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Rho(D) Immune Globulin use while Breastfeeding

Drugs containing Rho(D) Immune Globulin: RhoGAM, Anti-D (RHO) Immunoglobulin, Rhophylac, Liberim D, Partobulin SDF, D-Gam Anti-D, BayRHo-D Mini-Dose, BayRHo-D Full Dose, BayRHo-D, Mini-Gamulin Rh, Show all 18 »HypRho-D Mini-Dose, Gamulin Rh, MICRhoGAM, HyperRHO S/D Mini-Dose, MicRhoGAM Ultra-Filtered Plus, RhoGAM Ultra-Filtered Plus, WinRho SDF, HyperRHO S/D Full Dose

Medically reviewed on Jul 2, 2018

Rho(D) Immune Globulin Levels and Effects while Breastfeeding

Summary of Use during Lactation

Rho(D) immune globulin is a immune globulin (IgG) rich in IgG antibodies against erythrocyte antigen Rho(D). IgG is a normal component of breastmilk. Rho(D) immune globulin is frequently used in nursing mothers and no adverse effects have been reported in breastfed infants. No special precautions are required.

Holder pasteurization (62.5 degrees C for 30 minutes) decreases the concentration of endogenous immunoglobulin G by up to 79%.[1][2] Higher temperatures of 72 and 85 degrees C appear to cause greater loss, but further lyophylization does not cause marked additional loss.[3] A flash heating pasteurization reduced the concentration of endogenous immunoglobulin G by 33%.[4] A continuous flow, high-temperature short-time (HTST) pasteurizer at temperatures ranging from 71 to 74 degrees C retained from about 38 to 79% of IgG activity depending on the temperature and exposure time.[5] A study of 67 colostrum samples that underwent Holder pasteurization found that IgG amounts decreased by 34 to 40%. Immunoreactivity against ovalbumin decreased by 4 to 18% and immunoreactivity against tetanus toxoid decreased by 8 to 20%. Specific IgG subclasses decreased by different amounts, with IgG4 retaining all of its activity and IgG1 and 2 decreasing by about 40 to 50%.[6]

Drug Levels

Maternal Levels. Colostrum (3 days postpartum) and milk (7 days postpartum) samples from 2 mothers who were receiving intravenous immunoglobulin (IVIG) for the treatment of common variable immunodeficiency were studied. One mother was receiving 400 to 500 mg/kg of IVIG monthly and the other received 600 to 700 mg/kg of IVIG monthly. The time of the last dose before sample collection was not reported. Immune globulin G (IgG) concentrations were normal in the first mother's colostrum and milk and higher than normal in the colostrum of the second mother. IgM levels were normal in the colostrum and milk first mother and low in the second.[7]

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants

Relevant published information was not found as of the revision date.

Effects on Lactation and Breastmilk

Relevant published information was not found as of the revision date.

References

1. Koenig A, de Albuquerque Diniz EM, Barbosa SF et al. Immunologic factors in human milk: The effects of gestational age and pasteurization. J Hum Lact. 2005;21:439-43. PMID: 16280560

2. Adhisivam B, Vishnu Bhat B, Rao K et al. Effect of Holder pasteurization on macronutrients and immunoglobulin profile of pooled donor human milk. J Matern Fetal Neonatal Med. 2018;1-4. PMID: 29587541

3. Castro Albarran J, Navarro Hernandez RE, Solis Pacheco JR et al. [Impact of pasteurization/freeze-drying on available immunoglobulin content of the mature human milk. Use in human milk banking of hospitals]. Nutr Hosp. 2017;34:899-906. PMID: 29095015

4. Chantry CJ, Israel-Ballard K, Moldoveanu Z et al. Effect of flash-heat treatment on immunoglobulins in breast milk. J Acquir Immune Defic Syndr. 2009;51:264-7. PMID: 19421069

5. Dhar J, Fichtali J, Skura BJ et al. Pasteurization efficiency of a HTST system for human milk. J Food Sci. 1996;61:569-73. DOI: doi:10.1111/j.1365-2621.1996.tb13160.x

6. Rodriguez-Camejo C, Puyol A, Fazio L et al. Antibody profile of colostrum and the effect of processing in human milk banks: Implications in immunoregulatory properties. J Hum Lact. 2018;34:137-47. PMID: 28586632

7. Palmeira P, Costa-Carvalho BT, Arslanian C et al. Transfer of antibodies across the placenta and in breast milk from mothers on intravenous immunoglobulin. Pediatr Allergy Immunol. 2009;20:528-35. PMID: 19220771

Rho(D) Immune Globulin Identification

Substance Name

Rho(D) Immune Globulin

CAS Registry Number

887269-77-4

Drug Class

Antibodies

Immunoglobulins

Immunoglobulin G

Administrative Information

LactMed Record Number

844

Disclaimer

Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.

Further information

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