RESUMO
OBJECTIVE: To determine whether a correlation exists between gestational ages of idiopathic recurrent pregnancy loss (iRPL). STUDY DESIGN: Cohort of women with iRPL who had an initial loss (qualifying pregnancy [QP]) with precise documentation of gestational age. Outcomes in the immediate next pregnancy (index pregnancy [IP]) were compared between preembryonic (group I), embryonic (group II), or fetal (group III) losses in the QP. RESULTS: Three hundred thirty-four women met inclusion criteria. In their IP, group I had 41% preembryonic, 28% embryonic, and 10% fetal losses. Group II had 14% preembryonic, 53% embryonic, and 9% fetal losses. Group III had 19% preembryonic, 23% embroyonic, and 29% fetal loses. Correlation coefficient for type of loss among the QPs and IPs was 0.14, P = .009. CONCLUSIONS: Women with iRPL tend to have losses recur in the same gestational age period. Causes for RPL may be gestational age specific and should guide further investigations into causes.
Assuntos
Aborto Habitual/epidemiologia , Idade Gestacional , Adulto , Estudos de Coortes , Feminino , Humanos , GravidezRESUMO
OBJECTIVE: To estimate whether polymorphisms in the collagen 1Alpha1 gene (COL1Alpha1) and the transforming growth factor-beta gene (TGF-beta;1) are more common in women with cervical insufficiency than in those without the condition. METHODS: Medical, obstetric, and family histories and blood were obtained from women with (n=121) and those without (n=165) cervical insufficiency. DNA was extracted and purified by using commercial DNA isolation kits. Samples were analyzed for variants in two genes, the COL1A1 intron 1SP1 and TGF-beta Arg-25-Pro polymorphism, by using an allele-specific polymerase chain reaction assay. RESULTS: Thirty-four of 125 (27.2%) women with cervical insufficiency had at least one first-degree female relative affected. The frequency of the homozygous TT genotype in the COL1A1 gene was increased in women with a history of cervical insufficiency compared with controls (10.8% compared with 3.1%, P=.04). The TGF-beta polymorphisms (ArgPro and ProPro) also were increased in cases (38.3% compared with 14.6%, P<.001). CONCLUSION: Over one fourth of women with cervical insufficiency have a family history of cervical insufficiency, and the COL1A1 intron 1SP1 and TGF-beta Arg-25-Pro polymorphisms are associated with the condition. These observations suggest that, in part, cervical insufficiency is mediated by genetic factors. LEVEL OF EVIDENCE: II.
Assuntos
Colágeno Tipo I/genética , Polimorfismo Genético/genética , Fator de Crescimento Transformador beta/genética , Incompetência do Colo do Útero/genética , Estudos de Casos e Controles , Cerclagem Cervical , Feminino , Predisposição Genética para Doença , Genótipo , Humanos , Reação em Cadeia da Polimerase/métodos , Gravidez , Incompetência do Colo do Útero/cirurgiaRESUMO
Since Medawar's initial contemplations in 1953 on the mechanisms of immune evasion allowing for the survival of the allogeneic conceptus in an immunologically competent mother, physicians and immunologists alike have struggled to understand the immunological paradox of pregnancy. Ultimately, our attempts to define the immunology of normal pregnancy have broadened our appreciation of the myriad mechanisms at play that enable the promotion of implantation and maintenance of pregnancy. In this review, we summarise what is known regarding the immunology of normal pregnancy, with special emphasis on the relation to common disorders of pregnancy.