Abstract
The fetus is semiallogeneic in relation to the maternal immune system yet is tolerated during normal pregnancy. This paradox was recognized as a result of transplantation research done by Sir P. Medawar about 60 years ago. Today, we know that the fetus employs many mechanisms to not only evade rejection by the maternal immune system but also indeed promote maternal immune cells in the aid of placentation and normal development. These mechanisms include expression of immunosuppressive molecules and growth factors by the placenta, production of anti-inflammatory mediators by maternal immune cells, and redirection of maternal immune cell function by regulatory T cells. In the event that immune tolerance to the fetus fails, ‘rejection’ of the fetus may result in pregnancy loss: the best documented incidence of this is when maternal alloimmunization against fetal red blood cell antigens occurs, in which maternal anti-fetal antibodies can cause dire consequences to fetal health.
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