC. Intravenous gamma-globulin in pregnancy: a review. Obstet Gynecol Surv 1988;44:2534.
- Lynch L, Bussel JB, McFarland JG, Chitkara U, Berkowitz RL. Antenatal treatment of alloimmune thrombocytopenia. Obstet Gynecol 1992;80:6771.
- Wenstrom KD, Weiner CP, Williamson RA. Antenatal treatment of fetal alloimmune thrombocytopenia. Obstet Gynecol 1992;80:4335.
- Scott JR, Branch DW, Kochenour NK, Ward K. Intravenous immunoglobulin treatment of pregnant patients with recurrent pregnancy loss caused by antiphospholipid antibodies and Rh immunization. Am J Obstet Gynecol 1988;159:10556.
- Orvieto R, Achiron A, Ben-Rafael Z, Achiron R. Intravenous immunoglobulin treatment for recurrent abortions caused by antiphospholipid antibodies. Fertil Steril 1991;56:101320.
- Kaaja R, Julkunen H, mml P, Teppo A-M, Kurki P. Congenital heart block: successful prophylactic treatment with intravenous gamma globulin and corticosteroid therapy. Am J Obstet Gynecol 1991;165:13334.
- Chitkara U, Bussel J, Alvarez M, Lynch L, Meisel RL, Berkowitz RL. High-dose intravenous gamma globulin: does it have a role in the treatment of severe erythroblastosis fetalis? Obstet Gynecol 1990;76:7038.
Marzusch K, Tinneberg H, Mueller-Eckhardt G, Kaveri SV, Hinney B, Redman C. Is immunotherapy justified for recurrent spontaneous abortion? Lancet 1992;339:1543.
Questions and Answers
What is the drug category for Gamunex?, The full name for Gamunex is Immune Globulin Intravenous.
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
Definition: A nucleoside analog antiretroviral drug whose chemical structure constitutes a modified version of a natural nucleoside. These compounds suppress replication of retroviruses by interfering with the reverse transcriptase enzyme. The nucleoside analogs cause premature termination of the proviral (viral precursor) DNA chain. All NRTIs require phosphorylation in the host's cells prior to their incorporation into the viral DNA.