Integration of noninvasive prenatal prediction of fetal blood group into clinical prenatal care

ABSTRACT Incompatibility of red blood cell blood group antigens between a pregnant woman and her fetus can cause maternal immunization and, consequently, hemolytic disease of the fetus and newborn. Noninvasive prenatal testing of cell‐free fetal DNA can be used to assess the risk of hemolytic disease of the fetus and newborn to fetuses of immunized women. Prediction of the fetal RhD type has been very successful and is now integrated into clinical practice to assist in the management of the pregnancies of RhD immunized women. In addition, noninvasive prediction of the fetal RhD type can be applied to guide targeted prenatal prophylaxis, thus avoiding unnecessary exposure to anti‐D in pregnant women. The analytical aspect of noninvasive fetal RHD typing is very robust and accurate, and its routine utilization has demonstrated high sensitivities for fetal RHD detection. A high compliance with administering anti‐D is essential for obtaining a clinical effect. Noninvasive fetal typing of RHC/c, RHE/e, and KEL may become more widely used in the future. © 2014 John Wiley & Sons, Ltd. What's already known about this topic? Risk assessment of hemolytic disease of the fetus and newborn is possible by noninvasive DNA testing of fetal blood group antigens. Application of noninvasive fetal RHD typing has been very successful to assist RhD immunized women and can be used to guide targeted prenatal prophylaxis to avoid unnecessary exposure to anti‐D. What does this study add? This review gives an overview of the current practice of noninvasive prenatal prediction of fetal blood group antigens, particularly fetal RhD. The integration into clinical care is highly feasible.