Maternal-fetal immunity and recurrent spontaneous abortion.

Recurrent Spontaneous Abortion (RSA) is a common pregnancy complication, that has multifactorial causes, and currently, 40%-50% of cases remain unexplained, referred to as Unexplained RSA (URSA). Due to the elusive etiology and mechanisms, clinical management is exceedingly challenging. In recent years, with the progress in reproductive immunology, a growing body of evidence suggests a relationship between URSA and maternal-fetal immunology, offering hope for the development of tailored treatment strategies. This article provides an immunological perspective on the pathogenesis, diagnosis, and treatment of RSA. On one hand, it comprehensively reviews the immunological mechanisms underlying RSA, including abnormalities in maternal-fetal interface immune tolerance, maternal-fetal interface immune cell function, gut microbiota-mediated immune dysregulation, and vaginal microbiota-mediated immune anomalies. On the other hand, it presents the diagnosis and existing treatment modalities for RSA. This article offers a clear knowledge framework for understanding RSA from an immunological standpoint. In conclusion, while the "layers of the veil" regarding immunological factors in RSA are gradually being unveiled, our current research may only scratch the surface. In terms of immunological etiology, effective diagnostic tools for RSA are currently lacking, and the efficacy and safety of immunotherapies, primarily based on lymphocyte immunotherapy and intravenous immunoglobulin, remain contentious.

Brief of Amici Curiae economists in support of respondents in Dobbs v. Jackson Women's Health Organization.

A pillar of Mississippi's argument in Dobbs v. Jackson Women's Health was that there is no evidence of "societal reliance" on abortion, meaning no reason to believe that access to abortion impacts the ability of women to participate in the economic and social life of the nation. Led by economist Caitlin Myers and attorney Anjali Srinivasan, more than 150 economists filed an amicus brief seeking to assist the Court in understanding that this assertion is erroneous. The economists describe developments in causal inference methodologies over the last three decades, and the ways in which these tools have been used to isolate the measure of the effects of abortion legalization in the 1970s and of abortion policies and access over the ensuing decades. The economists argue that there is a substantial body of well-developed and credible research that shows that abortion access has had and continues to have a significant effect on birth rates as well as broad downstream social and economic effects, including on women's educational attainment and job opportunities. What follows is a reprint of this brief.

Coxiella burnetii and Reproductive Disorders in Cattle: A Systematic Review.

Coxiellosis or Q fever is an infectious zoonotic disease caused by the bacterium Coxiella burnetii. A systematic review using bibliographic research was carried out, and the focus was the relationship between C. burnetii infection and reproductive disorders in cattle [abortion/stillbirth/perinatal morality/weak calves (ASPW complex); retained foetal membranes (RFMs); metritis/endometritis; and infertility/sub-fertility]. The bibliographical search yielded 443 results from databases, but only 61 were deemed eligible. For each disorder, summary tables were prepared, and a scientific evidence score was calculated for each study based on four criteria to help assess the level of evidence for the impact of C. burnetii on the reproductive disorders assessed: type of publication (peer-reviewed or other); type of study (case-control/cohort or other); type of C. burnetii test (direct or indirect); and comparative statistical analysis (yes or no). In addition, summary tables also included information on the study population, country, authors and year of publication, key findings and an assessment of the evidence for an association. For the ASPW complex, RFMs, metritis/endometritis and infertility/sub-fertility, 43, 9, 8 and 19 studies provided data, respectively. On a scale of four, nearly 50% of all study citations had evidence scores of three or four. For ASPW, RFMs and infertility/sub-fertility, there is a significant body of evidence to support a deleterious role for Q fever. In contrast, for metritis/endometritis, the evidence is unclear. It is concluded that there is a substantial need for further research, particularly involving larger animal populations in more controlled settings. To provide more consistency, it is recommended that authors follow more precise definitions of reproductive parameters and more robust diagnostic methodologies.

Bioinformatics-based analysis of the dialog between COVID-19 and RSA.

Pregnant women infected with SARS-CoV-2 in early pregnancy may face an increased risk of miscarriage due to immune imbalance at the maternal-fetal interface. However, the molecular mechanisms underlying the crosstalk between COVID-19 infection and recurrent spontaneous abortion (RSA) remain poorly understood. This study aimed to elucidate the transcriptomic molecular dialog between COVID-19 and RSA. Based on bioinformatics analysis, 307 common differentially expressed genes were found between COVID-19 (GSE171110) and RSA (GSE165004). Common DEGs were mainly enriched in ribosome-related and cell cycle-related signaling pathways. Using degree algorithm, the top 10 hub genes (RPS27A, RPL5, RPS8, RPL4, RPS2, RPL30, RPL23A, RPL31, RPL26, RPL37A) were selected from the common DEGs based on their scores. The results of the qPCR were in general agreement with the results of the raw letter analysis. The top 10 candidate drugs were also selected based on P-values. In this study, we provide molecular markers, signaling pathways, and small molecule compounds that may associate COVID-19. These findings may increase the accurate diagnosis and treatment of COVID-19 patients.

Do Not Risk Homicide: Abortion After 10 Weeks Gestation.

When an abortion is performed, someone dies. Are we killing a human person? Widespread disagreement exists. However, it is not necessary to establish personhood in order to establish the wrongness of abortion: a substantial chance of personhood is enough. We defend The Do Not Risk Homicide Argument: abortions are wrong after 10 weeks gestation because they substantially and unjustifiably risk homicide, the unjust killing of a human person. Why 10 weeks? Because the cumulative evidence establishes a substantial chance (a more than one in five chance) that preborn human beings are persons after 10 weeks (if not before then). We submit evidence from our bad track record, widespread disagreement about personhood (after 10 weeks gestation), problems with theories of personhood, the similarity between preborn human beings and premature newborns, miscalculations of gestational age, and the common intuitive responses of women to their pregnancies and miscarriages. Our argument is cogent because it bypasses the stalemate over preborn personhood and rests on common ground rather than contentious metaphysics. It also strongly suggests that society must do more to protect preborn human beings. We briefly discuss its practical implications for fetal pain relief, social policy, and abortion law.

Impact of the Dobbs decision on abortion services from a large tertiary center in Oregon.

OBJECTIVE: Evaluate the impact of the Dobbs vs Jackson decision on abortion volume and patient characteristics in Oregon, a state with no legal restrictions on abortion, at a single tertiary care hospital. METHODS: Electronic health records from patients who received an abortion at Oregon's largest tertiary health center were utilized comparing the year before and after Dobbs. RESULTS: Monthly average abortions increased from 57.8 pre-Dobbs to 77.1 post-Dobbs (p=0.001). This trend was associated with an increased proportion of out-of-state patients (14.3% vs 9.5%, p=0.004) presenting with gestational duration ≥ 26 weeks (23.6% vs 3.7% in-state, p<0.001). CONCLUSIONS: The Dobbs decision resulted in increased utilization of hospital-based abortion care in a protective state, characterized by a greater prevalence of patients traveling from out-of-state and presenting at later gestational durations. These trends reflect the critical role of protective states in preserving access to abortion care.

The role of doulas and community birth workers in abortion and contraception care: An international scoping review.

OBJECTIVES: Equitable and safe access to abortion and contraception is essential to protecting reproductive autonomy. Despite this, barriers to access remain. "Doulas", non-clinical support people providing supporting throughout the perinatal period, may be able to facilitate access to abortion and contraception services and care, but evidence on the scope and efficacy of doulas in abortion and contraception care is lacking. The aim of this scoping review was to synthesize what is known about the role of doulas in abortion and contraception care. STUDY DESIGN: We followed the Joanna Briggs Institute (JBI) methodology for scoping reviews. A clinical librarian performed an initial search of all relevant databases. Three reviewers independently screened the titles and abstracts for assessment against the inclusion and exclusion criteria. The populations of interest included doulas, non-clinical and/or untrained birth attendants and birth companions, and patients who use doula services. The concept of interest was the doula role and the context was access to abortion or contraception care RESULTS: Our review identified thirty-three relevant studies conducted in sixteen different countries, published between 1976 and 2023. Studies broadly focused on three key themes: doulas performing procedural abortions, doulas supporting abortion care, and doulas supporting contraception. Outcomes of interest included client outcomes, barriers to access, and doula training, roles and attitudes. CONCLUSIONS: Doulas have the potential to improve client satisfaction and mitigate barriers to accessing abortion and contraception services. Further research is needed to identify the training needs of doulas, the potential for their integration into interdisciplinary abortion and contraception care teams, and the doula role in supporting medication abortion. DATA AVAILABILITY STATEMENT: Data sharing is not applicable to this article as no new data were created or analyzed in this study.

Seroprevalence and molecular detection of brucellosis among Pakistani women with spontaneous abortion.

Background: Human brucellosis is a neglected disease transmitted to humans from animals such as cattle, goats, dogs, and swine. The causative agents are bacteria of the genus Brucella, intracellular pathogens usually confined to the reproductive organs of their animal hosts causing sterility and abortions. The objective of the study was to determine the seroprevalence of brucellosis among women with spontaneous abortions (SAW) and compare this seroprevalence with that of healthy pregnant women (HPW). Methods: The case-control study was designed to determine the seroprevalence and molecular detection of brucellosis in women who suffered from spontaneous abortion and healthy pregnant women of the Haripur District of Pakistan. A total of 770 blood samples (n = 385 for each group) were collected from 9 public and 11 private hospitals in Haripur District from December 2021-March 2023. Data on demographic features, epidemiological variables, and risk factors were collected from each participant by structured questionnaires. Initial screening for brucellosis was performed by Rose Bengal Plate Test followed by qRT-PCR for molecular detection of the genus-specific BCSP-31 gene of Brucella. Results: The study showed that anti-Brucella antibodies were more found in SAW 23.63% (91/385) than in HPW 1.29% (5/385). Brucella specific DNA was amplified in 89.01% (81/91) seropositive samples of SAW. Demographic features and risk factors such as age, urbanicity, socioeconomic status, education, occupation, and animal contact were found significantly associated with brucellosis (p ≤ 0.05). Consumption of unpasteurized raw milk (OR = 18.28, 95%CI: 8.16-40.94) was found highly concomitant with seroprevalence. Conclusion: This study reports the first evidence of involvement of brucellosis in spontaneous abortions in women of Pakistan. The study can be used to develop strategies for risk management during pregnancy, to raise awareness for brucellosis, and develop control programs.

Telehealth Medication Abortion in Primary Care: A Comparison to Usual in-Clinic Care.

INTRODUCTION: Providing abortion in primary care expands access and alleviates delays. The 2020 COVID-19 public health emergency (PHE) led to the expansion of telehealth, including medication abortion (MAB). This study evaluates the accessibility of novel telehealth MAB (teleMAB) initiated during the PHE, with the lifting of mifepristone restrictions, compared with traditional in-clinic MAB offered before the PHE at a Massachusetts safety-net primary care organization. METHODS: We conducted a retrospective electronic medical record review of 267 MABs. We describe sociodemographic, care access, and complete abortion characteristics and compare differences between teleMAB and in-clinic MABs using Chi-squared test, fisher's exact test, independent t test, and Wilcoxon rank sum. We conducted logistic regression to examine differences in time to care (6 days or less vs 7 days or more). RESULTS: 184 MABs were eligible for analysis (137 in-clinic, 47 teleMAB). Patients were not significantly more likely to receive teleMAB versus in-clinic MAB based on race, ethnicity, language, or payment. Completed abortion did not significantly differ between groups (P = .187). Patients received care more quickly when accessing teleMAB compared with usual in-clinic MAB (median 3 days, range 0 to 20 vs median 6 days, range 0 to 32; P < . 001). TeleMAB patients had 2.29 times the odds of having their abortion appointment within 6 days compared with in-clinic (95% CI: 1.13, 4.86). CONCLUSION: TeleMAB in primary care is as effective, timelier, and potentially more accessible than in-clinic MAB when in-person mifepristone regulations were enforced. TeleMAB is feasible and can promote patient-centered and timely access to abortion care.

Pregnancy, abortion, and birth control methods' complicity with breast cancer occurrence.

Reproductive factors play significantly important roles in determining the breast cancer (BC) risk. The impact of pregnancy, abortion, and birth control methods on tumor development remains unclear. It has been found that early full-term pregnancies in young women can lower their lifetime risk of developing the type of cancer in question. However, having a first full-term pregnancy at an older age can increase this risk. The relationship between pregnancy and breast cancer (BC) is, however, much more complicated. Both induced and spontaneous abortions lead to sudden changes in hormonal balance, which could cause different effects on sensitive breast epithelial cells, making abortion a potential risk factor for breast cancer. The influence of hormonal contraception on carcinogenesis is not comprehensively understood, and therefore, more exhaustive analysis of existing data and further investigation is needed. This review explores how the mentioned reproductive factors affect the risk of breast cancer (BC), focusing on the molecular mechanisms that contribute to its complexity. By comprehending this intricate network of relationships, we can develop new strategies for predicting and treating the disease.

Availability of Mifepristone and Misoprostol in Oregon Pharmacies: A Comparison by Rural and Urban Status.

OBJECTIVES: To evaluate the availability of mifepristone and misoprostol at pharmacies in a state with protective abortion legislation and variation in access by rurality. STUDY DESIGN: Using a secret shopper survey, researchers attempted to contact all community pharmacies in Oregon and evaluate their mifepristone and misoprostol provision. RESULTS: Among the 444 pharmacies surveyed, mifepristone was planned at 19.2%. Misoprostol was available at 77.5%, but stocking issues and medication ordering impact access, without significant difference by rurality. CONCLUSIONS: Pharmacy engagement and support is key to increasing access to these essential medicines, which may be improved through education and referral programs.

Is it an abortion: Classification of pregnancy-ending interventions after 24 weeks in the presence of lethal fetal anomalies.

OBJECTIVE: To determine how obstetrician-gynecologists categorize pregnancy-ending interventions in the setting of lethal fetal anomalies. STUDY DESIGN: We conducted a sequential explanatory mixed methods study of U.S. obstetrician-gynecologists from May to July 2021. We distributed a cross-sectional online survey via email and social media and completed qualitative telephone interviews with a nested group of participants. We assessed institutional classification as induced abortion versus indicated delivery for six scenarios of ending a pregnancy with lethal anomalies after 24 weeks, comparing classification using McNemar chi-square tests with Benjamini-Hochburg correction for multiple comparisons with false discovery rate of 0.05. We performed thematic analysis of qualitative data and then performed a mixed methods analysis. RESULTS: We included 205 respondents; most were female (84.4%), had provided abortion care (80.2%), and were general OB/GYNs (59.3%), with broad representation across pre-Dobbs state and institutional abortion policies. Twenty-one qualitative participants had similar characteristics to the whole sample. Scenarios were classified as induced abortion by the majority of respondents, ranging from 53.2% for 32-week induction for anencephaly, to 82.9% for feticidal injection and 24-week induction for anencephaly. Mixed methods analysis revealed the relevance of gestational age (later interventions less likely to be considered induced abortion) and procedure method and setting (dilation and evacuation, feticidal injection, and freestanding facility all increasing classification as induced abortion). CONCLUSION: There is wide variation in classification of pregnancy-ending interventions for lethal fetal anomalies, even among trained OB/GYNs. Method, timing, and location of ending a nonviable pregnancy influence classification, though perinatal outcome is unchanged. IMPLICATIONS: The classification of pregnancy-ending interventions for lethal fetal anomalies after 24 weeks as indicated delivery versus induced abortion is reflective of sociopolitical regulatory factors as opposed to medical science. The regulatory requirement for classification negatively impacts access to care, especially in environments where induced abortion is legally restricted.

Analysis of the relationship between religion, abortion, and assisted reproductive technology: Insights into cross-national public opinion.

With advancement in reproductive technologies, public opinion regarding these procedures varies considerably across the world. While prominent public debates have focused on abortion, we know less about the factors shaping feelings regarding Assisted Reproductive Technologies (ART). Both procedures challenge the idea that human life starts with conception - with the fertilization of an embryo. Using European Values Survey data and multilevel modeling, we compare how religion and other personal and country-level factors shape disapproval toward abortion and ART. Conservative Protestants and people who are more engaged with their religion and live in a more religious country are more likely to disapprove of abortion and ART. More supportive polices and attitudes regarding ART, but not abortion, are correlated. Additionally, economic development moderates the relationship between personal religiosity and abortion, but not ART. This finding provides important insight into why abortion has remained such a controversial issue, even in richer nations.

Subacute exposure to DEHP leads to impairing decidualization process and exacerbating the risk of early pregnancy miscar-riage in mice. / 孕早期增塑剂DEHPäºšæ€¥æ€§æš´éœ²å½±å“èœ•è†œååº”å¹¶å¢žåŠ æµäº§é£Žé™©.

OBJECTIVES: To investigate the effect of subacute exposure of Di (2-ethylhexyl) phthalate (DEHP) on endometrial decidualization in mice. METHODS: CD1 mice were orally administrated with 300 mg·kg－1·d－1 (low-dose group), 1000 mg·kg－1·d－1 (medium-dose group), or 3000 mg·kg－1·d－1 DEHP (1/10 LD50, high-dose group) for 28 days, respectively. The early natural pregnancy model and artificially induced decidualization model were established, and the uterine tissues were collected on D7 of natural pregnancy and D8 of artificially induced decidualization, respectively. The effects of subacute exposure to DEHP on the decidualization of mice were detected by HE staining, Masson staining, TUNEL staining, and Western blotting, respectively. A model of spontaneous abortion was constructed in mice after subacute exposure to 300 mg·kg-1·d-1 DEHP, and the effect of impaired decidualization on pregnancy was investigated by observing the pregnancy outcome on the 10th day of gestation. RESULTS: Compared with the control group, the conception rate was significantly lower in the high-dose DEHP subacute exposure group. HE staining showed that, compared with the control group, the decidual stromal cells in the low- and medium-dose exposure groups were disorganized, the nuclei of the cells were irregular, the cytoplasmic staining was uneven, and the number of polymorphonuclear cells was significantly reduced. Masson staining showed that compared with the control group, the collagen fibers in the decidua region of the DEHP low-dose group and the medium-dose group were more distributed, more abundant and more disorderly. TUNEL staining showed increased apoptosis in the decidua area compared to the control group. Western blotting showed that the expression of BMP2, a marker molecule for endometrial decidualization, was significantly reduced. The abortion rate and embryo resorption rate were significantly higher, and the number of embryos, uterine wet weight, uterine area and placenta wet weight were significantly lower in mice exposed to 300 mg·kg－1·d－1 DEHP than in control mice stimulated by mifepristone abortifacient drug. CONCLUSIONS: Subacute exposure to DEHP leads to impaired endometrial decidualization during early pregnancy and exacerbates the risk of adverse pregnant outcomes in mice.

Analysis of copy number variants detected by sequencing in spontaneous abortion.

BACKGROUND: The incidence of spontaneous abortion (SA), which affects approximately 15-20% of pregnancies, is the most common complication of early pregnancy. Pathogenic copy number variations (CNVs) are recognized as potential genetic causes of SA. However, CNVs of variants of uncertain significance (VOUS) have been identified in products of conceptions (POCs), and their correlation with SA remains uncertain. RESULTS: Of 189 spontaneous abortion cases, trisomy 16 was the most common numerical chromosome abnormality, followed by monosomy X. CNVs most often occurred on chromosomes 4 and 8. Gene Ontology and signaling pathway analysis revealed significant enrichment of genes related to nervous system development, transmembrane transport, cell adhesion, and structural components of chromatin. Furthermore, genes within the VOUS CNVs were screened by integrating human placental expression profiles, PhyloP scores, and Residual Variance Intolerance Score (RVIS) percentiles to identify potential candidate genes associated with spontaneous abortion. Fourteen potential candidate genes (LZTR1, TSHZ1, AMIGO2, H1-4, H2BC4, H2AC7, H3C8, H4C3, H3C6, PHKG2, PRR14, RNF40, SRCAP, ZNF629) were identified. Variations in LZTR1, TSHZ1, and H4C3 may contribute to embryonic lethality. CONCLUSIONS: CNV sequencing (CNV-seq) analysis is an effective technique for detecting chromosomal abnormalities in POCs and identifying potential candidate genes for SA.

Impact of Post-Dobbs Abortion Restrictions on Maternal Fetal Medicine Physicians in the Southeast: A Qualitative Study.

BACKGROUND: The US Supreme Court overturned federal abortion protections in Dobbs v. Jackson Women's Health Organization. Many states in the Southeastern US responded with restrictive policies that limit and criminalize abortion care. OBJECTIVE: To characterize the impacts of abortion restrictions on maternal fetal medicine physicians (MFMs) in the Southeastern US post Dobbs. STUDY DESIGN: We conducted qualitative, semi-structured interviews with 35 MFMs in 10 Southeastern states between February and June 2023. Our recruitment strategy relied on convenience and snowball sampling. Audio-recorded interviews were analyzed using Dedoose software and a descriptive qualitative approach that incorporated deductive and inductive approaches. RESULTS: Emergent themes were identified, and a conceptual framework was developed based on overarching themes. We found that abortion laws and external constraints following Dobbs resulted in ethical, professional, and legal challenges for MFMs that led to changes in clinical practice and deviations from patient-centered care. These forced changes resulted in negative impacts on MFMs such as increased fear, hypervigilance, and increased workload for MFMs. The changes also prompted concerns about health risks and negative emotional impacts for patients. Supportive colleagues, hospital systems, and policies were associated with decreased stress, emotional distress, and disruption of healthcare delivery. CONCLUSIONS: Abortion restrictions in the Southeastern US limit the ability of MFMs to provide or facilitate abortions in the setting of fetal anomalies and maternal health risk. MFMs perceived these restrictions to have negative professional and emotional repercussions for themselves, as well as negative impacts on patients. Supportive colleagues and clear guidance from hospital systems and departments on how to interpret laws were protective. Our findings have implications for the MFM workforce and patient care in the region.

Impairment Arguments, Interests, and Circularity.

A common justification for abortion rights is that the death of the fetus does not violate any of the fetus's time-relative interests. The time-relative interest account (TRIA) of harm and wrongdoing tells us that a necessary condition for harming someone is that his or her time-relative interests are frustrated. Regarding the justification for abortion, this account falls prey to impairment arguments. Impairment arguments entertain cases of prenatal injury, such as the mother using illicit drugs that disable the child. The intuition is that the child who is born with such disabilities is harmed by the mother's drug use. But it is unclear what time-relative interest is violated in cases of prenatal harm. Typical responses to impairment arguments point out that the abortion case is different because the child does not exist to experience such harms; but in prenatal injury + survival cases, the child does live to experience those harms. Thus, the TRIA justification for abortion is not impugned by impairment counter-examples. This article argues that this response to impairment arguments is viciously circular. The response must say that so long as you kill the child, no harm is done. But this assumes that killing itself is morally inconsequential and is not itself a case of harm. The response to impairment arguments, then, assumes the permissibility of abortion.

Occurrence of ultrasonographic assessed placental abnormalities, treatments, pregnancy outcome, and subsequent fertility on a large warmblood stud farm: A retrospective field study.

Little is known about the incidence and outcome of high-risk pregnancies in equine practice and clinical studies on spontaneous occurring placentitis cases and treatments are missing. Therefore, the aims of this retrospective field study were to (1) describe the incidence and severity of ultrasonographic assessed placental abnormalities (UPA) in 4,192 pregnancies on a large commercial warmblood stud farm in 2017 - 2019 and (2) characterize these UPA cases and their pregnancy outcome. UPA severity (Placental abnormality score (PSc) 1-3; low to high), nine treatment regimens (TM1-9) used in UPA cases and treatment duration as well as subsequent fertility were analyzed in the group of UPA mares. The proportion of pregnancies affected by UPA was 4.2 % (n=177/4192). Placental abnormality severity was scored as PSc1 (51.4 %), PSc2 (32.8 %) and PSc3 (15.8 %). The generalized mixed model revealed PSc was affected by mare age and mare status (own pregnancy (OP) or embryo transfer recipient (ER)) (P=0.035) with ER mares having increased PSc compared with mares having their own pregnancy. Abortion occurred in 17/177 (9.6 %) UPA pregnancies. Overall, at the end of the next season, 61.1 % of UPA mares were pregnant, 32.0 % barren, and 6.9 % open (n=175). Pregnancy was established in 62/91(68.1 %) of mares with PSc1, 31/58 (53.4 %) with PSc2 and 14/26 (53.8 %) with PSc3. Most pregnancies were achieved in the first 81/107 (75.7 %) or second 18/107 (16.8 %) inseminated cycle. In conclusion, early detection and treatment of ultrasonographic assessed placental abnormalities can save high-risk pregnancies in > 90 % of cases with a satisfying subsequent fertility.