Immunological Causes Associated to Foetal Death: An Update

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.