ABO Incompatibility, Pregnancy, and Severe Newborn Jaundice

Since treatments for Rh Disease have been developed, ABO Incompatibility has become the more common cause of jaundice and anemia in newborns. ABO Incompatibility can occur if the mother and the baby have different blood types. It most commonly occurs when the mother has type O blood and the baby has type A, B, or AB blood.

What Causes ABO Incompatibility? People with type O blood produce anti-A and anti-B antibodies. When a type O blood mom is pregnant with a type A, B, or AB blood baby, there is a chance that the anti-A or anti-B antibodies will pass through the placenta during pregnancy or birth and cause ABO Incompatibility.

Like the antibodies produced in Rh Disease, the antibodies with ABO Incompatibility attack the baby's red blood cells once they pass through the placenta. These antibodies can cause the rapid breakdown of the baby's red blood cells. Bilirubin is produced when the body breaks down red blood cells and this rapid breakdown of the baby's red blood cells causes a quick build up of bilirubin, resulting in jaundice and sometimes anemia.

ABO Incompatibility Vs. Rh Disease. Rh Disease tends to be more mild in first pregnancies affected by it and becomes more severe in following pregnancies that have it. ABO Incompatibility can be significant in a first pregnancy and does not become worse or more dangerous in following pregnancies. ABO Incompatibility is usually not as serious as Rh Disease and the jaundice and anemia caused by ABO Incompatibility are usually not as severe, but there are cases when it is serious and/or severe. My best friend and I have both had experience with serious cases of ABO Incompatibility.

Personal Experience with ABO Incompatibility. When I brought my first daughter home at two days old, none of the medical staff, including our pediatrician, told me that my baby had jaundice even though she was yellow before we left the hospital. Since I didn't know anything about jaundice and no one said anything, I thought it must be something normal that happens to newborns.

It wasn't until one of my best friend's came to see my daughter when she was four days old that I found out that something was wrong. He had a daughter that had severe jaundice as a newborn. He took one look at my baby and said, "Get her to the doctor now. She has really bad jaundice."

Talk about freaking a new mom out. I got her to the doctor as quickly as possible and sure enough, he was right. My daughter had severe jaundice, with a bilirubin level of 17, and had to be admitted to the hospital immediately. I was so scared and upset and didn't understand what had happened to make my baby so sick.

I was told that my baby would be kept in the hospital receiving phototherapy under bili lights until her bilirubin levels came down to a safe amount. She was in the neonatal intensive care unit for two days. I couldn't stay at the hospital and could only visit and hold her for a little while each day. It was so hard and I was so glad when it was over and I could take her home.

When the hospital discharged my daughter, they told me to lay my baby with as much skin exposed as possible, in the sunlight coming through a window to continue to help her body break down the bilirubin. I also had to continue to take her in for bilirubin tests at our doctor's office to keep an eye on things for a while.

No one ever explained to me why she had gotten such severe jaundice and this happened almost twenty years ago, so I was very young and not as pushy for an explanation as I would be now. I knew that I had type O+ blood and my first daughter had type A+ blood, but I had no idea that could be a problem. It wasn't until my best friend had a similar, but even more severe, experience with her second child that I became convinced that I had dealt with ABO Incompatibility with my first daughter.

ABO Incompatibility in Another Newborn. My best friend was scheduled for a C-section with her second child, but ended up having the C-section two days early because the baby's heart rate was dropping. At first everything seemed fine, but within twenty-four hours, her newborn daughter had severe jaundice.

My friend has O+ blood and her daughter had A+ blood, so a blood test called the Coombs test was done to check the baby to see if anti-A antibodies had passed through the placenta to the baby during pregnancy or birth. The test came back positive, which meant the baby had the antibodies.

The anti-A antibodies were breaking down the baby's red blood cells rapidly and her bilirubin levels were dangerously high. My friend and her husband were told that their daughter may need an exchange transfusion (replacement of the baby's blood with fresh blood) and that she would have to be taken to a different hospital that specialized in doing the transfusion so it could be done immediately if needed. My friend had to stay in the hospital where the C-section was done, while her baby was taken to the other hospital. It was two days before my friend was released and able to go see her baby.

Fortunately, the exchange transfusion never had to be done, but the baby had to stay in the neonatal intensive care unit for ten days. She was receiving phototherapy under bili lights and had to have blood tests done every four hours because her bilirubin levels kept spiking. At first the baby couldn't even be taken out from under the bili lights for her parents to hold her.

Once the baby's bilirubin levels came down some, the blood tests were every eight hours and her parents could finally hold and feed her. My friend and her husband traveled three hours every day to go to the hospital to be with their daughter and come home every night.

After ten days, the baby's bilirubin levels were staying down without being under the bili lights and they were able to take their daughter home, but they had to take her in for blood tests the next day and once a week for several weeks to keep an eye on things.

Our O+ Babies Were Fine. If the baby of a type O mom has type O blood, there won't be ABO Incompatibility. My second daughter and my best friend's first child were both O+ and didn't have any of the problems we experienced with our other babies because there was no ABO Incompatibility.

Related Content:

Rh Factor Disease & Severe Anemia & Jaundice in Newborns

Sources:

Stanford School of Medicine - Coombs Test

Healthline - ABO Incompatibility

Pregnancy Birth & Beyond - ABO Incompatibility in Newborns