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September 19, 1990, Vol 264, No. 11 >
ARTICLE | September 19, 1990

Autoimmunity and Pregnancy Loss FREE

D. Ware Branch, MD
[+] Author Affiliations

Reprint requests to Department of Obstetrics and Gynecology, University of Utah School of Medicine, 50 N Medical Dr, Salt Lake City, UT 84132 (Dr Branch).


JAMA. 1990;264(11):1453-1454. doi:10.1001/jama.1990.03450110099036
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References

The spontaneous loss of a clinically recognized pregnancy is the most common complication of human gestation and is a significant emotional disappointment for the involved couple. Recurrent pregnancy loss (traditionally defined as three consecutive losses) occurs in 0.5% to 1% of women, an incidence equal to or exceeding that of most major medical problems. Genetic, anatomic, hormonal, and infectious factors have each been implicated as causing some spontaneous abortion, but even when taken together they do not explain the majority of losses. Within the last 10 years several maternal autoimmune conditions have been linked to pregnancy loss. Although these autoimmune conditions do not appear to explain a large proportion of losses, they are as important numerically as uterine malformations and parental chromosome abnormalities.

A few maternal autoimmune conditions cause pregnancy loss through the transplacental passage of maternal autoantibodies that act on the fetus through classic autoantibody-mediated mechanisms. The best example

REFERENCES

1 +
Carter JB, Blieden LC, Edwards JE.  Congenital heart block: anatomic correlations and review of the literature . Arch Pathol. 1974;;97:51-57.
2 +
Scott JS, Maddison PJ, Taylor PV, Esscher E, Scott O, Skinner RP.  Connective-tissue disease, antibodies to ribonucleoprotein, and congenital heart block . NEngl JMed. 1983;;309:209-212.
3 +
Taylor PV, Scott JS, Gerlis LM, Esscher E, Scott O.  Maternal antibodies against fetal cardiac antigens in congenital complete heart block . N Engl J Med. 1986;;315:667-672.
4 +
Lee LA, Harmon CE, Huff JC, Norris DA, Weston WL.  The demonstration of SS-A/Ro antigen in human fetal tissues and in neonatal and adult skin . J Clin Invest Dermatol. 1985;;85:143-146.
5 +
Pekonen F, Teramo K, Makinen T, Ikonee E, Osterlund K, Lamberg BA.  Prenatal diagnosis and treatment of fetal thyrotoxicosis . Am J Obstet Gynecol. 1984;;150:893-894.
6 +
Davis LE, Lucas MJ, Hankins GDV, Roark ML, Cunningham FG.  Thyrotoxicosis complicating pregnancy . Am J Obstet Gynecol. 1989;;160:63-70.
7 +
Munro DS, Dirmikis SM, Humphries H, Smith T, Broadhead GD.  The role of thyroid stimulating immunoglobulins of Graves' disease in neonatal thyrotoxicosis . Br J Obstet Gynaecol. 1978;;85:837-843.
8 +
Laros RK, Sweet RL.  Management of idiopathic thrombocytopenic purpura during pregnancy . Am J Obstet Gynecol. 1975;;122:182-190.
9 +
Harris EN.  Syndrome of the black swan . Br J Rheumatol. 1987;;26:324-326.
10 +
Branch DW, Scott JR.  Clinical implications of antiphospholipid antibodies: the Utah experience . In: Harris EN, Exner T, Hughes GRV, Asherson R, eds. Phospholipid-binding Antibodies . Boca Raton, Fla: CRC Press. In press.
11 +
DeWolf F, Carreras LO, Moerman P, et al.  Decidual vasculopathy and extensive placental infarction in a patient with repeated thromboembolic accidents, recurrent fetal loss, and a lupus anticoagulant . Am J Obstet Gynecol. 1982;;142:829-834.
12 +
Branch DW, Dudley DJ, Mitchell MD, et al.  IgG fractions from patients with antiphospholipid antibodies cause fetal death in Balb/C mice: a model for autoimmune fetal loss . Am J Obstet Gynecol. 1990;;163:210-216.
13 +
Sheppard BL, Bonnar J.  An ultrastructural study of the utero-placental spiral arteries in hypertensive and normotensive pregnancy and fetal growth retardation . Br J Obstet Gynaecol. 1981;;88:695-705.
14 +
Stagnaro-Green A, Roman SH, Cobin RH, El-Harazy E, Alvarez-Marfany M, Davies TF.  Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies . JAMA . 1990;;264:1422-1425.
15 +
Ramsey I.  Postpartum thyroiditis—an underdiagnosed disease . Br J Obstet Gynaecol. 1986;;93:1121-1123.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Carter JB, Blieden LC, Edwards JE.  Congenital heart block: anatomic correlations and review of the literature . Arch Pathol. 1974;;97:51-57.
2 +
Scott JS, Maddison PJ, Taylor PV, Esscher E, Scott O, Skinner RP.  Connective-tissue disease, antibodies to ribonucleoprotein, and congenital heart block . NEngl JMed. 1983;;309:209-212.
3 +
Taylor PV, Scott JS, Gerlis LM, Esscher E, Scott O.  Maternal antibodies against fetal cardiac antigens in congenital complete heart block . N Engl J Med. 1986;;315:667-672.
4 +
Lee LA, Harmon CE, Huff JC, Norris DA, Weston WL.  The demonstration of SS-A/Ro antigen in human fetal tissues and in neonatal and adult skin . J Clin Invest Dermatol. 1985;;85:143-146.
5 +
Pekonen F, Teramo K, Makinen T, Ikonee E, Osterlund K, Lamberg BA.  Prenatal diagnosis and treatment of fetal thyrotoxicosis . Am J Obstet Gynecol. 1984;;150:893-894.
6 +
Davis LE, Lucas MJ, Hankins GDV, Roark ML, Cunningham FG.  Thyrotoxicosis complicating pregnancy . Am J Obstet Gynecol. 1989;;160:63-70.
7 +
Munro DS, Dirmikis SM, Humphries H, Smith T, Broadhead GD.  The role of thyroid stimulating immunoglobulins of Graves' disease in neonatal thyrotoxicosis . Br J Obstet Gynaecol. 1978;;85:837-843.
8 +
Laros RK, Sweet RL.  Management of idiopathic thrombocytopenic purpura during pregnancy . Am J Obstet Gynecol. 1975;;122:182-190.
9 +
Harris EN.  Syndrome of the black swan . Br J Rheumatol. 1987;;26:324-326.
10 +
Branch DW, Scott JR.  Clinical implications of antiphospholipid antibodies: the Utah experience . In: Harris EN, Exner T, Hughes GRV, Asherson R, eds. Phospholipid-binding Antibodies . Boca Raton, Fla: CRC Press. In press.
11 +
DeWolf F, Carreras LO, Moerman P, et al.  Decidual vasculopathy and extensive placental infarction in a patient with repeated thromboembolic accidents, recurrent fetal loss, and a lupus anticoagulant . Am J Obstet Gynecol. 1982;;142:829-834.
12 +
Branch DW, Dudley DJ, Mitchell MD, et al.  IgG fractions from patients with antiphospholipid antibodies cause fetal death in Balb/C mice: a model for autoimmune fetal loss . Am J Obstet Gynecol. 1990;;163:210-216.
13 +
Sheppard BL, Bonnar J.  An ultrastructural study of the utero-placental spiral arteries in hypertensive and normotensive pregnancy and fetal growth retardation . Br J Obstet Gynaecol. 1981;;88:695-705.
14 +
Stagnaro-Green A, Roman SH, Cobin RH, El-Harazy E, Alvarez-Marfany M, Davies TF.  Detection of at-risk pregnancy by means of highly sensitive assays for thyroid autoantibodies . JAMA . 1990;;264:1422-1425.
15 +
Ramsey I.  Postpartum thyroiditis—an underdiagnosed disease . Br J Obstet Gynaecol. 1986;;93:1121-1123.

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