American Journal of Reproductive Immunology最新文献

Pregnancy loss affects approximately 23% of women, with 1%–3% experiencing recurrent pregnancy loss (RPL), defined as two or more consecutive miscarriages. Despite extensive research, up to 50% of RPL cases remain unexplained, making it a complex issue in reproductive medicine. Coagulation Factor XII (FXII) a key component of the contact activation pathway, has been suggested to play a role in RPL. Low FXII levels may lead to placental dysfunction and hypercoagulability, increasing the risk of adverse pregnancy outcomes, including RPL. This scoping review aimed to evaluate the association between FXII levels and RPL. Literature was retrieved from the PubMed database and EMBASE by a systematic search. A total of 218 studies were identified, of which 12 met the inclusion criteria published between 1992 and 2015, encompassing a total of 2362 RPL patients. They investigated FXII activity (n = 7), the C46T polymorphism (n = 3), or autoantibodies to FXII (n = 2) association to RPL. Available evidence suggests a potential association between low FXII levels, FXII antibodies, and RPL, probably via a prothrombotic mechanism as indicated by studies conducted 10–30 years ago. This highlights the need for further and more recent research to better elucidate the role of FXII in reproductive health and pregnancy outcomes.

Problem: Systemic lupus erythematosus (SLE) is characterized by an abnormal immune response, leading to elevated levels of autoantibodies that may distress the hepatic, renal, and central nervous systems. Cognitive dysfunction (CD) is the second most common neuropsychiatric symptom reported in SLE patients, after headache. CD has been linked to increased liver serum markers and kidney dysfunction in SLE patients. However, CD has not been previously described in pregnant women with SLE, although it can significantly impact decision-making and quality of life during pregnancy. Our primary goal was to assess the prevalence of CD in pregnant women with quiescent SLE (QSLE). Additionally, we aimed to describe the correlation between CD and serum levels of autoantibodies, complement system components, and hepatic and renal serology.

Method of study: We conducted a cross-section study involving QSLE pregnant women (n = 63) and healthy pregnant controls (n = 52) in their third trimester. CD was assessed using the MoCA test. Biochemical determinations were performed by ELISA, and clinical data for creatinine and urea were also analyzed.

Results: Higher CD rates were observed in QSLE pregnant women (30.16 %, QSLE CD(+)) compared to the healthy group (5.7%, CTR CD(+)). Serum levels of liver (ALT: QSLE CD(+) 65.9 ± 26.5 vs. QSLE CD(-) 39.9 ± 14.6, p = 0.00) and renal markers (urea: QSLE CD(+) 6.27 ± 2.1 vs. QSLE CD(-) 3.3 ± 1.1, p = 0.00) were significantly elevated in QSLE CD(+) pregnant women. AST and ALT showed a significant correlation with the MoCA score for QSLE CD(+) patients.

Conclusions: MoCA total score, as well as attention, visuospatial/executive, and abstraction domains were found to be impaired in QSLE CD(+) pregnant patients. Subclinical liver and kidney dysfunction were associated with cognitive impairment in QSLE pregnant women.

Background: The relationship between sex hormone-binding globulin (SHBG) levels and the risk of adverse pregnancy outcomes (APOs) remains controversial. A two-sample Mendelian randomization (MR) study was performed to clarify the causality of SHBG on the risk of APO.

Methods: Significant single-nucleotide polymorphisms (SNPs) associated with SHBG levels were obtained from the genome-wide association study (GWAS) in the European population. Summary statistics of the number of spontaneous miscarriages, preeclampsia, gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP), and female infertility were utilized as the outcome. The causality was examined primarily by inverse-variance weighted (IVW), along with MR-Egger regression, weighted median estimator, and weighted mode method.

Results: Based on the IVW model, every genetically predicted standard deviation (SD) increase in SHBG levels was causally associated with 0.023 SDs decrease of the number of spontaneous miscarriages (Beta ± SE: -0.023 ± 0.010, p = 0.018), 11.3% decrease of the risk of preeclampsia (OR = 0.887, 95% CI: 0.806-0.977, p = 0.015), 17% decrease of the risk of GDM (OR = 0.830, 95% CI: 0.753-0.914, p = 0.000), 23.6% decrease of the risk of ICP (OR = 0.764, 95% CI: 0.584-0.999, p = 0.049), and 14% decrease of the risk of infertility (OR = 0.860, 95% CI: 0.777-0.951, p = 0.003).

Conclusion: Our study indicated that the increased levels of SHBG could significantly reduce the risk of APO. SHBG may be helpful as the indicator for preconception risk assessment and pregnancy risk monitoring. These findings are limited to European and require further validation in diverse populations.