Maternal Titers Research Articles

Thyroid antibodies during pregnancy and in the newborn.

Twenty-two women, found to have circulating antithyroid antibody (AAB) either before or during pregnancy, were observed during 23 pregnancies. The maternal AAB titers began to fall as early as the first trimester, tended to strike a plateau at a low level in the third trimester, and rose again during the first few months after the termination of pregnancy. These antibodies were demonstrated in the cord blood of 8 newborn infants of 9 mothers who had demonstrable circulating AAB at the time of delivery, but could not be demonstrated in the cord blood of 7 newborn infants of mothers whose AAB titers had fallen to zero by the time of delivery. AAB disappeared from the blood of all infants during the first 3 months of life. No clinical evidence of hypothyroidism was found in the living off spring at birth or at the time of follow-up examination for as long as 2 years after birth. The levels of serum protein-bound iodine at birth in 6 newborn infants with proved transplacental transfer of AAB, and later in 4 o...

The selection of antibodies by the gut of the young rat

The young of mother rats which had been immunized against Salmonella pullorum absorbed relatively much less antibody when they suckled during the period shortly after the initial immunization than during the period of hyperimmunity. After hyperimmunization against Brucella abortus both the maternal serum titres attained and the amounts of antibody reaching the young were similar to those of rats given a single immunizing injection of Salmonella pullorum. Antibodies from hyperimmune anti-SaZm. pullorum sera produced in a number of species of rodents and in rabbits, and from hyperimmune anti-Brucella abortus sera produced in rats, guinea-pigs and rabbits, when fed to young rats, were absorbed in amounts which were independent of the species in which the antisera were produced but related to the antigen used. The gut of the young rat was therefore showing a selection between antibodies produced in the same animal to the same antigen, the donor differing only in serum titre and length of the immunization period; and between antibodies produced in the same species to different antigens. The fractionation of antisera and titration of the fractions produced evidence that this selection of antibodies is related to their location in the serum proteins.

Studies on the Development of Natural Immunity to Poliomyelitis in Louisiana

Summary Maternal, umbilical cord, and serially-collected infant blood samples, were available incidental to the “Louisiana Study” of natural infection with polioviruses. By means of the simultaneous titration of series of these specimens, the passive transfer of circulating maternal antibody to the infant and the decline in the infant of the maternally-derived antibody were investigated by the neutralization test. Sixty-six maternal cord blood pairs permitted observation on 188 typespecific comparisons, and showed that the titer of humoral antibody varies, in general, very little within each pair, but that there is a greater tendency for type 3 transfer to be inefficient as compared with types 1 and 2. However, specific transfer inefficiency of any antibody type may be associated with individual women. Since the antibody comparison possessed by children at birth is a function of maternal titer and since the passively acquired antibody gradually disappears, the percentage of seropositive infants in a population gradually diminishes with postpartum age. In this highly endemic area, over 50% of infants were seronegative, at a serum dilution of 1:10, against any one antibody type, by 3 months of age. The implications of this finding to early vaccination were discussed. The half-life for passive polioantibody was calculated by a study of the mean titer of antibody at successive monthly intervals of infants born of mothers with various antibody levels. The decline was found to be exponential in nature and not to vary appreciably or consistently with maternal titer. The half-life of the passive antibody was found to be approximately 25 days.

The transmission of anti-Brucella agglutinins from the mother to the young in Erinaceus europaea.

The transmission of anti-Brucellaagglutinins to the young from mothers immunized during pregnancy, and from mothers immunized before and during pregnancy was studied. There is no significant transfer of anti-Brucellaagglutinins before birth, and the post-natal transfer of these antibodies is of a very low order. The highest concentration obtained in the sera of suckling young was only 3% of that in the maternal sera. At parturition the titre of the milk is of the same order as that of the maternal serum, but with suckling it declines to about 25% of the maternal serum titre.

The evaluation of the partial absorption test for Rh antibodies in the prognosis of haemolytic disease of the newborn.

SummaryThe partial absorption test for titrating Rh antibodies in the maternal serum has been evaluated as a prognostic tool in a series of 290 cases of infants born to Rh‐immunized women. The P.A. test enables a more accurate prognosis to be made of the outcome for the infant than if the indirect antiglobulin titre of the maternal serum is used alone.The statistical coefficient of correlation between the P.A. titre of the maternal serum at the time of birth and cord blood haemoglobin for liveborn Rh‐positive infants is ‐0.72.The P.A. titre is unreliable in predicting stillbirths unless regular titrations have been carried out at least from the twentyfourth week of pregnancy. The unreliability is due to the rapid fall in P.A. titre in many cases after the foetus has died in utero. However, if the P.A. titre at the end of the second trimester is 1 : 64 or higher, the outcome is almost invariably fatal.The use of the P.A. test in conjunction with the ordinary indirect antiglobulin titrations of the maternal serum enables a more accurate discrimination to be made between mild and severe cases of hæmolytic disease of the newborn. It also makes possible the more reliable diagnosis of an Rh‐negative infant in cases in which the father is known to be heterozygous D/d, and is a valuable guide for giving advice to parents of Rh‐affected infants on when to start another pregnancy.It is recommended that exchange‐transfusion should be carried out in all cases in which the maternal indirect antiglobulin titre at the time of birth is 1 : 256 or higher. Exchange‐transfusion is not warranted if the maternal indirect antiglobulin titre is less than 1 : 128 at the time of birth. Where the maternal indirect antiglobulin titre is 1 : 128, exchange‐transfusion is not necessary if the P.A. titre is zero.

The prevention of bilirubin encephalopathy

Summary<ul><li>1.Maternal titer values and/or apositive Coombs' test by themselves are not an indication for replacement transfusion in hemolytic disease of the newborn due to Rh incompatibility. The main emphasis should be placed on the clinical condition and early course of the newborn infant, particularly the ability to handle bilirubin.</li><li>2.A demonstrated rise of serumbilirubin toward critical levels (20 mg. per cent) early, particularly within 12 hours, remains the best single criterion for the need of replacement transfusion in questionable cases. Close supervision is essential.</li><li>3.Clinical judgment, which requires a thorough understanding of the clinical and laboratory data, may indicate the necessity of transfusion in individual cases. Therefore, it is desirable to refer these infants to a Center if adequate facilities and personnel are not available. The procedure itself is not without hazard, particularly in the hands of unskilled personnel.</li><li>4.Replacement transfusions by present methods may be inadequate, in rare instances, to control the serum bilirubin level and prevent brain damage.</li></ul>

Neonatal immunity. I. Disparity in maternal-infant poliovirus antibody.

SummaryNeutralizing antibody titrations for the 3 poliovirus serotypes performed on maternal and umbilical cord bloods at 48 deliveries revealed disparities of 4 to 64-fold in 14 individuals, the maternal titer always being higher. Double ovum twins had identical titers with each other, though not necessarily with their mother. The least frequent disparity was for the Type 1 antibody. The possible role of physical factors affecting the transfer of the different serotype antibody molecules is discussed.

THE EVALUATION OF CORD-BLOOD HEMOGLOBIN, RETICULOCYTE PERCENTAGE AND MATERNAL ANTIGLOBULIN TITER IN THE PROGNOSIS OF HEMOLYTIC DISEASE OF THE NEWBORN (ERYTHROBLASTOSIS FETALIS)

An unselected series of 218 consecutive pregnant women in whom Rh antibodies were detected by means of a standardized antiglobulin test has been studied to evaluate the prognostic significance of values for cord-blood hemoglobin, reticulocyte percentage and maternal antibody titer at term. Twenty-four of the women gave birth to Rh-negative infants, 35 to stillborn infants, the majority of whom were severely macerated, and 159 to liveborn Rh-positive infants. All but three of the Rh-positive liveborn infants who were not moribund at birth were exchange-transfused if the maternal titer at term was 1:128 or higher. Of the 159 Rh-positive liveborn infants, 19 subsequently died, 5 of these being in the untreated group. The remainder were alive and well at least 1 month after birth. The antibody titer of the maternal serum at term determined by the indirect antiglobulin technique is not quite such a good prognostic index of the chance of survival of liveborn Rh-positive infants as either values for cord-blood hemoglobin or reticulocyte percentage. Titration values of the maternal serum have the distinct advantage that they can be determined before birth, and so give guidance in the management of the case, including the early induction of labor. A statistical comparison of the effectiveness of treatment showed that the lower neonatal death rate achieved in the present series was not significantly different from that in comparable series in England and America. Comparison with results published for a comparable American series, where the prognostic significance of maternal antibody titer at term as determined by the plasma-albumin method was evaluated, suggests that the indirect antiglobulin technique for titrating the antibodies in the maternal serum is not only more sensitive than the plasma-albumin method, but it achieves a more clear-cut separation between mild and severe cases. In consequence the indirect antiglobulin technique gives titration values of greater prognostic significance. Once the child is born, prognosis based on a combination of either maternal antibody titer with values for cord-blood hemoglobin or reticulocyte percentage is more accurate than one based on maternal antibody titer alone.

A Study of Normal and Pathologic Variants&lt;subtitle&gt;II. Patterns of A and B Isoantibodies in the Cord Blood of Normal Infants&lt;/subtitle&gt;

IN THE PRECEDING paper, 1 the anti-A and B isoantibody patterns of unselected women in homospecific and heterospecific pregnancies were described. The present paper deals with the infants born to those mothers and is concerned with the isoantibodies of the cord bloods and their relationship to the maternal isoantibodies. The methods used were the same as those described in the first paper. OBSERVATIONS Homospecific Pregnancies .–Cord bloods for isoantibody studies were available from 69 of the 92 Group O infants of O mothers. In 23 cases the cord serum could not be obtained either because the child had been delivered at home or in another hospital or because of accidental losses in collecting the samples. The results of the anti-A and anti-B titrations of the 69 cord sera are given in Table 1, together with the corresponding maternal titers drawn within 24 hours after delivery. It will be seen that

Deficient prothrombin and fibrinogen in fatalerythroblastosis fetalis

Summary Fatal pulmonary hemorrhage in acase of hemolytic disease of the newborn (erythroblastosis fetalis) was associated with a fibrinogen deficiency and an associated prothrombin deficiency. The deficiency was not correlated with morphological damage to the hepatic parenchyma. These defects were associated with a high maternal titer of saline and albumin antibodies.

Placental transmission of mumps and streptococcus MG antibodies.

SummaryQuantitative data are presented to show that both the mumps viral complement fixing and agglutination-inhibiting antibodies are transmitted from mother to child without any significant loss in titer. In contrast, titrations for streptococcus MG agglutinins show in most of the instances at least a 4-fold diminution of the maternal titer in the cord blood. There was no difference in results when specimens were from premature or full term infants.

ERYTHROBLASTOSIS FETALIS&lt;subtitle&gt;VI. Prevention of Kernicterus&lt;/subtitle&gt;

IN PREVIOUS reports 1 we have shown that during a 12 year study period (1937 through 1948) kernicterus was the chief hazard to the recovery of liveborn infants with erythroblastosis fetalis seen at the Children's Medical Center, Boston, and the Boston Lying-in Hospital. Kernicterus not only has been the chief cause of death in liveborn infants but has led to brain damage in a small percentage of surviving infants, who present an important and tragic socioeconomic problem. We have summarized the evidence 2 which indicates that kernicterus is an acute condition of early postnatal life and have outlined the factors which are related to the likelihood of its occurrence in babies with erythroblastosis fetalis (high maternal titer, immaturity, male sex and previous occurrence in a family). We emphasized that maturity of the infant is an important safeguard against the occurrence of kernicterus. It is the purpose of this paper to

ERYTHROBLASTOSIS FETALIS

The prognosis of erythroblastosis fetalis has been studied in relation to maternal history, maternal titer of Rh antibody, and length of fetal gestation. The outlook for recovery of the first Rh-positive infant born to a mother after sensitization to the Rh factor occurs is good. About 30% of such infants have no clinical disease. Few are stillborn. Subsequent affected babies have a less favorable prognosis. Stillbirths become common (about 40%) and are related to the fact that the maternal titer is likely to be high throughout a large part of pregnancy. The authors have not seen a general tendency to increasing severity of erythroblastosis after the second affected baby. The prognosis of erythroblastosis fetalis in live born infants is more closely related to maternal titer than to family history of affected infants, with high titers carrying increased risk of kernicterus. Immaturity in a live born baby with erythroblastosis fetalis carries an increased risk of unfavorable outcome, particularly with respect to kernicterus.

INDIVIDUAL BLOOD DIFFERENCES IN RELATION TO PREGNANCY, WITH SPECIAL REFERENCE TO THE PATHOGENESIS OF PREECLAMPTIC TOXEMIA

Abstract 1. The titers of the isoagglutinins anti-A and anti-B in pregnant women at term do not differ significantly from the isoagglutinin titers in normal male adult blood donors. This indicates that pregnancy itself does not ordinarily stimulate a rise in isoagglutinin titer. 2. The frequency of incompatible blood groups in the infants of 31 mothers with toxemia of pregnancy was slightly higher (29 per cent) than that in a series of 166 infants of mothers without toxemia (22.3 per cent), but the difference was not statistically significant. 3. Of 37 normal mothers whose infants had blood groups incompatible with theirs, 9 were found to have a significant rise in isoagglutinin titer one week post partum. An appreciable rise in isoagglutinin titer occurred under similar circumstances in 6 of 9 mothers with toxemia. The series are too small to permit definite conclusions regarding the significance of this in relation to toxemia. However, there appears to be no doubt that under certain circumstances parturition can stimulate a rise in the maternal isoagglutinin titer. 4. No correlation was found between the occurrence of Rh incompatibility and toxemia of pregnancy. 5. The data obtained furnish additional evidence to support the theory of multiple allelic genes of heredity of the Rh blood types and also Race and Taylor’s theory of inheritance of the Hr factor.