Yoko Maesawa

Divergence of helper, cytotoxic, and regulatory T cells in the decidua from miscarriage.

The aim of this prospective study was to evaluate phenotypic differences of helper T (Th), cytotoxic T (Tc), and regulatory T (Treg) cells in the deciduae of missed miscarriage with a normal chromosome karyotype of a fetus (MN) and missed miscarriage with an abnormal chromosome karyotype of a fetus (MA).

Medium-dose intravenous immunoglobulin therapy for women with six or more recurrent miscarriages

This study aimed to evaluate changes in natural killer (NK) cell activity and the percentage of monocytes in women with recurrent miscarriage who received medium-dose intravenous immunoglobulin (IVIg) therapy. Fourteen women with a history of six or more recurrent miscarriages of unexplained etiology received 60-g IVIg therapy (20 g daily, for three days) during early gestation. NK cell activity in the peripheral blood decreased to 12% one week after therapy compared with before therapy (median, 22%, P < 0.001) and the percentage of monocytes increased from 5.2% to 7.5% (P < 0.005). Four pregnancies ended in live births of healthy neonates, whereas the other ten pregnancies ended in miscarriages. Excluding one miscarriage with a chromosomal abnormality, the live birth rate was 30.8% (4/13). The rate of reduction of NK cell activity in the success group (-58.8%) tended to be greater than that in the failure group (-14.8%, P = 0.057).

History of biochemical pregnancy was associated with the subsequent reproductive failure among women with recurrent spontaneous abortion

Abstract The aim of this study was to evaluate whether the presence of history of biochemical pregnancy (BP) was associated with clinical characteristics and the subsequent pregnancy outcome among women with recurrent spontaneous abortion (RSA). One-hundred and seventy-five RSA women with two or more clinical pregnancy losses were enrolled. The clinical characteristics were compared between 164 women with history of 0–1 BP (Group A) and 11 women with two or more BP (Group B). The frequency of previous pregnancy loss and history of in vitro fertilization and embryo transfer in Group B was higher than that in Group A; while frequency of secondary RSA in Group B was lower than Group A. The subsequent pregnancy outcome was assessed prospectively; and live-birth rate in Group A (72.9%) was higher (p < 0.05) than that in Group B (41.7%). The incidence of reproductive failure (58.3%, p < 0.05) and spontaneous abortion with normal chromosome (25.0%, p = 0.050) in Group B was higher than those (27.1 and 5.9%, respectively) in Group A. RSA women with two or more BP had higher risk of reproductive failure and spontaneous abortion with normal chromosome together with lower chance of live-birth. The results of the present study involve important information and are helpful for clinical practitioners.

Effectiveness of high-dose i.v. immunoglobulin therapy for pregnant women with aspirin-heparin-resistant secondary antiphospholipid syndrome

This study aimed to assess the efficacy of high‐dose i.v. immunoglobulin (HIVIg) therapy in pregnant women with antiphospholipid syndrome (APS) secondary to systemic lupus erythematosus with a history of pregnancy failure, despite receiving low‐dose aspirin plus unfractionated heparin therapy, of which condition being designated as “aspirin–heparin‐resistant APS” (AHRAPS).

Factors associated with adverse pregnancy outcomes in women with systematic lupus erythematosus

The aim of this prospective study was to determine clinical factors associated with adverse pregnancy outcomes in women with systematic lupus erythematosus (SLE). Fifty-six pregnancies from 46 women with SLE were enrolled. Risk factors for pregnancy loss, premature delivery, hypertensive disorders of pregnancy (HDP), and light-for-date neonate (LFD), were evaluated. Univariate and multivariate logistic regression analyses revealed a history of two or more pregnancy losses before 10 gestational weeks (GW) (OR 11.5, 95%CI 1.72-76.8) as a risk factor for pregnancy loss; low levels of blood complements (OR 7.55, 95%CI 1.10-51.9) and antiphospholipid syndrome (OR 26.5, 95%CI 3.17-219) as risk factors for premature delivery before 37 GW; SLEDAI score at conception (OR 1.68, 95%CI 1.05-2.68) and positive tests for two or more antiphospholipid antibodies (OR 6.89, 95%CI 1.13-41.9) as risk factors for premature delivery before 34 GW; prednisolone therapy >14mg/day (OR 7.55, 95%CI 1.10-51.9) as a risk factor for HDP; and low dose aspirin therapy (OR 0.21, 95%CI 0.05-0.97) decreased the risk for LFD neonate. These results have important implications for clinicians managing SLE complicated pregnancy.

Natural killer cell activity in women with recurrent miscarriage: Etiology and pregnancy outcome

This study aimed to evaluate whether natural killer (NK) cell activity was associated with the etiology of recurrent miscarriage (RM), and to evaluate the predictive value of NK cell activity for outcomes of following pregnancies in women with RM. Peripheral NK cell activity was measured in 160 non-pregnant women with a history of two or more miscarriages. This activity was compared according to the etiology of RM and to pregnancy outcomes in women who became pregnant. NK cell activity in women with unexplained RM was significantly higher than that in those with known etiologies of RM. NK cell activity in women whose next pregnancies ended in miscarriage of fetuses with a normal chromosome karyotype (MN) was higher than that in those with live births (p<0.05). Women with NK cell activity ≥33% had a higher risk for MN (relative risk 3.4, 95% confidence interval 1.3-8.7). An increase in peripheral NK cell activity was associated with MN. This increase might be involved in the pathophysiology underlying RM.

The Management of Antiphospholipid Antibodies Affected Pregnancy

Antiphospholipid antibody (aPL) is a heterogeneous group of autoantibodies directed against phospholipids-binding proteins. Antiphospholipid syndrome (APS) is defined by two major components: 1) presence of at least one type of aPLs, 2) the occurrence of at least one clinical feature from a list of potential disease manifestations, the most common of which are categorized as venous or arterial thromboses, and pregnancy complications. The pregnancy complications include recurrent spontaneous abortion (RSA), unexplained fetal death, severe pre-eclampsia, fetal growth restriction (FGR), and premature delivery. International consensus conferences have proposed and revised classification criteria for definite APS. Two types of aPLs were originally included in the laboratory criteria: IgG and IgM anticardiolipin antibody (aCL); and lupus anticoagulant (LA) (1). After that, IgG and IgM anti-β2 glycoprotein-I antibody (aβ2GPI) were included as laboratory criteria (2). However, scant evidence exists in regard to a relationship between the aPL profile and serious adverse pregnancy outcome.