Noninvasive fetal blood grouping: present and future

Identification of the molecular basis of the D polymorphism of the Rh blood group system in the 1990s made it possible to predict D phenotype from DNA. The most valuable application of this has been the determination of fetal D type in pregnant D-negative women with anti-D. Knowledge of fetal D type reveals whether the fetus is at risk of hemolytic disease of the fetus and newborn so that the pregnancy can be managed appropriately. Noninvasive fetal D typing for D-negative pregnant women with anti-D, performed on the small quantity of fetal DNA present in the blood of pregnant women, is now routine practice in several European countries. Noninvasive fetal blood grouping for C, c, E, and K also may be provided as a routine service for alloimmunized pregnant women. In many countries, all D-negative pregnant women are offered anti-D prophylaxis antenatally, yet in a predominantly Caucasian population, about 38% will be carrying a D-negative fetus and will receive the treatment unnecessarily. Large-scale trials to ascertain the accuracy of high-throughput, automated methods suggest that fetal D screening of all D-negative pregnant women is feasible, and it is likely that fetal D screening in D-negative pregnant women will be policy in some European countries within the next few years.