Antiphospholipid syndrome and recurrent miscarriage: A systematic review and meta-analysis

Santos, Thaís da Silva; Ieque, Andressa Lorena; Carvalho, Hayalla Corrêa de; Sell, Ana Maria; Lonardoni, Maria Valdrinez Campana; Demarchi, Izabel Galhardo; Neto, Quirino Alves de Lima; Teixeira, Jorge Juarez Vieira

doi:10.1016/j.jri.2017.09.007

Cited by 52 publications

(40 citation statements)

References 65 publications

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“…We have found that it is the most prevalent clinical manifestation in our population, in both previous and historical episodes. This is in line with what was published by other authors, in which women with aPL could have a higher rate of early pregnancy loss [37]. Reviewing the different associations according to the laboratory categories, we have a homogeneous distribution and we have observed a strong association between category I and category IIa, with recurrent miscarriages and foetal losses respectively.…”

Section: Tablesupporting

confidence: 92%

The European Registry on Obstetric Antiphospholipid Syndrome (EUROAPS): A survey of 1000 consecutive cases

Alijotas‐Reig¹,

Esteve-Valverde

Ferrer‐Oliveras³

et al. 2019

Autoimmunity Reviews

125

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Section: Tablesupporting

confidence: 92%

The European Registry on Obstetric Antiphospholipid Syndrome (EUROAPS): A survey of 1000 consecutive cases

Alijotas‐Reig¹,

Esteve-Valverde

Ferrer‐Oliveras³

et al. 2019

Autoimmunity Reviews

125

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“…The incidence of those antibodies in recurrent miscarriages is considered to be between 15%-20%. 110 Agmon-Levin et al 111 demonstrated a greater vitamin D deficiency in APS patients as compared to healthy controls (49% vs 30%, P < .001), which was also significantly associated with thrombosis (P < .001).…”

Section: How Vitamin D Impacts the Association Between Autoimmune Dmentioning

confidence: 95%

Vitamin D, autoimmunity and recurrent pregnancy loss: More than an association

Sharif

Watad

et al. 2018

American J Rep Immunol

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Recurrent pregnancy loss (RPL) affects close to 1% of couples; however, the etiology is known in only about 50% of the cases. Recent studies show that autoimmune dysregulation is a probable cause of RPL, which in some cases may be overlooked. In order for a pregnancy to proceed to term, early modulation of immunologic response is required to induce tolerance to the semi-allogenic fetus. Certain subsets of both the innate and adaptive immune responses play a role in the induction of fetomaternal tolerance. A relatively predominant T-cell helper (Th) 2 and T regulatory (Treg) cell population seem to favor a better pregnancy outcome, whereas Th1 and Th17 cell populations appear to have an opposite effect. Lately, the role of vitamin D in the modulation of immune response was established. Vitamin D has been shown to promote a more favorable environment for pregnancy through various mechanisms, such as enhancement of the shift toward Th2 cells and regulation of immune cell differentiation and cytokine secretion. Therefore, it seems that vitamin D deficiency sways the balance toward a worse outcome and may play a part in recurrent pregnancy loss. This review sheds light on the immunologic changes, which occur in early pregnancy and the regulatory role vitamin D has in the maintenance of this delicate balance.

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“…Interestingly, the fetoplacental unit is resilient to attack by humoral immune factors except for anti-phospholipid antibodies which are clearly implicated in a proportion of RSM. 6 Much attention has been focused on cell-mediated immune effectors as possible etiologic factors; these include maternal T lymphocytes, macrophages, and natural killer (NK) cells in maternal peripheral blood and in uteroplacental tissues. A significant boost to research in this area came from the revolutionary discovery of the different subsets of T helper (Th) lymphocytes and the cytokines produced by them.…”

Section: Immunologic Etiologies Of Recurrent Spontaneous Miscarriagementioning

confidence: 99%

Using the Immune System to Manage Immunologically-Mediated Pregnancy Loss

Rajgopal

2020

ANAMS

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Pregnancy is not nearly as successful as laypersons might assume, challenged as it is by several complications such as threatened abortion, spontaneous miscarriage, preeclampsia, and preterm delivery, among others. The maternal immune system has been shown to contribute to the etiopathogenesis of some of these pregnancy complications. Pro-inflammatory and anti-inflammatory cytokines have been studied for their effects on pregnancy because of their powerful and versatile effects on cells and tissues. This review addresses the relationship between pro-inflammatory cytokines and recurrent miscarriage, which is an important complication of pregnancy. References for this review were identified by using PRISMA-IPD (Preferred Reporting Items for a Systematic Review and Meta-analysis of Individual Participant Data) Guidelines by conducting searches for published articles from January 1, 1990 until March 1, 2020 in the following databases: PubMed, Google Scholar, and MEDLINE via OVID by the use of the search terms “recurrent spontaneous miscarriage,” “cytokines,” “progesterone,” “progestogen,” “dydrogesterone,” and “immunomodulation.” This review also presents the proposed mechanisms of action of pro-inflammatory cytokines in pregnancy loss, and then goes on to discuss the modulation of cytokine profiles to a state that is favorable to the success of pregnancy. In addition to its indispensable endocrinologic role of progesterone in pregnancy, it also has some intriguing immunomodulatory capabilities. We then summarize studies that show that progesterone and dydrogesterone, an orally-administered progestogen, suppress the production of pro-inflammatory cytokines and enhance the production of anti-inflammatory cytokines before mentioning clinical studies on progestogen supplementation. These studies support the contention that progestogens should be explored for the immunotherapeutic management of pregnancy complications.

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Antiphospholipid syndrome and recurrent miscarriage: A systematic review and meta-analysis

Cited by 52 publications

References 65 publications

The European Registry on Obstetric Antiphospholipid Syndrome (EUROAPS): A survey of 1000 consecutive cases

The European Registry on Obstetric Antiphospholipid Syndrome (EUROAPS): A survey of 1000 consecutive cases

Vitamin D, autoimmunity and recurrent pregnancy loss: More than an association

Using the Immune System to Manage Immunologically-Mediated Pregnancy Loss

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