Why Use RhoGAM Shot | YMyHealth

Preventive care during pregnancy involves tracking numerous health considerations. Recently, a concerning trend has emerged: pregnant women refusing the RhoGAM shot. To explore this issue, YMyHealth spoke with Katie Shanahan, a nurse practitioner, mother who experienced alloimmunization during her first pregnancy, and Director of Development for Allo Hope Foundation. Katie shares critical information about RhoGAM, alloimmunization, and why this preventive treatment is so important.

Q: What exactly is alloimmunization?

Katie Shanahan: Alloimmunization is a rare pregnancy condition where the mother's body creates antibodies, which is a normal process of the immune system. But when you're pregnant, it can be an issue because it can attack your baby's red blood cells and destroy them, causing the baby to become anemic in utero. This condition needs to be treated and is called hemolytic disease of the fetus and newborn, or HDFN.

If a baby becomes anemic in utero, the only treatment is a blood transfusion called an intrauterine blood transfusion, where they deliver blood to the baby in utero. It's medically incredible but very scary. This is the rare pregnancy disease I had with my son, and with the right monitoring and care, we were able to have a positive outcome.

Q: What is RhoGAM and how does it work?

Katie: RhoGAM is actually the brand name. The drug itself is Rh immune globulin, but most people know it as RhoGAM. It's a medication used to prevent women who are Rh negative from becoming sensitized or alloimmunized, which means developing antibodies.

There are over 50 types of antibodies, but RhoGAM only helps prevent against the development of one, which is called anti-D. Sometimes you'll hear RhoGAM referred to as the anti-D injection. Once you have these antibodies, you'll have them for the rest of your life, so there's no going back, which is why prevention with this medication is so important.

The medication itself is created from human blood plasma—it's made from other people's anti-D antibodies. The small amount of anti-D antibodies that's injected into a mom tricks their immune system into thinking it's already producing antibodies so that it doesn't need to make more. In reality, these injected antibodies will eventually die off, but they protect the mom from developing her own antibodies that might affect future pregnancies.

Q: When is RhoGAM given during pregnancy?

Katie: RhoGAM should be given to all Rh negative women during pregnancy. It's routinely given at 28 weeks gestation and within 72 hours after birth. It's also given after any miscarriage, abortion, vaginal bleeding during pregnancy, or invasive testing like amniocentesis—any major events that occur during pregnancy if you're Rh negative.

Q: Why are some pregnant women refusing the RhoGAM shot?

Katie: There have always been people wary of preventative medicine, especially regarding routine vaccines or medications. We see this unfortunately with childhood vaccines, but in the last few years since the COVID pandemic, we've seen increasing numbers of vaccine hesitancy since the development of the COVID vaccine, and unfortunately, that's included RhoGAM.

I also think over the last couple of years, women have felt a lot of external pressure about medical decisions and what they can and cannot do with their bodies. While pregnant women have every right to refuse medically recommended treatment, they also carry the responsibility of understanding why that treatment is being recommended and what the true consequences of refusing that treatment are.

Q: What concerns do women express about getting RhoGAM?

Katie: One of the main things we hear is that women want to have a more natural pregnancy, which is completely understandable. But the truth is, not getting RhoGAM and having an alloimmunized pregnancy is the most unnatural pregnancy you could possibly have.

If you skip RhoGAM, you have a very high possibility of becoming sensitized. I experienced this condition myself after not being offered RhoGAM when I should have been, and it's truly something I wouldn't wish even on my worst enemy.

For me, to explain how unnatural these pregnancies are: I had weekly ultrasounds, invasive procedures, epidurals with each procedure so that I didn't move, I was induced, and I had a two-week stay with my baby in the NICU where he got all sorts of "unnatural" therapies. He had multiple blood transfusions and weekly labs. The list goes on and on.

So really, the best way to protect your natural pregnancy—if you want an intervention-free pregnancy or a home birth—is to get RhoGAM. The side effect profile is very minimal compared to other vaccines, and it has a short half-life, so it's in your body for a very short period of time.

Another thing we hear is that it's just medicine, science, technology, or pharma driving this "RhoGAM agenda." I'm not going to say there aren't issues with some of these things, but if it really was all about money, they would actually stop giving RhoGAM because alloimmunized pregnancies are so expensive and lucrative for the medical system. We totaled some of my son's medical bills, and pre-insurance, it was almost a million dollars. So if they really wanted to make money, they would stop giving it.

Katie and her now, healthy son Liam. He had to spend two weeks in the NICU and needed four additional post-birth transfusions after Katie developed Anti-D antibodies during her pregnancy—something that your healthcare provider’s proper timing and giving of the RhoGAM shot to pregnant women can prevent from developing.

Q: What would you recommend for those concerned about getting the RhoGAM shot?

Katie: I want to say that I'm slightly biased because I've experienced this disease by not getting RhoGAM when I should have. But I also want people to understand it's your body, and you can make the medical decisions that are best for you. I just want people to truly understand what the consequences could be.

There are only a few reasons you wouldn't need RhoGAM:

If you're Rh positive—if you have a positive blood type, you don't need RhoGAM. It's only for women with a negative blood type.
If you've already developed anti-D antibodies.
If you are Rh negative and you're carrying an antigen-negative fetus.

For that third group, there's testing available called cell-free fetal DNA testing in pregnancy. This is something commonly done at 10-12 weeks to check for chromosomal abnormalities or determine gender early. But they can also test the blood type and antigen status of the baby. If the baby is also negative, then mom doesn't need RhoGAM.

It's a wonderful test—just a blood draw from mom that tests circulating fetal DNA. It's available pretty much anywhere in the U.S. If a mom is on the fence, it's a great way to determine if RhoGAM is even indicated in the first place. This is actually done routinely in other countries, and the U.S. is integrating it more and more, especially now that there's been a shortage of RhoGAM recently.

Q: Why is the RhoGAM shot a crucial piece of preventive care in pregnancy?

Katie: The bottom line is RhoGAM has dramatically decreased alloimmunization rates—from 20% when we didn't have the drug to 1% now. We hear people say, "Well, this disease is so rare, I don't need it." But this disease is rare because RhoGAM exists, which should be enough evidence to show that it's working. It's truly saved so many lives and is one of the most miraculous medical interventions of our time.

I don't think people understand what our world was like 60 years ago before this medication existed. To paint a picture of this, there's still a reality where RhoGAM doesn't exist—in developing countries. The Allo Hope Foundation does work in sub-Saharan Africa, where they don't have routine blood typing in pregnancy or access to RhoGAM. They're living in a world like we experienced 60 years ago without RhoGAM, and we've seen women who have lost six, seven, eight babies because they don't have access to this medication.

The more women who refuse this medication, the more we revert back to what our world was like before it existed. We're really lucky to live in a place where we have access to it and would be taking it for granted if we didn't receive it.

Q: What advice do you have for women seeking information about RhoGAM?

Katie: I understand people's hesitancy and wanting more information about something you're putting into your body when pregnant. That's completely valid. But when questioning this, I want women to make sure they're finding trusted, reputable, evidence-based resources—not Reddit posts or biased groups.

We're actually in the process of creating an entire page about RhoGAM at the Allo Hope Foundation. I know we're coming from a biased place, but I want people to have all the information they need when making this decision.

Allo Hope Foundation’s Rh Immune Globulin Resource

Learn everything from the history of Rh Immune Globulin and how it works to information on its safety, efficacy, indications, and even when it is not needed by clicking on this dedicated site.

Want to hear directly from Katie or our other YMyHealth contributors? Check out the podcast!

Why Women Are Refusing RhoGAM Shots and Why You Shouldn't: Expert Q&A