Unexplained recurrent miscarriages: predictive value of immune biomarkers and immunomodulatory therapies for live birth

Abstract

Introduction: Recurrent miscarriages are defined as three or more early miscarriages before 12 weeks of gestation. The aim of this study was to describe a cohort of women with unexplained recurrent miscarriages, evaluate several potential biomarkers of immune origin, and describe the outcome of pregnancies under immunomodulatory therapies.Methods: Women having a history of at least 3 early miscarriages without any etiology were recruited from 3 university hospitals.Results: Among 101 women with recurrent miscarriages, overall, 652 pregnancies have been included in the analysis. Women which experienced miscarriages were older (33.3 ± 5.4 versus 31.9 ± 6.7; p = 0.03), with history of more pregnancies (4 (2-6) versus 3.5(1-5.75); p 0.0008), and less frequently the same partner (406 (74%) versus 79 (86%); p=0.01). There was no difference in the level and frequencies of biomarkers of immune origin (NK, lymphocyte, gamma globulins and blood cytokine levels and endometrial uNK activation status), except the higher rates of positive antinuclear antibodies in women with live birth (12 (13%) versus 36 (7%); p=0.03). Among the 652 pregnancies, 215 (33%) have been treated and received either aspirin/low weighted molecular heparin (LMWH) and/or combined to different lines of immunomodulatory treatment.Patients with pregnancy under treatment had a significantly higher rate of cumulative live birth rate than those with untreated ones (43.0% vs 34.8%; p = 0.04). When compared to patients with untreated pregnancies, patients with steroids during the pregnancy had twice more chances to obtain live birth (OR 2.0, CI95% 1.1 -3.7, p = 0.02). Conclusions:Unexplained recurrent miscarriages could have improved obstetrical outcome under immunomodulatory therapies and in particular steroids.

The Efficacy and Safety of the Zhuyun Formula and Auricular Acupressure for the Infertile Women with Recurrent Implantation Failure: A Randomized Controlled Trial

“…About 1∼3% of women experience early recurrent implantation failure; about 50% of patients are associated with unexplained RIF [ 21 – 23 ]. Many studies have found that the cytokine balance of Th1/Th2/Th17/regulatory T cells (Treg) plays an important role in the maintenance of embryo implantation and normal pregnancy, especially for unexplained RIF [ 23 ].…”

“…We believe this is the first time to evaluate the efficacy and maternal and child health of the CAM therapy (ZYF with auricular acupressure) for the RIF and a correlation between serum T lymphocyte expression and the use of the CAM therapy in IVF cycles has been reported. 4 Evidence-Based Complementary and Alternative Medicine About 1∼3% of women experience early recurrent implantation failure; about 50% of patients are associated with unexplained RIF [21][22][23]. Many studies have found that the cytokine balance of 1/ 2/ 17/regulatory T cells (Treg) plays an important role in the maintenance of embryo implantation and normal pregnancy, especially for unexplained RIF [23].…”

“…4 Evidence-Based Complementary and Alternative Medicine About 1∼3% of women experience early recurrent implantation failure; about 50% of patients are associated with unexplained RIF [21][22][23]. Many studies have found that the cytokine balance of 1/ 2/ 17/regulatory T cells (Treg) plays an important role in the maintenance of embryo implantation and normal pregnancy, especially for unexplained RIF [23]. e disorder of the cytokine balance will lead to repeated implantation failure and recurrent abortion.…”

Unexplained recurrent miscarriages: Predictive value of immune biomarkers and immunomodulatory therapies for live birth

“…Dear Editor, I would like to congratulate you on the publication of the article entitled Unexplained Recurrent Miscarriages: Predictive Value of Immune Biomarkers and Immunomodulatory Therapies for Live Birth, by Kolanska et al 1 Medical centers are characterized by the plurality of its audience, with personalized treatments and outcomes of non-homogeneous populations. Although it is not possible to make a population inference from a longitudinal observational study due to the heterogeneity of its sample, it seems to be very helpful in the practical reality.…”

“…The Kolanska et al 1 study defined spontaneous miscarriage as miscarriage before 12 weeks gestation, with the same partner. Regardless of the conceptual definition on recurrent miscarriage, which varies along studies, the risk of miscarriage increases independently with maternal age and the number of previous losses.…”