In normal pregnancy the fetus, although a semi-allograft,
is tolerated by the maternal immune system. It has been suggested that an
inadequate maternal allo-immune response to the paternal antigens of the
fetus is responsible for a proportion of the unexplained recurrent
miscarriage.
In chapter 2 we provide an overview on the possible role of the HLA system in
recurrent miscarriage. No consistent conclusions can be drawn since the
observed odd ratios found were relatively small and the risk of bias in the
selected studies was high. In chapter 3 we compared the genetic polymorphisms
of HLA-G in women with recurrent miscarriage with women with uneventful
pregnancy. The HLA-G UTR-4 haplotype was less frequently observed in women
with recurrent miscarriage, suggesting an immunoregulatory role of this
haplotype. The combined results from chapter 4, chapter 6 and chapter 7
suggest that in a portion of women with unexplained recurrent miscarriage
antibody-mediated rejection of the fetal allograft may play a role. We showed
in chapter 8 that human seminal plasma contains all kinds of immunoregulatory
factors and has an immunomodulatory effect on T cells. In chapter 9 a matched
case-control study practicing oral sex was negatively associated with the
occurrence of recurrent miscarriage.
department of
Gynaecology and Obstetrics Leiden University Medical Center, Nationaal Referentie
Centrum voor Histocompatibiliteit, Stichting Oranjekliniek, Stichting NVLE Fonds, Stichting
HELLP, Chipsoft, BMA Mosos, VPS Diagnostics, RabobankLUMC / Geneeskund