Abstract
Recurrent pregnancy loss (RPL) commonly refers to three or more miscarriages that occur before 20 weeks of pregnancy. The immunological cause of RPL could be either an auto- or alloimmune-related event or both. Because of the discovery of immunological abnormalities in RPL patients in clinical practice, several immunomodulatory therapies were introduced to maintain the immune balance at the maternal-fetal interface. Intravenous immunoglobulin (IVIg) is one of the immunomodulators. In recent years, several studies have analyzed the therapeutic effect of IVIg on RPL patients with antiphospholipid syndrome (APS) or unexplained RPL. However, their results are controversial. IVIg can be used in RPL patients with APS who have previously failed in other treatments. It is recommended that IVIg infusion could be considered used before conception in RPL patients who have cellular immune abnormalities such as increased natural killer (NK) cell counts, NK cell cytotoxicity, or increased T helper (Th)1/Th2 ratio, depending on the cut-off values of each hospital. The aim of this review was to summarize the mechanisms, efficacy, pharmacokinetics, and side effects associated with passive immunization using IVIg in immunologic RPL, according to the literature published in recent years. We hope that more obstetricians will be able to understand the timing and indication of IVIg properly in immunologic RPL patients and effectively enhance pregnancy outcomes for mothers and neonates.
Highlights
Recurrent pregnancy loss (RPL) commonly refers to three or more miscarriages that occur before 20 weeks of pregnancy [1]
In a randomized controlled study, Triolo et al confirmed that lowmolecular-weight (LMW) heparin and aspirin showed a higher live birth rate than Intravenous immunoglobulin (IVIg) in patients with RPL associated with antiphospholipid syndrome (APS) (84% vs. 57%) [52]
Two recent meta-analyses of IVIg use in RPL found no evidence of improved live birth rates [58, 168]
Summary
Recurrent pregnancy loss (RPL) commonly refers to three or more miscarriages that occur before 20 weeks of pregnancy [1]. Several studies and randomized controlled trials have analyzed the therapeutic effect of IVIg on immunologic RPL patients. The lack of sufficient evidence is the reason IVIg is not included in the clinical treatment guidelines for RPL [31] This conclusion was mainly suggested by Daya et al [32] and from the meta-analysis of six studies conducted by the German RSA/IVIG Group [33], Christiansen et al [34], Stephenson et al [35], Perino et al [36], Coulam et al [37], and Kipron et al [38]. We hope that more obstetricians will be able to understand the timing and indication of IVIg properly in immunologic RPL patients and effectively enhance pregnancy outcomes for mothers and neonates
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