Abstract
OBJECTIVES: This study sought to quantify the magnitude of Rh disease reduction occurring secondary to Rh prophylaxis and other determinants. METHODS: Outcomes considered included maternal Rh sensitization, neonatal Rh disease, and perinatal deaths from Rh disease. Analysis was based on Poisson regression modeling of ecological data from Manitoba, Canada, and conditional probability modeling. RESULTS: The ecological analysis showed that changes in birth order and Rh prophylaxis resulted in 24% (95% confidence interval [CI] = 1% 42%) and 69% (95% CI = 61%, 76%) decreases, respectively, in Rh sensitizations (D and non-D) in Manitoba between 1963 and 1988. Rh prophylaxis and nonprogram factors were responsible for 83% (95% CI = 44%, 95%) and 78% (95% CI = 42%, 91%), respectively, of the reduction in perinatal deaths from Rh disease. Similar results were obtained with conditional probability modeling, which also provided estimates for the effects of changes in abortion rates and racial composition. CONCLUSIONS: In addition to Rh prophylaxis, changes in other determinants were responsible for an important fraction of the decline in Rh disease. These results provide a historical perspective on the conquest of Rh disease and also have important implications for public health policy, particularly in developing countries.
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Selected References
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- Adams M. M., Marks J. S., Koplan J. P. Cost implications of routine antenatal administration of Rh immune globulin. Am J Obstet Gynecol. 1984 Jul 15;149(6):633–638. doi: 10.1016/0002-9378(84)90248-5. [DOI] [PubMed] [Google Scholar]
- Ascari W. Q., Levine P., Pollack W. Incidence of maternal Rh immunization by ABO compatible and incompatible pregnancies. Br Med J. 1969 Feb 15;1(5641):399–401. doi: 10.1136/bmj.1.5641.399. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bowman J. M., Chown B., Lewis M., Pollock J. Rh isoimmunization, Manitoba, 1963-75. Can Med Assoc J. 1977 Feb 5;116(3):282–284. [PMC free article] [PubMed] [Google Scholar]
- Critchfield G. C., Willard K. E. Probabilistic analysis of decision trees using Monte Carlo simulation. Med Decis Making. 1986 Apr-Jun;6(2):85–92. doi: 10.1177/0272989X8600600205. [DOI] [PubMed] [Google Scholar]
- Doubilet P., Begg C. B., Weinstein M. C., Braun P., McNeil B. J. Probabilistic sensitivity analysis using Monte Carlo simulation. A practical approach. Med Decis Making. 1985 Summer;5(2):157–177. doi: 10.1177/0272989X8500500205. [DOI] [PubMed] [Google Scholar]
- Eklund J., Nevanlinna H. R. Rh prevention: a report and analysis of a national programme. J Med Genet. 1973 Mar;10(1):1–7. doi: 10.1136/jmg.10.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Joseph K. S. Controlling Rh haemolytic disease of the newborn in India. Br J Obstet Gynaecol. 1991 Apr;98(4):369–377. doi: 10.1111/j.1471-0528.1991.tb13427.x. [DOI] [PubMed] [Google Scholar]
- Knox E. G. Control of haemolytic disease of the newborn. Br J Prev Soc Med. 1976 Sep;30(3):163–169. doi: 10.1136/jech.30.3.163. [DOI] [PMC free article] [PubMed] [Google Scholar]
- LEWIS M., CHOWN B., PETERSON R. F. On the Kell-Cellano (K-k) blood group: the distribution of its genes in the white population of Manitoba. Am J Phys Anthropol. 1955 Jun;13(2):323–330. doi: 10.1002/ajpa.1330130210. [DOI] [PubMed] [Google Scholar]
- Lucciola L. The blood groups and red cell enzymes of a sample of Cree Indians. Can J Genet Cytol. 1974 Sep;16(3):691–695. doi: 10.1139/g74-075. [DOI] [PubMed] [Google Scholar]
- MURRAY S., KNOX E. G., WALKER W. RHESUS HAEMOLYTIC DISEASE OF THE NEWBORN AND THE ABO GROUPS. Vox Sang. 1965 Jan-Feb;10:6–31. doi: 10.1111/j.1423-0410.1965.tb04316.x. [DOI] [PubMed] [Google Scholar]
- Morgenstern H. Uses of ecologic analysis in epidemiologic research. Am J Public Health. 1982 Dec;72(12):1336–1344. doi: 10.2105/ajph.72.12.1336. [DOI] [PMC free article] [PubMed] [Google Scholar]