Advanced

Multiple pregnancy failures: an immunological paradigm.

Matthiesen, Leif LU ; Kalkunte, Satyan and Sharma, Surendra (2012) In American Journal of Reproductive Immunology 67(4). p.334-340
Abstract
Recurrent spontaneous abortion (RSA), three or more pregnancy losses prior to 20 weeks, occurs in about 1% of all pregnancies, 50% of RSA cases remain unexplained and unresolved. Recently, immune pathways have been implicated in the pathophysiology of RSA. Immune tolerance of the fetal-placental unit and placental angiogenesis are mandatory for a successful pregnancy outcome. Unscheduled dysregulation of the placental vasculature is thought to be the pathophysiologic mechanisms underlying an array of pregnancy complications like infertility, miscarriage, pre-eclampsia, and fetal growth restriction and death. Investigations on mechanisms and management of RSA are mired by substandard design and lack of optimal randomized clinical trials and... (More)
Recurrent spontaneous abortion (RSA), three or more pregnancy losses prior to 20 weeks, occurs in about 1% of all pregnancies, 50% of RSA cases remain unexplained and unresolved. Recently, immune pathways have been implicated in the pathophysiology of RSA. Immune tolerance of the fetal-placental unit and placental angiogenesis are mandatory for a successful pregnancy outcome. Unscheduled dysregulation of the placental vasculature is thought to be the pathophysiologic mechanisms underlying an array of pregnancy complications like infertility, miscarriage, pre-eclampsia, and fetal growth restriction and death. Investigations on mechanisms and management of RSA are mired by substandard design and lack of optimal randomized clinical trials and have resulted in disagreement on guidelines for evaluation and treatments for patients with multiple pregnancy losses of unknown etiology. The present review focuses on evidence-based research discussion with immunologic causes, and immune-regulatory therapies recommended for helping patients with a history of RSA. We highlight data that might support revalidation of low molecular weight heparin as a protective therapy in RSA. Newly launched growth factors, GM-CSF, and potentially novel agents to suppress inflammatory rejection, including regulatory T cells, human chorionic gonadotropin, and M-CSF/IL-10, may work in concert with tender-loving-care therapy and give hope to couples with multiple pregnancy losses. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
American Journal of Reproductive Immunology
volume
67
issue
4
pages
334 - 340
publisher
Wiley-Blackwell
external identifiers
  • wos:000302600000011
  • pmid:22380628
  • scopus:84863402627
ISSN
1600-0897
DOI
10.1111/j.1600-0897.2012.01121.x
language
English
LU publication?
yes
id
77552f75-3260-4f5f-b26a-acc869fbf616 (old id 2432362)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/22380628?dopt=Abstract
date added to LUP
2012-04-03 08:00:14
date last changed
2017-11-05 04:43:10
@article{77552f75-3260-4f5f-b26a-acc869fbf616,
  abstract     = {Recurrent spontaneous abortion (RSA), three or more pregnancy losses prior to 20 weeks, occurs in about 1% of all pregnancies, 50% of RSA cases remain unexplained and unresolved. Recently, immune pathways have been implicated in the pathophysiology of RSA. Immune tolerance of the fetal-placental unit and placental angiogenesis are mandatory for a successful pregnancy outcome. Unscheduled dysregulation of the placental vasculature is thought to be the pathophysiologic mechanisms underlying an array of pregnancy complications like infertility, miscarriage, pre-eclampsia, and fetal growth restriction and death. Investigations on mechanisms and management of RSA are mired by substandard design and lack of optimal randomized clinical trials and have resulted in disagreement on guidelines for evaluation and treatments for patients with multiple pregnancy losses of unknown etiology. The present review focuses on evidence-based research discussion with immunologic causes, and immune-regulatory therapies recommended for helping patients with a history of RSA. We highlight data that might support revalidation of low molecular weight heparin as a protective therapy in RSA. Newly launched growth factors, GM-CSF, and potentially novel agents to suppress inflammatory rejection, including regulatory T cells, human chorionic gonadotropin, and M-CSF/IL-10, may work in concert with tender-loving-care therapy and give hope to couples with multiple pregnancy losses.},
  author       = {Matthiesen, Leif and Kalkunte, Satyan and Sharma, Surendra},
  issn         = {1600-0897},
  language     = {eng},
  number       = {4},
  pages        = {334--340},
  publisher    = {Wiley-Blackwell},
  series       = {American Journal of Reproductive Immunology},
  title        = {Multiple pregnancy failures: an immunological paradigm.},
  url          = {http://dx.doi.org/10.1111/j.1600-0897.2012.01121.x},
  volume       = {67},
  year         = {2012},
}