REVIEW ARTICLE: Immunological Modes of Pregnancy Loss

Abstract

Citation Kwak‐Kim J, Park JC, Ahn HK, Kim JW, Gilman‐Sachs A. Immunological modes of pregnancy loss. Am J Reprod Immunol 2010During the implantation period, a significant portion of embryos are lost and eventually less than half of clinically established pregnancies end as full‐term pregnancies without obstetrical complications. A significant portion of these pregnancy losses is associated with immune etiologies, including autoimmune and cellular immune abnormalities. Although an autoimmune etiology such as anti‐phospholipid antibodies (APAs) has been reported to induce placental infarct and thrombosis at maternal–fetal interface, APAs induce inflammatory immune responses as well. Inflammatory immune responses, such as increased proportions of NK cells and Th1/Th2 cell ratios in peripheral blood are related to recurrent pregnancy losses and multiple implantation failures. Systemic and local inflammatory immune responses seem to be induced by activation of Toll‐like receptors with infectious agents, fetal cell debris, or gonadotropin‐releasing hormone agonist, etc. Cellular activation of T and NK cells leads to pro‐inflammatory cytokine storm and consequently, placental infarction and thrombosis. Potential application of anti‐inflammatory therapeutic agents for the prevention of pregnancy losses should be explored further.

Characteristics of immune cell changes before and after immunotherapy and their clinical significance in patients with unexplained recurrent spontaneous abortion

“…It has been reported that during the implantation period, a significant number of embryos are lost, and less than half of clinically established pregnancies eventually carry to full term without obstetric complications (Kwak-Kim et al, 2010). In this study, it was shown that most SAs and RSAs occurred soon after implantation, before the development of the fetal cardiac system as evidenced by the description of fetuses with empty gestational sacs and fetal poles without fetal cardiac activity.…”

“…In at least 35-44% of patients, the factors inducing abortion are still unclear; these particular cases are now referred to as unexplained recurrent spontaneous abortion (URSA). However, it has recently been shown that URSA has features of an alloimmune disease associated with failure of the fetal-maternal immunologic tolerance (Christiansen et al, 2004;Kwak-Kim et al, 2010;Leber et al, 2011).…”

Review Article: Causes of Recurrent of Abortion

“…They are considered deleterious to the pregnancy by direct embryotoxic activity or by damaging the placental trophoblasts. Conversely, high concentrations of the anti-inflammatory cytokines IL-4, -6, -10, and -13 (Th2 type) are beneficial to the developing embryo by enhancing placental growth and function (53). Evidence exists that inter individual variation in the inflammatory cytokine response may affect the risk of unexplained recurrent pregnancy loss (RPL).…”

The Role of Glucocorticoids in Pregnancy: Four Decades Experience with Use of Betamethasone in the Prevention of Pregnancy Loss

“…. Nevertheless, abnormal inflammatory events may lead to adverse pregnancy outcomes, such as implantation failure, pregnancy loss, preeclampsia, preterm labour, intrauterine growth restriction (IUGR), and foetal inflammatory syndrome (Kwak-Kim et al, 2010). Disregulation of cell function mediators can simply derive from genetic conditions, with no need for infectious or inflammatory external stimuli.…”