An Immunological Profile is Associated with Development of Clinical Abnormalities in Women with Recurrent Pregnancy Loss

Background. Immunological abnormalities are present in a subset of women with recurrent pregnancy loss (RPL). The combination of these abnormalities might be a surrogate profile for the presence of a subclinical inflammatory or autoimmune condition.

Objective. In a cohort of women with unexplained RPL we evaluated if an immunological profile was associated with the presence of distinct clinical characteristics that are commonly observed in autoimmune diseases.

Methods. We evaluated 366 women with RPL defined as 2 or more abortions. We defined the immune profile as the presence of 2 or more of the following abnormalities: Peripheral blood NK cell percentages > 15%, positive antiphospholipid antibodies, positive antinuclear antibodies, positive anti-thyroid antibodies, low complement C3 levels and low C4 complement levels. Statistics: Chi-square test.

Results. The prevalence of women with 2 or more immunological abnormalities was 57 out of 366 women (15.6%). Demographic clinical characteristics were similar in women with 2 or more immunological abnormalities as compared with women with only one immunological alteration or no abnormalities. The presence of the immunological profile was significantly associated with the presence of the following clinical characteristics: Leucopenia (p=0.048), lymphopenia (p=0.007), livedo reticularis (p=0.01), cutaneous rash (p=0.009), and arthritis (p=0.001). During follow-up 17 patients (4.6%) developed an inflammatory or autoimmune disease that was not present at the time of the diagnose of RPL. Women with the immunological profile were at higher risk for evolution into these diseases: OR 4.19, 95% confidence interval 1.52-11.51, p=0.0055.

Conclusion. A subgroup of women with unexplained RPL are at risk of developing clinical characteristics of an inflammatory or autoimmune disease. In this regard, the immunological evaluation of women with RPL might be necessary not only to identify a potential cause of abortion but also to identify high risk women that could require a more careful clinical follow-up.