Immunological Risk Factors in Recurrent Pregnancy Loss: Guidelines Versus Current State of the Art

Vomstein, Kilian; Feil, Katharina; Strobel, Laura; Aulitzky, Anna; Hofer, Susanne; Kuon, Ruben; Tóth, Bettina

doi:10.3390/jcm10040869

Cited by 71 publications

(61 citation statements)

References 193 publications

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“…Women with autoimmune diseases with the proper therapeutic conditions may undergo pregnancy without major complications. The most common autoimmune disease is anti-thyroid antibodies [41,42,[56][57][58]; however, the most difficult to treat is antiphospholipid antibody and lupus. The main issue depends upon the control of autoantibodies and thrombosis.…”

Section: Nk Cells In Autoimmune Diseasesmentioning

confidence: 99%

“…Autoantibodies may be responsible for NK cell activation in the decidua; however, the mechanism is unclear [41,42,[56][57][58]. Control of thyroid hormone can be achieved pharmacologically.…”

Section: Nk Cells In Autoimmune Diseasesmentioning

confidence: 99%

“…Vitamin D appears to have a protective role in this process as human chorionic gonadotrophin [56][57][58]. Both induce a tolerogenic immune response [56][57][58][59]. However, anti-nuclear and antiphospholipid antibodies may require special medical treatment.…”

Section: Nk Cells In Autoimmune Diseasesmentioning

confidence: 99%

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A Brief Analysis of Tissue-Resident NK Cells in Pregnancy and Endometrial Diseases: The Importance of Pharmacologic Modulation

Garmendia

Sanctis

2021

Immuno

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NK cells are lymphocytes involved in the innate and adaptative immune response. These cells are located in peripheral blood and tissues with ample functions, from immune vigilant to tolerogenic reactions. In the endometrium, NK cell populations vary depending on age, hormones, and inflammation. When pregnancy occurs, tissue-resident NK cells and conventional NK cells are recruited to protect the fetus, a tolerogenic response. On the contrary, in the inflamed endometrium, various inflammatory cells down-regulate NK tolerance and impair embryo implantation. Therefore, NK cells’ pharmacological modulation is difficult to achieve. Several strategies have been used, from progesterone, lipid emulsions to steroids; the success has not been as expected. However, new therapeutic approaches have been proposed to decrease the endometrial inflammatory burden and increase pregnancy success based on understanding NK cell physiology.

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Section: Nk Cells In Autoimmune Diseasesmentioning

confidence: 99%

Section: Nk Cells In Autoimmune Diseasesmentioning

confidence: 99%

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A Brief Analysis of Tissue-Resident NK Cells in Pregnancy and Endometrial Diseases: The Importance of Pharmacologic Modulation

Garmendia

Sanctis

2021

Immuno

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“…It is estimated that up to 6% of women suffer from recurrent pregnancy loss (RPL) [ 1 , 2 , 3 ]. The World Health Organization defined this condition in 1976 [ 4 ] as three or more consecutive pregnancy losses before the 20th week of pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Anti-Phosphatidylserine/Prothrombin Antibodies in Healthy Women with Unexplained Recurrent Pregnancy Loss

Pleguezuelo

Cabrera-Marante

Abad

et al. 2021

JCM

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Recurrent pregnancy loss (RPL) affects up to 6% of couples. Although chromosomal aberrations of the embryos are considered the leading cause, 50% of cases remain unexplained. Antiphospholipid Syndrome is a known cause in a few cases. Antiphospholipid antibodies (aPL) anticardiolipin, anti-Beta-2-Glycoprotein-I and Lupus Anticoagulant (criteria aPL) are recommended studies in RPL workup. We tested healthy women with unexplained RPL for criteria aPL and anti-Phosphatidylserine/Prothrombin antibodies (aPS/PT). Patients were classified into three groups according to the number and pregnancy week of RPL: Extra-Criteria (EC), with 2 miscarriages, Early Miscarriage (EM), with ≥3 before pregnancy at week 10 and Fetal Loss (FL), with ≥1 fetal death from pregnancy at week 10. Circulating criteria aPL were absent in 98.1% of EM, 90.9% of FL and 96.6% of EC groups. In contrast, aPS/PT were positive in 15.4% of EM, 15.1% of FL, 16.6% of EC patients and 2.9% in controls. aPS/PT posed a risk for RPL, with an odds ratio of 5.96 (95% confidence interval (CI): 1.85–19.13. p = 0.002) for EM, 7.28 (95% CI: 2.07–25.56. p = 0.002) for FL and 6.56. (95% CI: 1.77–24.29. p = 0.004) for EC. A successful live birth was achieved in all pregnant patients positive for aPS/PT who received treatment with heparin, aspirin and/or hydroxychloroquine.

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“…1 About 15% of couples are affected by RPL, with significant consequences concerning their partnership and quality of life. 2,3 Parental chromosomal anomalies, uterine structural anomalies, maternal thrombophilic disorders and antiphospholipid antibodies have been directly associated with RPL. However, in almost 50 % of cases, the pathophysiology remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Peri conceptional association of the triad of hyperhomocsteinemia, hypothyroidism and impaired carbohydrate metabolism with recurrent pregnancy loss

Gadwal¹,

R²,

Rao

2021

Int J Reprod Contracept Obstet Gynecol

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Background: Recurrent pregnancy loss is a cause of great concern to the affected couple as well as the treating physician. We evaluated the periconceptional association of the triad of hyperhomocystienemia, hypothyroidism, and impaired carbohydrate metabolism with RPL and to identify the potential risk factors for RPL which are probably nutritional.Methods: Seven hundred ninety-six consecutive pregnancies with two or more abortions referring to our Infertility clinic were selected to be studied in a descriptive, prospective observational study in 2012-2014. All the pregnant women were subjected to routine blood tests/ examination/ imaging as per hospital protocols. All underwent TSH, FT4, GTT 75 gm (fasting and 2 h postprandial) as per routine antenatal workup. Additionally, fasting plasma homocysteine, antinuclear antibody, anti phospholipid antibody, anti- thyroid peroxidase antibody tests were performed for patients with RPL. All the patients were studied for the triad of hypothyroidism, hyperhomocysteinemia and impaired carbohydrate metabolism.Results: The incidence of RPL was found to be 5.65 %. Majority of women (51.1%) were in the age group 30-34 years. Majority of the women (55.6%) had 2 previous abortions. Majority of women (57.7%) had conceived normally. Majority of women (46.7%) had BMI<25. PCOS was reported in 28.9% women. HHcy, hypothyroidism and impaired carbohydrate metabolism was found in 78%, 73% and 73% women, respectively. The presence of two factors was reported in 60 to 65% women. 56% women reported the presence of the triad. About 7% of the patients underwent repeat abortion in second trimester of which 66.6% had the association of triad.Conclusions: Investigating these three factors in patients with RPL would help in early recognition, monitoring, and aggressive surveillance, which will help prevent obstetric complications. Simple nutritional correction may allow for better maternal and fetal programming and appropriate risk modulation.

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Immunological Risk Factors in Recurrent Pregnancy Loss: Guidelines Versus Current State of the Art

Cited by 71 publications

References 193 publications

A Brief Analysis of Tissue-Resident NK Cells in Pregnancy and Endometrial Diseases: The Importance of Pharmacologic Modulation

A Brief Analysis of Tissue-Resident NK Cells in Pregnancy and Endometrial Diseases: The Importance of Pharmacologic Modulation

Anti-Phosphatidylserine/Prothrombin Antibodies in Healthy Women with Unexplained Recurrent Pregnancy Loss

Peri conceptional association of the triad of hyperhomocsteinemia, hypothyroidism and impaired carbohydrate metabolism with recurrent pregnancy loss

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