Immunologic causes and thrombophilia in recurrent pregnancy loss

Certain miscarriages result from immunologic factors, but there is no clear identification of the precise causes of recurrent pregnancy loss (RPL). Miscarriages and RPL can arise from a disruption of maternal-fetal immune homeostasis. Remodeling of the maternal uterine spiral arteries is one of the key steps for normal growth and development of the fetus. An adequate oxygen supply is necessary for correct placentation, and it is accomplished by proper vascular changes. The development of fetal tissues creates a potential immunologic problem since the fetus can express paternal antigens and, in some cases, antigens of a gamete donor. The maternal immune system actively responds to fetal antigens, and dysregulation of this crosstalk could partly explain pregnancy complications such as miscarriages and RPL. RPL resulting from thrombophilia is primarily due to acquired thrombophilia, and therefore screening and treatment should be focused on antiphospholipid antibody syndrome. ((C) 2021 by American Society for Reproductive Medicine.)

Automated summary

Immunologic factors may contribute to miscarriages and recurrent pregnancy loss, with disruption of maternal-fetal immune homeostasis being a potential cause. Remodeling of maternal uterine spiral arteries is crucial for fetal development, ensuring adequate oxygen supply for proper placentation. Development of fetal tissues can lead to immunologic challenges, as the fetus may express paternal and gamete donor antigens, triggering a response from the maternal immune system.