Pregnant women's knowledge and clinical management of hemolytic disease of the fetus and newborn in Pará, Brazil

Silva, Jhemily de Nazaré Gonçalves e; Souza, Andrya Maia de; Rosario, Fabiane Monteiro do; Pinto, Laine Celestino

doi:10.1016/j.htct.2024.03.007

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Original article • Hematol., Transfus. Cell Ther. 46 (Suppl 2) • 2024 • https://doi.org/10.1016/j.htct.2024.03.007 linkcopy

Pregnant women's knowledge and clinical management of hemolytic disease of the fetus and newborn in Pará, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective To evaluate the knowledge of pregnant women and the clinical management of hemolytic disease of the fetus and newborn, as well as to describe the gestational profile, risk factors and socio-epidemiological profile of pregnant women treated at two municipal health units in Belém (Pará, Brazil).

Methods This was a cross-sectional analytical study, which consisted in the application of questionnaires to pregnant women who underwent prenatal care at the municipal health units.

Results A total of 104 pregnant women were evaluated; most were aged between 24 and 29 years old, had high school degrees (38 %), family incomes between 1 and 2 minimum wages (45 %) and blood type O+ (43 %). Regarding the gestational profile, the participants were predominantly in the third trimester of pregnancy (49 %), started prenatal care in the first gestational trimester (81 %) and were primiparous (61 %). Failures in the management of prenatal care were observed, especially with regard to access to information about the disease, since most pregnant women did not receive information about blood incompatibility during prenatal care. This led to limited knowledge about the pathology of the disease evidenced by the fact that most of the correct answers were between Questions 0-4, which were significantly associated with the women's education and income.

Conclusions Although hemolytic disease of the fetus and newborn is serious, the pregnant women in this study demonstrated little knowledge about the disease and had inadequate care by health professionals, reinforcing the importance of improving care for women's health and prenatal care.

Keywords
Hemolytic disease of the fetus and newborn; Erythroblastosis fetalis; Incompatibility; Pregnant women

Variable	n	%
Socio-epidemiological
Age group
<18 years old	3	3
18-23 years old	27	26
24-29 years old	32	31
30-35 years old	25	24
>36 years old	17	16
Level of education
Incomplete and complete primary education	5	5
Incomplete high school education	11	11
Complete high school education	40	38
Incomplete higher education	15	14
Complete higher education	33	32
Family income
<1 minimum wage	34	33
Between 1 and 2 minimum wages	47	45
>2 minimum wages	23	22
Gestational profile
Gestational age
First trimester (1-12 weeks)	15	14
Second trimester (13-26 weeks)	38	37
Third trimester (27-40 weeks)	51	49
Start of prenatal care
First trimester (1-12 weeks)	84	81
Second trimester (13-26 weeks)	19	18
Third trimester (27-40 weeks)	1	1
Number of pregnancies
Primiparous	63	61
Multiparous	41	39
Risk factors related to HDFN
Pregnant woman's blood type
A+	25	24
B+	11	11
AB+	3	3
O+	45	43
O-	4	4
Do not know	16	15
Biological father's blood type
A+	13	12
B+	4	4
AB+	1	1
O+	27	26
B-	2	2
O-	4	4
Do not know	53	51
Have you ever had a blood transfusion?
Yes	14	13
No	90	87
Clinical management of HDFN
Have you received information about blood incompatibility during pregnancy?
Yes	14	13
No	90	87
Did you perform blood typing during pregnancy?
Yes	80	77
No	23	22
Do not know	1	1
Did you perform antibody screening?
Yes	1	1
No	6	6
Do not know	97	93
Did you receive anti-D vaccine in previous pregnancies?
Yes	2	2
No	39	37
Do not know	63	61
When did you receive vaccine?
During pregnancy	-	-
After pregnancy	2	2
Not applicable	101	97
Do not know	1	1

Questions	n	%
Have you read/heard any information about HDFN (regardless of prenatal care)?
Yes	28	27
No	76	73
Is the disease related to incompatibility?
Yes	57	55
No	13	12
I don't know	34	33
Can the newborn have a different blood type from the mother?
Yes	55	53
No	35	34
I don't know	14	13
Do you know what the anti-D vaccine is for?
Yes	13	12
No	91	88
If the newborn is negative, will he need the anti-D vaccine?
Yes	50	48
No	16	15
I do not know	38	37
Should the mother and newborn receive the vaccine?
Yes	66	64
No	19	18
I do not know	19	18
If the newborn is Rh negative, can the disease occur regardless of the mother's blood type?
Yes	25	24
No	29	28
I do not know	50	48
Can pregnant women with negative blood type develop the disease?
Yes	43	41
No	11	11
I do not know	50	48

Variable	0-4 correct answers Total=91		5-8 correct answers Total = 13
	n	%	n	%
Level of education a
Elementary School education	5	6	-	-
Incomplete high school education	11	12	-	-
Complete high school education	37	41	3	23
Incomplete higher education	14	15	1	8
Complete higher education	24	26	9	69
Family income b
<1 minimum wage	33	36	1	8
Between 1 and 2 minimum wages	45	50	2	15
>2 minimum wages	13	14	10	77
Age group c
<18 years	3	3	-	-
18-23 years	25	28	2	15
24-29 years	27	30	5	39
30-35 years	22	24	3	23
>36 years	14	15	3	23
Gestational age d
First trimester (1-12 weeks)	15	17	-	-
Second trimester (13-26 weeks)	34	37	4	31
Third trimester (27-40 weeks)	42	46	9	69
Number of pregnancies e
Primiparous	53	58	8	62
Multiparous	38	42	5	38

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Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH) R. Dr. Diogo de Faria, 775 cj 133, 04037-002, São Paulo / SP - Brasil - São Paulo - SP - Brazil
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[TFN1] ^a
p-value = 0.0456.

[TFN2] ^b
p-value≤0.0001.

[TFN3] ^c
p-value = 0.7596.

[TFN4] ^d
p-value = 0.0855 by G test.

[TFN5] ^e
p-value = 0.9400 by chi-square test.