Does the immune system induce labor? Lessons from preterm deliveries in women with autoimmune diseases.
A recent review of the literature suggested that thyroid autoimmunity is statistically associated with preterm delivery. This observation raises a number of follow-up questions, among them whether autoimmune function, in general, predisposes to premature delivery. A review of the English literature for the last 10 years, via PubMed search, finds strong supportive evidence for such a hypothesis. Since the fetal-placental unit represents a (semi) allograft within a maternal (allograft) recipient, it is reasonable to assume that it is subject to similar immunologic tolerance (and failure thereof) as solid organ transplants. As autoimmune responses represent a normal feature of tolerance failure in organ transplantation, similar autoimmune responses can also be expected with failure of tolerance of the fetal-maternal graft. The association of premature (and possibly also term) labor with autoimmune function may, therefore, be the consequence of abnormalities in normal fetal-placental tolerance, leading to uterine activation and labor.
Gleicher
Norbert
N
Center for Human Reproduction, 21 East 69th Street, New York, NY 10021, USA. ngleicher@thechr.com
D001327:Autoimmune Diseases / Q000276:immunology*; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007108:Immune Tolerance; D007752:Obstetric Labor, Premature / Q000276:immunology; D010920:Placenta / Q000276:immunology; D011247:Pregnancy; D047928:Premature Birth / Q000276:immunology*