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Recurrent Pregnancy Loss and Cytokines: Title and subTitle BreakNot as Simple as It Seems FREE

Donald J. Dudley, MD
[+] Author Affiliations

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


JAMA. 1995;273(24):1958-1959. doi:10.1001/jama.1995.03520480078045
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Recurrent pregnancy loss is a particularly vexing problem. The patient desperately wants to achieve a successful pregnancy and is frustrated by her seeming inability to accomplish a life goal often taken for granted. The physician feels stymied because an identifiable cause can be found in only about 50% of women with recurrent pregnancy loss. Because of the unique immunologic state of pregnancy and similarities to allogeneic transplantation, putative immunologic causes have been attributed to recurrent pregnancy loss. In other words, "If we don't understand it, it must be immunologic." Consequently, a number of diagnostic tests and immunologic treatments have been tried with limited success.

Currently the most widely used immunotherapy for recurrent pregnancy loss is injecting the patient with white blood cells obtained from the potential father. The rationale for this immunotherapy was derived from studies of kidney transplant patients, who were less likely to reject renal allografts if they

REFERENCES

Opoelz G, Sengar DPS, Mickey MR, Terasaki PI.  Effect of blood transfusions on subsequent kidney transplants. Transplant Proc . 1972;;5:253-259.
The Recurrent Miscarriage Immunotherapy Trialists Group.  Worldwide collaborative observational study and meta-analysis on allogenic leukocyte immunotherapy for recurrent spontaneous abortion. Am J Reprod Immunol . 1994;;32:55-72.
Hill JA, Polgar K, Anderson DJ.  T-helper 1-type immunity to trophoblast in women with recurrent spontaneous abortion. JAMA . 1995;;273:1933-1936.
Mosmann TR, Coffman RL.  TH1 and TH2 cells: different patterns of lymphokine secretion lead to different functional properties. Annu Rev Immunol . 1989;;7:145-173.
Dudley DJ, Chen CL, Mitchell MD, Daynes RA, Araneo BA.  Adaptive immune responses during murine pregnancy: pregnancy-induced regulation of lymphokine production by activated T lymphocytes. Am J Obstet Gynecol . 1993;;168:1155-1163.
Lin H, Mosmann TR, Guilbert L, Tuntipopipat S, Wegmann TG.  Synthesis of T helper 2—type cytokines at the maternal-fetal interface. J Immunol . 1993;;151:4562-4573.
Boue J, Boue A, Lazar P.  Retrospective and prospective epidemiological studies of 1500 karyotyped spontaneous human abortions. Teratology . 1975;;12:11-26.
Wegmann TG, Lin H, Guilbert L, Mosmann TR.  Bidirectional cytokine interactions in the maternal-fetal relationship: is successful pregnancy a TH2 phenomenon? Immunol Today . 1993;;14:353-356.
Leveno KJ, Cunningham FG, Nelson S, et al.  A prospective comparison of selective and universal electronic fetal monitoring of 34,995 pregnancies. N Engl J Med . 1986;;315:615-619.
The Canadian Preterm Labor Investigators Group.  Treatment of preterm labor with the beta-adrenergic agonist ritodrine. N Engl J Med . 1992;;327:308-312.

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

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Opoelz G, Sengar DPS, Mickey MR, Terasaki PI.  Effect of blood transfusions on subsequent kidney transplants. Transplant Proc . 1972;;5:253-259.
The Recurrent Miscarriage Immunotherapy Trialists Group.  Worldwide collaborative observational study and meta-analysis on allogenic leukocyte immunotherapy for recurrent spontaneous abortion. Am J Reprod Immunol . 1994;;32:55-72.
Hill JA, Polgar K, Anderson DJ.  T-helper 1-type immunity to trophoblast in women with recurrent spontaneous abortion. JAMA . 1995;;273:1933-1936.
Mosmann TR, Coffman RL.  TH1 and TH2 cells: different patterns of lymphokine secretion lead to different functional properties. Annu Rev Immunol . 1989;;7:145-173.
Dudley DJ, Chen CL, Mitchell MD, Daynes RA, Araneo BA.  Adaptive immune responses during murine pregnancy: pregnancy-induced regulation of lymphokine production by activated T lymphocytes. Am J Obstet Gynecol . 1993;;168:1155-1163.
Lin H, Mosmann TR, Guilbert L, Tuntipopipat S, Wegmann TG.  Synthesis of T helper 2—type cytokines at the maternal-fetal interface. J Immunol . 1993;;151:4562-4573.
Boue J, Boue A, Lazar P.  Retrospective and prospective epidemiological studies of 1500 karyotyped spontaneous human abortions. Teratology . 1975;;12:11-26.
Wegmann TG, Lin H, Guilbert L, Mosmann TR.  Bidirectional cytokine interactions in the maternal-fetal relationship: is successful pregnancy a TH2 phenomenon? Immunol Today . 1993;;14:353-356.
Leveno KJ, Cunningham FG, Nelson S, et al.  A prospective comparison of selective and universal electronic fetal monitoring of 34,995 pregnancies. N Engl J Med . 1986;;315:615-619.
The Canadian Preterm Labor Investigators Group.  Treatment of preterm labor with the beta-adrenergic agonist ritodrine. N Engl J Med . 1992;;327:308-312.
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