Understanding Neonatal Hemochromatosis and GALD
Neonatal Hemochromatosis (NH) is a rare yet serious condition that affects the liver of a developing fetus. Unlike adult hemochromatosis, NH involves excessive iron deposition in the liver due to a condition known as gestational alloimmune liver disease (GALD).
In GALD, the mother’s immune system produces antibodies that target the fetal liver, leading to damage. This condition can cause devastating complications, including stillbirth or neonatal death, making it a heartbreaking experience for affected families.

Causes and Symptoms of GALD
Research suggests that up to 95% of NH cases are linked to GALD. The maternal antibodies cross the placenta and harm the developing liver, potentially leading to severe outcomes such as liver failure, fluid buildup (hydrops), growth restriction, and clotting disorders. GALD is not caused by anything the mother does, and its exact origins remain unclear.
NH may present itself during late pregnancy or shortly after birth, with symptoms like jaundice, swelling, difficulty breathing, and coagulopathy. Unfortunately, the condition often leads to neonatal demise unless promptly diagnosed and treated.

How does GALD Contribute to Neonatal Loss?
GALD severely disrupts the liver’s ability to function, which is critical for a newborn’s survival. The liver damage caused by maternal antibodies can lead to an accumulation of toxic substances in the blood, impairing other organs and causing irreversible harm. Without intervention, the fetus may experience life-threatening complications in utero or within days of birth.
The risk of recurrence is high—around 90%—for subsequent pregnancies after a baby has been affected by NH due to GALD. However, early intervention during pregnancy can significantly improve outcomes.

Treatment and Hope for Future Pregnancies
Fortunately, medical advancements have made it possible to treat GALD effectively during pregnancy. Intravenous immunoglobulin (IVIG) therapy is a game-changer for expectant mothers who have previously experienced NH-related pregnancy loss. IVIG works by blocking the maternal antibodies that cause liver damage in the fetus. When started early—often by the 14th week of pregnancy—IVIG offers a nearly 100% chance of delivering a healthy baby.
Treatment typically involves weekly IVIG infusions, lasting six to eight hours each until delivery. Though the process may feel physically taxing, the results are often life-changing, providing hope for families who have endured the heartbreak of NH.

Raising Awareness to Promote Empathy and Support
Despite its rarity—fewer than one in a million pregnancies worldwide—NH and GALD have profound implications for families. Misunderstandings and stigma often leave parents feeling isolated. Raising awareness about NH and the availability of treatments like IVIG is crucial. It fosters empathy and encourages support for ongoing research and resources.
For families going through this journey, the Stanford Medicine Children’s Health program offers exceptional care, combining expertise, compassion, and innovative treatments. Their dedicated team works with specialists nationwide to ensure families receive the help they need, no matter where they live.
By increasing awareness and encouraging donations, we can support vital research and offer hope to families affected by NH and GALD, ensuring more babies get the chance to thrive.