title: Elevated Th1/Th2 cell ratios in a pregnant woman with a history of RSA, secondary Sjögren's syndrome and rheumatoid arthritis complicated with one fetal demise of twin pregnancy.
abstract: OBJECTIVE
  Elevated Th1/Th2 cytokine producing CD3(+)/CD4(+) cell ratios were reported in women with a history of recurrent spontaneous abortion (RSA) and multiple implantation failures. We report, significantly elevated Th1/Th2 cell ratios were noticed in a pregnant woman with twin pregnancies complicated with one fetal demise, who had a history of RSA, secondary Sjögren's syndrome (SS), and rheumatoid arthritis.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  Peripheral blood Th1/Th2 cell ratios were significantly elevated 3 weeks prior to a fetal demise of twin pregnancies at 20 week gestation. Two weeks after fetal demise, the ratio of intracellular tumor necrosis factor-alpha/interleukin-10 producing CD3(+)/CD4(+) cells in peripheral blood was further increased to three times higher than prior ratio. Elevated Th1/Th2 ratio was down regulated after increasing dose of IVIg treatment. The patient gave birth to a male baby weighing 2650 g at 36 weeks gestation. No serious complications were found in the patient or the baby.
  
  
  CONCLUSIONS
  Systemic inflammatory immune response pre-exists prior to a fetal demise and the degree of inflammatory immune response got worse with a presence of fetal demise in utero. We infer that the placenta is not an immunological barrier to maternal Th1/Th2 immune responses.
authors.affiliation: Reproductive Medicine, Department of Obstetrics and Gynecology, Rosalind Franklin University of Medicine and Science/The Chicago Medical School, North Chicago, IL 60064, USA. joanne.kwak-kim@rosalindfranklin.edu
authors.forename: Joanne
authors.initials: J
authors.lastname: Kwak-Kim
authors.forename: Sung-Ki
authors.initials: SK
authors.lastname: Lee
authors.forename: Alice
authors.initials: A
authors.lastname: Gilman-Sachs
mesh_terms: D000026:Abortion, Habitual / Q000276:immunology*; D000328:Adult; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000276:immunology*; D017252:CD3 Complex / Q000032:analysis; D015704:CD4 Antigens / Q000032:analysis; D004200:Diseases in Twins / Q000276:immunology*; D005260:Female; D005313:Fetal Death / Q000276:immunology*; D005865:Gestational Age; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage; D007155:Immunologic Factors / Q000008:administration & dosage; D007231:Infant, Newborn; D050498:Live Birth; D008297:Male; D011247:Pregnancy; D012859:Sjogren's Syndrome / Q000150:complications / Q000276:immunology*; D018417:Th1 Cells / Q000187:drug effects / Q000276:immunology*; D018418:Th2 Cells / Q000187:drug effects / Q000276:immunology*; D014427:Twins
chemical_list: D017252:CD3 Complex; D015704:CD4 Antigens; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors