Immunological Causes Associated to Foetal Death: An Update (Pages 50-57)
Alejandra Comins Boo1, Juliana Ochoa Grullón1, Pluvio Coronado2, Miguel Ángel Herráiz2 and Silvia Sánchez-Ramón1
1Department of Clinical Immunology, Hospital Clínico San Carlos, Madrid, Spain; 2Department of Obstetrics & Gynecology, Hospital Clínico San Carlos, Madrid, Spain
Abstract: Up to 5% of couples at reproductive age suffer from at least two consecutive miscarriages, and around 1% experience three or more consecutive gestational losses, most of them during the first ten weeks of pregnancy, resulting in a significant personal, social and economic public health burden. The pregnancy losses occurring after the twentieth gestational week, namely foetal death or stillbirth, are even more emotionally and psychologically devastating for the couple. In almost half of these cases there is not any known cause of foetal death. In the last years, significant progress in the identification and treatment of the risk factors associated to foetal death has been made: advanced maternal age, obesity, pre-existing maternal diseases or acquired infections during pregnancy; and associated immunological disorders. Among the latter, the most common cause is the obstetric antiphospholipid syndrome, autoimmune disease that can present with placental infarction, thrombosis in the utero-placental circulation and foetal loss. Here we review the evidence of other immunological disorders that have been associated with intrauterine foetal death: non-diagnosed celiac disease, peripheral expansion of natural killer cells and diverse autoimmune or inflammatory abnormalities. The detection and control of such abnormalities in women with history of prior foetal death may lead to a successful subsequent pregnancy.
Keywords: Foetal loss, antiphospholipid syndrome, immunological causes.