Disturbed Inflammatory/Anti-inflammatory Milieu and Activation of Primary Phase Reactants may Underlie Development and Recurrence of First trimester Pregnancy Loss.

Abstract

Objective: Estimation of serum levels of tumor necrosis factor-a (TNF-a), interleukin (IL-) 6 and 10 and alpha-1 antitrypsin (AAT) in pregnant women with current pregnancy loss (CPL) and non-pregnant women with history of recurrent PL (RPL) compared versus women with normal pregnancy (NP).Patients & Methods: All studied women underwent clinical and vaginal ultrasonographic examination for assurance of inclusion criteria and then gave blood samples for ELISA estimation of studied parameters.Results: Patients of CPL and RPL groups showed significantly high serum TNF-a and IL-6 levels with significantly lower serum IL-10 levels than women of NP group with significant difference between CPL and RPL groups. Serum AAT levels were significantly lower in CPL group than RPL and NP groups with significantly lower levels in RPL than NP group. High serum TNF-a and low AAT levels showed high positive predictive value (PPV) and sensitivity, respectively, for possibility of presence or recurrence of PLConclusion: Disturbed serum levels of pro- and anti-inflammatory cytokines could diagnose CPL with high PPV and persistence of their disturbed levels may predispose to RPL. Activation of primary phase reactant system may underlie, accompany or initiate PL, so low serum AAT during 1st trimester and its persistently low serum levels during inter-pregnancy intervals could be used as screening test for presence or liability for development of PL.