Immunogenesis of preeclampsia: lessons from donor gametes.
BACKGROUND
Preeclampsia remains an important complication of pregnancy. It is associated with mortality and morbidity for both maternal and fetal/newborn patients. Although major inroads have been made in understanding the pathophysiology of preeclampsia in recent decades, the initial primary cause of its occurrence in some women and not others has escaped clarification.


METHODS
There have been a number of clinical clues pointing to an immune genesis of this disease, including most recently the use of donor gametes in assisted reproductive technology (ART). Despite a number of confounding variables, most studies investigating the addition of donor ova to the ART environment point in the direction of an immune genesis due to the burden of an increasingly foreign fetal allograft on the maternal host. A review of a selection of these studies and a contemporary review of our own Maternal Fetal Medicine practice observations in this regard was completed.


CONCLUSIONS
This retrospective evidence suggests a highly likely association. A more basic understanding of the immune interactions at the maternal-fetal interface is required before a final solution to this problem will be at hand and targeted remedies can be formulated.
a Maternal Fetal Medicine , Presbyterian/St.Luke's Medical Center, Obstetrix Medical Group of Colorado , Denver , CO , USA.
Richard P
RP
Porreco
b Obstetrics and Gynecology , Denver Health and Hospital Authority , Denver , CO , USA.
Kent D
KD
Heyborne
D000328:Adult; D005260:Female; D054502:Histocompatibility, Maternal-Fetal / Q000276:immunology; D006801:Humans; D008297:Male; D018587:Oocyte Donation; D009865:Oocytes / Q000276:immunology; D011225:Pre-Eclampsia / Q000276:immunology*; D011247:Pregnancy; D027724:Reproductive Techniques, Assisted; D013094:Spermatozoa / Q000276:immunology*; D014019:Tissue Donors; D009927:Tissue and Organ Procurement
Donor gametes; advanced maternal age; assisted reproductive technology; immunogenesis; preeclampsia