title: Vitamin D deficiency may be a risk factor for recurrent pregnancy losses by increasing cellular immunity and autoimmunity.
abstract: OBJECTIVE
  Do women with recurrent pregnancy losses (RPL) and low vitamin D have increased prevalence of auto- and cellular immune abnormalities when compared with women with RPL who have normal vitamin D, and does vitamin D have any effect on cellular immunity in vitro?
  
  
  CONCLUSIONS
  A high proportion of women with RPL have vitamin D deficiency and the risk of auto- and cellular immune abnormalities is increased in women with RPL and vitamin D deficiency.
  
  
  BACKGROUND
  Vitamin D deﬁciency in pregnant women is associated with increased risk of obstetrical complications such as pre-eclampsia, bacterial vaginosis associated preterm delivery, gestational diabetes mellitus and small-for-gestational age births.
  
  
  METHODS
  A retrospective cross-sectional study of 133 women with RPL who were enrolled in a 2-year period, together with laboratory experiments.
  
  
  METHODS
  Women with three or more consecutive spontaneous abortions prior to 20 weeks of gestation who were enrolled at the University clinic. Serum vitamin D level, cellular activity and autoimmune parameters in vivo and in vitro were measured.
  
  
  RESULTS
  Sixty-three out of 133 women (47.4%) had low vitamin D (<30 ng/ml). The prevalence of antiphospholipid antibody (APA) was significantly higher in low vitamin D group (VDlow) (39.7%) than in the normal vitamin D group (VDnl) (22.9%) (P< 0.05) and the adjusted odds ratio (OR) for APA in VDlow was 2.22 with the 95% confidence interval (CI) of 1.0-4.7. The prevalence of antinuclear antigen antibody (VDlow versus VDnl; 23.8% versus 10.0%, OR 2.81, 95% CI 1.1-7.4), anti-ssDNA (19.0% versus 5.7%, OR 3.76, 95% CI 1.1-12.4) and thyroperoxidase antibody (33.3% versus 15.7%, OR 2.68, 95% CI 1.2-6.1) was significantly higher in VDlow than those of VDnl (P < 0.05 each). Peripheral blood CD19(+) B and CD56(+) NK cell levels and NK cytotoxicity at effector to target cell (E:T) ratio of 25:1 were significantly higher in VDlow when compared with those of VDnl (P < 0.05 each). Reduction (%) of NK cytotoxicity (at E:T ratio of 50:1 and 25:1) by IgG (12.5 mg/dl) was significantly lower in VDlow than those of VDnl (P < 0.05, P < 0.01, respectively). There were no differences in Th1/Th2 ratios between VDlow and VDnl. When vitamin D3 was added in NK cytotoxicity assay in vitro, NK cytotoxicity at E:T ratio of 50:1 was significantly suppressed with 10 nMol/L (nM) (11.9 ± 3.3%) and 100 nM (10.9 ± 3.7%) of vitamin D3 when compared with controls (15.3 ± 4.7%) (P < 0.01 each). TNF-α/IL-10 expressing CD3(+)/4(+) cell ratios were significantly decreased with 100 nM of vitamin D3 (31.3 ± 9.4, P < 0.05) when compared with controls (40.4 ± 11.3) in vitro. Additionally, INF-γ/IL-10 expressing CD3(+)/4(+) cell ratio was significantly decreased with 100 nM of vitamin D3 (12.1 ± 4.0, P < 0.05) when compared with controls (14.8 ± 4.6). IFN-γ and TNF-α secretion from NK cells were significantly decreased (P < 0.01 each), and IL-10, IL-1β, vascular endothelial growth factor and granulocyte colony stimulating factor levels were significantly increased (P < 0.01 each) with vitamin D3 100 nM when compared with those of controls.
  
  
  CONCLUSIONS
  The prevalence of vitamin D deficiency in women with RPL in this study is open to a possible type I error since women with vitamin D supplementation were excluded from this study.
  
  
  CONCLUSIONS
  Assessment of vitamin D level is recommended in women with RPL. Vitamin D supplementation should be explored further as a possible therapeutic option for RPL.
  
  
  BACKGROUND
  This work was supported by the intramural funding from Department of Microbiology and Immunology, Chicago Medical School at Rosalind Franklin University of Medicine and Science. None of the authors has any conflict of interest to declare.
  
  
  BACKGROUND
  N/A.
authors.affiliation: Reproductive Medicine, Department of Obstetrics and Gynecology, Chicago Medical School at Rosalind Franklin University of Medicine and Science, Vernon Hills, IL 60061, USA.
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ota
authors.forename: Svetlana
authors.initials: S
authors.lastname: Dambaeva
authors.forename: Ae-Ra
authors.initials: AR
authors.lastname: Han
authors.forename: Kenneth
authors.initials: K
authors.lastname: Beaman
authors.forename: Alice
authors.initials: A
authors.lastname: Gilman-Sachs
authors.forename: Joanne
authors.initials: J
authors.lastname: Kwak-Kim
mesh_terms: D000026:Abortion, Habitual / Q000209:etiology / Q000276:immunology*; D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000097:blood; D015551:Autoimmunity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007111:Immunity, Cellular; D016130:Immunophenotyping; D020014:K562 Cells; D007694:Killer Cells, Natural / Q000166:cytology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology / Q000276:immunology; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D018417:Th1 Cells / Q000166:cytology; D018418:Th2 Cells / Q000166:cytology; D014808:Vitamin D Deficiency / Q000150:complications / Q000175:diagnosis*
chemical_list: D017152:Antibodies, Antiphospholipid
keywords: Th1; autoimmune abnormalities; natural killer cells; recurrent pregnancy loss; vitamin D