Routine testing is essential during the surrogacy process to help both the surrogate and the baby she’s carrying stay healthy. One of the important tests done during the first trimester is blood testing for the Rh factor. Problems found during this test could increase the risk of complications for the baby.
Fortunately, a treatment called RhoGAM can help protect the baby. This guide explores what RhoGAM is, when a surrogate might need it, how it works, potential side effects, and more.
What Is RhoGAM?
Rho(D) immune globulin is a medication that’s widely used when a pregnant woman is Rh-negative, but the child she’s carrying may be Rh-positive. It helps prevent her immune system from making antibodies that could harm the unborn baby — or any future pregnancies she chooses to have.
The medication is sold under several different brand names in the U.S., including RhoGAM. It’s injected into a muscle or, in some cases, given through a needle placed in a vein.
Understanding Rh Factor and Rh Incompatibility
To understand why doctors might recommend a RhoGAM injection, it’s helpful to know what the Rh factor is and why it matters if a surrogate and the baby she’s carrying don’t have the same Rh factor.
What Is the Rh Factor?
The Rhesus factor, or Rh factor, is a type of protein that can be found on the surface of red blood cells. The red blood cells are responsible for carrying oxygen throughout the body.
People whose red blood cells have the Rh protein are Rh-positive (like 85% of the population). People whose red blood cells don’t have the Rh protein are Rh-negative. A person’s Rh factor doesn’t affect their overall health, but it can sometimes cause problems during pregnancy.
What Is Rh Incompatibility?
Rh incompatibility is a preventable blood type issue during pregnancy. It can occur when a surrogate has Rh-negative blood, but the child she’s carrying has Rh-positive blood. If the incompatible blood types mix, her immune system sees the Rh-positive blood as foreign and makes antibodies against it.
Once a surrogate’s immune system is sensitized to the Rh factor, the antibodies can cause problems for any future Rh-positive pregnancy. The antibodies may attack and damage a Rh-positive fetus’ red blood cells. This can cause a potentially life-threatening condition, hemolytic disease of the newborn (HDN).
When Is RhoGAM Given?
If a surrogate has Rh-negative blood and hasn’t made antibodies to the Rh factor, her doctor may recommend a RhoGAM shot around the 28th week of pregnancy. It helps prevent her body from producing these antibodies for the remainder of the pregnancy.
A second dose of the RhoGAM shot might be recommended within 72 hours of delivery if the baby is Rh-positive. The second shot is given to help protect future pregnancies.
Doctors may recommend giving additional doses of the RhoGAM shot in certain situations, including:
- Bleeding during pregnancy.
- Invasive prenatal tests, such as amniocentesis or chorionic villus biopsy.
- Injury to the abdomen during pregnancy (falls, accidents, or injuries).
How Does the RhoGAM Injection Work?
RhoGAM contains Rh immune globulin (RhIg), an anti-Rh antibody. It’s made from plasma, the liquid portion of a person’s blood. People with Rh antibodies donate the plasma.
When an Rh-negative woman gets a RhoGAM shot, the Rh antibodies in the medication bind to fetal red blood cells that have entered her blood. This prevents her body from reacting to the Rh-positive cells and making antibodies that could harm the fetus.
The RhoGAM shot’s effects last for about 12 weeks. Depending on the timing of the first shot, some women may need follow-up doses to ensure the effects last throughout the pregnancy.
RhoGAM and Surrogacy – Special Considerations
Surrogates may need closer monitoring during their journey. That’s because the risks of Rh incompatibility will vary depending on the intended parents’ blood types.
A baby inherits the Rh factor from their biological parents. If both parents are Rh-positive, their baby likely will be as well. If both parents are Rh-negative, their baby will be Rh-negative. If one parent is Rh-positive and the other is Rh-negative, the baby could inherit either blood type.
It may sound complicated, but surrogacy agencies like Joy of Life are well-equipped to help surrogates get the medical care they need to avoid Rh factor issues. The RhoGAM shot is a simple treatment that helps protect both the surrogate pregnancy and any future pregnancies.
Side Effects and Risks of the RhoGAM Shot
The RhoGAM shot has been widely used since the 1960s and is considered safe for use during pregnancy. The common side effects of RhoGAM are generally mild and may include:
- Diarrhea, nausea, stomach pain, or vomiting.
- Dizziness, drowsiness, headache, or a general ill feeling.
- Joint or muscle pain.
- Pain or tenderness at the injection site.
In rare cases, more serious side effects may occur. Signs of a serious reaction that warrant immediate medical attention may include:
- Allergic reaction signs include chest tightness, difficulty breathing, hives, and swelling in the face and mouth.
- Back pain, bloody urine, chills, fever, shaking, unusual weakness.
- Dark urine, pale skin, rapid weight gain, swelling.
- Hemolytic reactions (very rare), including chills, headache, low blood pressure, and nausea.
- Interactions with recent vaccinations (especially live vaccines), resulting in the vaccine not working as well.
- Sudden numbness or weakness, swelling and redness in a leg, vision problems.
What Happens If You Don’t Get the RhoGAM Shot?
Without the RhoGAM shot, surrogates with Rh-negative blood can develop antibodies against the Rh factor. The antibodies can lead to serious complications in future pregnancies where the fetus is Rh-positive.
Hemolytic disease of the newborn is a blood disorder that can occur when a surrogate’s antibodies attack the baby’s red blood cells. It can cause serious problems for an unborn or newborn baby, including:
- Fluid buildup, potentially leading to brain damage or organ failure.
- Severe anemia (significantly low red blood cell count).
- Yellowing of the skin or eyes.
Before the RhoGAM shot was developed, about 10,000 newborns died every year in the U.S. because of this condition, and many more suffered permanent brain damage. Now, it’s almost completely preventable with a simple injection.
Final Thoughts on the RhoGAM Injection
Women who are Rh-negative may need a RhoGAM shot during pregnancy to protect the baby they’re carrying. This simple treatment prevents their bodies from producing antibodies that attack the baby — as well as any future baby they choose to carry.
If you have questions about the RhoGAM injection or any other aspect of prenatal care, don’t hesitate to reach out to your doctor or Joy of Life coordinator.
Become a Surrogate
A surrogacy journey is a rewarding experience that allows you to give an incredible gift to a family while supporting your own goals. At Joy of Life, our mission is to ensure your journey is as smooth and fulfilling as possible. Contact us to learn more about becoming a surrogate, and if you’re ready to start your journey, fill out our online application.
