Recurrent miscarriage is a very frustrating medical problem for couples trying to have children, as well as for the health professionals who assist the affected women, since it is very difficult to determine what the cause of these miscarriages is and how to avoid it.
With regard to the immunological causes accepted in the American and English international guidelines, up to now only the anti-phospholipid syndrome or Hughes syndrome, which affects blood coagulation, is considered to have a negative effect on pregnancy, and is included as part of the study recommended for these patients.
Advances in the identification of immunologic causes of recurrent miscarriage
However, in recent years much information has been accumulating on different immunological mechanisms that could explain why miscarriages occur.
From the beginning of gestation, a delicate and fine interaction is established between the mother and the foreign antigens of the fetus that correspond to the couple, and important tissue changes are produced related to the formation of new tissues, new blood vessels, production of hormones, cytokines, recirculation of different cell types, etc.
In most of these processes, the immune system is actively involved, hence, it seems logical to assume that if there are failures in the system, these may lead to a poor evolution of the pregnancy.
First world congress on recurrent miscarriage
In January of this year, the first world congress on recurrent miscarriage was held in Cannes, where experts from all continents gathered to review the latest advances in the field of the study and treatment of this problem.
It was agreed that the definition of recurrent miscarriage is established when 2 or more miscarriages have occurred, and the importance of the adequate characterization of cases was discussed.
Advances on the characterization of HLA polymorphisms, HLA-DQ2/DQ8 haplotypes, circulating and uterine NK cells, regulatory T cells, CD8+DR+ T cells, TH17 cells, Th1/Th2/TH17 cytokine profiles, antinuclear antibodies, anti-thyroid antibodies, the inflammasome and innate immunity, among others, were presented.
The current status of the study of chromosomal aberrations, the role of paternal factors, polycystic ovary, placental angiogenesis, as well as the detection of anatomical factors by 3D ultrasound, early ultrasound evaluation of fetal anatomy, pre-implantation genetic diagnosis or the role of chronic histiocytic intervillocytis were also updated.
Important aspects of lifestyle, vitamin D deficiency, hereditary thrombophilias and stress were also reviewed in relation to their possible influence on the pathogenesis of recurrent miscarriage.
The latest data on the possible therapeutic role of heparin, intravenous immunoglobulins, prednisone, G-CSF and GM-CSF factors as well as intralipid treatment also occupied an important place in this congress, in order to find a clear answer to the cause of recurrent miscarriage and to develop the best solution.