HLA-DR typing of women with recurrent late spontaneous abortion and unsuccessful cervical cerclage.
The release of certain cytokines, e.g. tumour necrosis factor (TNF)-alpha, in the amniotic fluid has been suggested to be a cause of preterm birth. The predisposition to excessive liberation of cytokines from peripheral leukocytes has been shown to depend partly on the individual's HLA-DR genotype. The HLA-DR1 and -DR3 alleles have previously been reported as being associated with a TNF-alpha high responder status and have also been associated with unexplained recurrent spontaneous abortions. In the present study, HLA-DR typing was performed in 10 women who had experienced recurrent very early preterm births resulting in perinatal death, or late spontaneous abortions under a clinical picture resembling that traditionally attributed to cervical incompetence. All patients had had at least one mid-trimester miscarriage in spite of the insertion of a cervical cerclage. Nine out of 10 (90%) patients had the HLA-DR phenotypes DR1 and/or DR3 compared with 37% in the background population (P < 0.005). The results suggest that HLA-DR-associated immunological factors might play a part in recurrent late spontaneous abortions and extremely preterm births under a cervical incompetence-like picture, at least in the subset of cases not treatable by cervical cerclage.
Mohapeloa
H
H
Department of Obstetrics and Gynaecology, Aalborg Hospital, Denmark.
Christiansen
O B
OB
Grunnet
N
N
D000026:Abortion, Habitual / Q000235:genetics / Q000276:immunology* / Q000601:surgery; D000328:Adult; D000483:Alleles; D002584:Cervix Uteri / Q000601:surgery*; D005260:Female; D006680:HLA Antigens / Q000145:classification* / Q000235:genetics; D015798:HLA-DR1 Antigen / Q000032:analysis; D015803:HLA-DR3 Antigen / Q000032:analysis; D006801:Humans; D011247:Pregnancy; D013536:Suture Techniques; D002581:Uterine Cervical Incompetence / Q000276:immunology / Q000601:surgery*
D006680:HLA Antigens; D015798:HLA-DR1 Antigen; D015803:HLA-DR3 Antigen