Understanding the Role of the Immune System in Recurrent Miscarriage

A number of important adaptations of the maternal immune system occur during pregnancy and recurrent miscarriage has been associated with disruptions to these mechanisms. 

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In particular, recurrent miscarriage has been associated in human studies with an increased Th1/Th2 ratio, reduced T regulatory cells, increased Th17 cells, and increased peripheral natural killer cells. These findings, coupled with extensive evidence of their importance in animal models of pregnancy loss, have led to suggestions that in some women immunological factors may be the cause of miscarriage. 

To date the studies have been exploratory, limited by small sample sizes, single centre recruitment, and heterogeneity of the assays utilised. Such deficiencies in the existing evidence mean that national guidelines do not currently support detailed immunological testing. However, patient and clinician demand has led to a rapid expansion in testing outside NHS settings, without a robust evidence base to aid interpretations of the findings.

Therefore we are conducting research to elucidate the role of immune testing in patients with recurrent miscarriages, and identify potential targets for immune therapy. Our investigations will enable us to ensure that couples seeking help with recurrent miscarriage are given correct advice regarding the significance or not of immunological tests and the implications of the results for their future prognosis.

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