title: Overcoming recurrent spontaneous abortions in women suffering from IgG subclass deficiency: high efficiency of low dose intravenous immunoglobulins treatment.
abstract: OBJECTIVE
  It's well known that iv. immunoglobulins may be useful to overcome habitual abortions, but the mechanisms at the base of a successful outcome and the likelihoods are still unknown.
  
  
  METHODS
  In one hundred and sixty women with habitual abortions and one hundred and sixty healthy mothers, we evaluated blood IgG subclasses; among the patients, sixteen merely showed IgG subclass deficiency, after leaving out any autoimmunity and/or coagulation disorders. All the patients (100%) showed IgG3, twelve (75%) IgG1, eight (50%) IgG4 and six (37,5%) IgG2 deficiency; healthy control people's IgG subclasses fell in normal range in 156 women, but just four women showed IgG2 and IgG4 deficiency with neither immune deficiency's clinical marks nor increased vulnerability to infections. All the patients were treated with whole immunoglobulins iv. infusion (200 mg/kg/monthly) all over the pregnancy.
  
  
  RESULTS
  The successful pregnancy rate is very high (>90%): 100% out of women showing IgG1 (12/12), 87,5% of IgG3 (14/16), 75% of IgG4 (6/8) and 66% of IgG2 deficiency (4/6) had successful pregnancies. The Odd's Ratio between IgG subclass deficiency and recurrent abortions is 4,33 with confidence interval of 95%; chi square value is 7.68 (p<0.025).
  
  
  CONCLUSIONS
  Low dose immunoglobulin infusion is the only effective way to reach successful pregnancy, despite previous habitual abortions in patients suffering from IgG subclass deficiency without autoimmunity and/or coagulation disorders, likely restoring idiotype-antiidiotype network; showing evidence of IgG subclasses deficiency (mostly IgG1 and IgG3) may help identify patients who can benefit from iv. immunoglobulin treatment.
authors.affiliation: Allergy and Clinical Immunology Unit, Clinical Medicine Dept., Religious Gen. Reg. Hospital "F. Miulli", Acquaviva (BA), Italy. Phone/fax: +39 080 52 77 317 Phone: +39 333 40 74 527. E-mail: giacomo.manfredi@alice.it.
authors.forename: G
authors.initials: G
authors.lastname: Manfredi
authors.affiliation: Obstaetric and Ginecology Unit, Mother-Child Dept., Religious Gen. Reg. Hospital "F. Miulli", Acquaviva (BA), Italy.
authors.forename: L
authors.initials: L
authors.lastname: Dell'Aera
authors.affiliation: Obstaetric and Ginecology Unit, Mother-Child Dept., Religious Gen. Reg. Hospital "F. Miulli", Acquaviva (BA), Italy.
authors.forename: R
authors.initials: R
authors.lastname: Liguori
mesh_terms: D000026:Abortion, Habitual / Q000097:blood / Q000175:diagnosis / Q000276:immunology / Q000517:prevention & control*; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D017099:IgG Deficiency / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D007074:Immunoglobulin G / Q000097:blood* / Q000145:classification; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D050498:Live Birth; D016017:Odds Ratio; D011247:Pregnancy; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D007074:Immunoglobulin G; D016756:Immunoglobulins, Intravenous
keywords: Idiotype-antiidiotype network restoration in pregnancy; IgG subclasses unbalance in habitual abortions; restoring maternal-foetus immunologic tolerance