Do decidual cytokines play a role in the aetiology of spontaneous miscarriage

Abstract

The establishment of pregnancy requires the co-ordinated implantation of the embryo into the receptive decidua, placentation, trophoblast invasion of the maternal decidua and myometrium as well as remodelling of the uterine spiral arteries. Failure of any of these steps can lead to a range of pregnancy complications including miscarriage, pre-eclampsia, fetal growth restriction, placenta accreta and pre-term birth. Cytokines are small multifunctional proteins often derived from leucocytes and have primarily been described through their immunomodulatory actions. The maternal-fetal interface is considered to be immunosuppressed to allow development of the semi-allogeneic placental-fetal unit. However, cytokine profiles of the decidua and different decidual cell types suggests that the in vivo situation is more complex. Data suggests that decidual derived cytokines not only play roles in immunosuppression but also in other aspects of the establishment of pregnancy including regulation of trophoblast invasion and spiral artery remodelling. This review focuses on the potential role of decidual derived cytokines in the aetiology of unexplained spontaneous miscarriage.