Antinuclear antibodies and recurrent miscarriage: Systematic review and meta‐analysis

Cavalcante, Marcelo Borges; Cavalcante, Candice Torres de Melo Bezerra; Sarno, Manoel; Silva, Arlley Cleverson Belo da; Barini, Ricardo

doi:10.1111/aji.13215

Cited by 32 publications

(28 citation statements)

References 34 publications

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“…Recent studies have demonstrated a significantly higher incidence of ANA positivity in RPL patients and an association between ANA positivity and increased RPL risk 14,15 . Besides pregnancy loss, research has been carried out into the association of ANA positivity and in vitro fertilization embryo transfer or intracytoplasmic sperm injection (IVF/ICSI) outcomes.…”

Section: Discussionmentioning

confidence: 99%

Association of prednisone and antinuclear antibodies with pregnancy outcomes in women with unexplained recurrent pregnancy loss

Sun

Kou

et al. 2021

Intl J Gynecology & Obste

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Objective To investigate the therapeutic role of prednisone in patients having unexplained recurrent pregnancy loss (URPL) with positivity of antinuclear antibodies (ANA) and the relationship between ANA titers, prednisone, and pregnancy outcomes. Methods We included 202 women diagnosed as having URPL with positive ANA at titer of 1:80 or more. Among them, 159 patients receiving prednisone plus aspirin were included as group PA and the remaining 43 patients prescribed aspirin only served as group A. Live birth rates were considered as the primary outcome. Incidence rates of pregnancy complications and outcomes of the newborns were also compared. Additionally, the association between live birth and major clinical variables was studied. Results Live birth rates were comparable between the two groups (93.1% versus 83.7%, P = 0.107). No significant differences were observed regarding the incidence rates of adverse pregnancy outcomes, other pregnancy complications and the fetal outcomes. Alteration of ANA titers after pregnancy compared with pre‐conception results was the only significant variable associated with live birth. Conclusion Prednisone plus aspirin did not show improved therapeutic effects over aspirin alone in URPL patients with positive ANA. Variation of ANA titers was found to be a prognostic indicator of pregnancy outcomes in these patients.

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Section: Discussionmentioning

confidence: 99%

Association of prednisone and antinuclear antibodies with pregnancy outcomes in women with unexplained recurrent pregnancy loss

Sun

Kou

et al. 2021

Intl J Gynecology & Obste

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“…Anti-dsDNA is the biomarker that is used in screening for the flare of systemic lupus erythematosus (SLE). It has been demonstrated throughout the past decades that women with anti-dsDNA face a higher risk of adverse pregnancy outcomes, including miscarriage ( 23 – 26 ). One retrospective study of 100 women with undifferentiated connective tissue disease (UCTD) demonstrated that there was a significant link between disease flare and both anti-dsDNA-positive antibodies at baseline ( P < 0.01) and disease activity at the beginning of pregnancy ( P < 0.01) ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

The Effects of LIT and MLR-Bf on Immune Biomarkers and Pregnancy Outcomes in Women With Previous Early Recurrent Miscarriage: A Retrospective Study

Meng

Tan

et al. 2021

Front. Immunol.

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Background: Immunological failure during pregnancy is considered one of the etiologies of recurrent miscarriage (RM). The decreased production of mixed lymphocyte reaction-blocking factors (MLR-Bf) may play a major role in this condition. Lymphocyte immunotherapy (LIT), which induces the production of MLR-Bf, has been used in treating RM patients since 1984. However, the effectiveness of LIT is currently being heatedly debated. In addition to that, possible changes to the maternal immune system upon induced MLR-Bf production by LIT remains unclear.Objectives: To explore the possible impacts that MLR-Bf may have on the expression of immune biomarkers and pregnancy outcomes, and deduce whether the prevention of miscarriages is possible with LIT or MLR-Bf in RM patients.Materials and Methods: Women with previous early RM (eRM) were enrolled in this retrospective study after they got pregnant again. LIT was implemented before pregnancy and during the first trimester. MLR-Bf and immune biomarkers were checked as the clinical routine. Patients were followed up until 12 gestational weeks. Levels of immune biomarkers and successful pregnancy rates were compared between MLR-Bf− group and MLR-Bf+ group stratified by LIT. Independent associations between LIT, or MLR-Bf, and miscarriage were estimated. All data management and analysis were conducted using SPSS 20.0.Results: A total of 1,038 patients, 497 MLR-Bf− (49 cases accepted LIT), and 541 MLR-Bf+(463 cases induced by LIT) were included in the study. Percentage of lymphocytes, the ratio of CD4+ T cells/lymphocytes, and levels of some rheumatoid biomarkers (anti-U1-nRNP, anti-SAA-52kd, and anti-CENOP B) were statistically higher in MLR-Bf+ group than in MLR-Bf− group among women without LIT. With LIT treatment the successful pregnancy rate was statistically higher in MLR-Bf+ group than in MLR-Bf− group (66.7% vs. 51.0%, P = 0.028) among women with LIT. Meanwhile, LIT was estimated to have an independent negative association with miscarriage.Conclusion: Upon LIT treament levels of immune biomarkers were different in women with and without MLR-Bf when stratified by whether they received LIT. Not MLR-Bf, but LIT, has an independent protective effect on miscarriage.

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“…Likewise, one should take into consideration that the anti‐TPO‐positive affinity‐purified IgG may encompass other autoantibodies. Antinuclear antibodies (ANA), a typical feature of autoimmunity, were found to be important as a risk factor for recurrent fetal loss 13,14 . Using proteomics approach, a correlation of anti‐a‐enolase and Hashimoto encephalopathy (HE) was documental 15 .…”

Section: Discussionmentioning

confidence: 99%

“…Antinuclear antibodies (ANA), a typical feature of autoimmunity, were found to be important as a risk factor for recurrent fetal loss. 13,14 Using proteomics approach, a correlation of anti-a-enolase and Hashimoto encephalopathy (HE) was documental. 15 In autoimmune diseases, alpha-enolase antibodies are very frequent.…”

Section: Histological Analysis Of the Placentae And Fetuses Developmentioning

confidence: 99%

The pathogenic role of circulating Hashimoto's Thyroiditis‐derived TPO‐positive IgG on fetal loss in naïve mice

Borodina

Katz

Antonelli

et al. 2020

American J Rep Immunol

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Problem Antibody‐mediated autoimmune diseases, such as autoimmune thyroid diseases (ATD), systemic lupus erythematosus (SLE), and antiphospholipid syndrome (APS), often are associated with recurrent fetal loss. One of the ATD is Hashimoto's thyroiditis which recently showed association with complications of pregnancy with increased levels of circulating autoantibodies reactive with epitopes on thyroid tissue such as thyroid peroxidase (anti‐TPO). In retrospective study of sera analyses in patients with Hashimoto's thyroiditis, all patients had mainly elevated circulating anti‐TPO autoantibodies. Aim We assessed the potential of human anti‐TPO highly positive IgG, derived from patients with Hashimoto's thyroiditis sera associated with complications of pregnancy, to cause directly complications of pregnancy in murine model. Method of study Naïve ICR female mice, infused intravenously with 100 μg of anti‐TPO‐positive IgG, showed increased fetal loss and embryo small for date (P < .001) in comparison with mice passively transferred with commercial IgG or PBS. Moreover, we observed embryos small for date in the mice passively transferred with anti‐TPO‐positive IgG, exemplified by reduced weight of embryos and placentae (P = .001). Histopathological examination revealed delay in fetal development in 50% cases of anti‐TPO‐positive IgG‐treated mice. Importantly, pathological changes in the transition zone, state of glycogen cells, and significant structural changes in the labyrinth part of placenta were observed in all anti‐TPO‐positive IgG samples. Conclusion The current study shows in the first time, a direct proof of concept, on the association of human TPO‐positive IgG from Hashimoto's thyroiditis patients on fetal loss induction in murine model.

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Antinuclear antibodies and recurrent miscarriage: Systematic review and meta‐analysis

Cited by 32 publications

References 34 publications

Association of prednisone and antinuclear antibodies with pregnancy outcomes in women with unexplained recurrent pregnancy loss

Association of prednisone and antinuclear antibodies with pregnancy outcomes in women with unexplained recurrent pregnancy loss

The Effects of LIT and MLR-Bf on Immune Biomarkers and Pregnancy Outcomes in Women With Previous Early Recurrent Miscarriage: A Retrospective Study

The pathogenic role of circulating Hashimoto's Thyroiditis‐derived TPO‐positive IgG on fetal loss in naïve mice

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