Impact of immunohematological evaluation as risk factors for recurrent miscarriage

Abstract

Recurrent miscarriage (RM) is defined as 3 consecutive pregnancy losses and has a frequency of 1-3% in reproductively active couples. The main causes are defined in approximately 50% of the cases and include inflammatory diseases, uterine malformations, infections, chromosomal abnormalities, auto-immune diseases (i.e.: antiphospolipid syndrome, Systemic Lupus Erythematosus, endocrine abnormalities (i.e.: obesity, diabetes, thyroid disorders, polycystic ovarian syndrome), tobacco use, alcohol consumption, moderate to high caffeine consumption, coagulation or thrombophilic disorders and environmental factors. An additional cause described is an inappropriate immune (cellular or humoral) response against the embryo. Recently, platelet and erythrocyte alloimmunization have been associated to RM, but the exact mechanism involved is not yet well understood. In approximately 50% of the cases, no causes for RM can be defined. These data have raised the question of immunohematological response being a risk factor for RM, and this cause might be specifically treated leading to a positive outcome of pregnancies. The present project aims to prospectively evaluate two distinct groups of patients: a control group of approximately 100 couples with a history of two or more uncomplicated term pregnancies and a group of approximately 100 couples presenting RM. In both groups, the frequencies of main platelet, erythrocyte and leucocyte (HLA) antigens will be defined, and the presence of alloantibodies against these antigens will be studied and a possible association of the alloantigens or the antibodies as risk factors for RM will be evaluated. This definition may point to a specific therapeutic intervention which could result in the success of pregnancies after previous RM. (AU)