Occurrence Of Pregnancy Loss Research Articles

P-432 The association of early pregnancy loss and thrombophilia

Abstract Study question Is there a correlation between thrombophilia and the occurrence of pregnancy loss? Summary answer No statistically significant association is observed between thrombophilia and the live births. What is known already The understanding of recurrent pregnancy loss is a subject of controversy, encompassing both its causes and potential treatments and there is currently no consensus regarding the criteria for examining patients experiencing pregnancy loss, the specific tests to be conducted, or the appropriate treatment approaches. The connection between hereditary thrombophilia and pregnancy loss remains unclear. Study design, size, duration Within the timeframe of 01/12/2020 to 01/06/2022, pregnancy loss clinic of a tertiary university hospital received a total of 296 patients who had experienced at least one pregnancy loss. Following examination, these patients were encouraged to return to clinic if they became pregnant again. Among them, 192 patients did become pregnant and sought further care. These patients received treatment based on pregnancy loss clinic’s management algorithm, and their subsequent pregnancies were closely monitored. Participants/materials, setting, methods This prospective study involved 192 patients who, after undergoing examination, experienced subsequent pregnancies. These patients were categorized into two groups based on their obstetric outcomes: live birth and pregnancy loss. The primary focus of the study was to compare hereditary and acquired thrombophilia between these two groups. Additionally, secondary outcomes included a comparison of obstetric history, genetics, uterine anomalies, and results from biochemical and hormonal examinations between the two groups. Main results and the role of chance 150 of 192 patients achieved live birth (78.13%). The prevalence of hereditary thrombophilia mutations showed no significant differences between the two groups. Specifically, in the pregnancy loss group, the FV Leiden mutation rate was 12.5%, compared to 13.7% in the live birth group (p = 0.836). The Prothrombin gene mutation was observed in 7.5% of the pregnancy loss group and 7.25% of the live birth group (p = 1.000). Additionally, the PAI 4G/5G polymorphism was present in 60% of the pregnancy loss group and 52% of the live birth group (p = 0.347), the MTHFR/C677T polymorphism was detected in 62.5% of the pregnancy loss group and 56.5% of the live birth group (p = 0.500), and the MTHFR/1298C polymorphism was identified in 62.5% of the pregnancy loss group and 60.1% of the live birth group (p = 0.788). While antithrombin III levels were comparable between the two groups (p = 0.53), a noteworthy decline in antithrombin III levels was observed with an increasing history of losses: 110.2 for one loss, 106.0 for two losses, and 100.2 for three or more losses (p = 0.033). The homocysteine level was found to be 10.85 μM (range: 6.60-24.80 μM) in the pregnancy loss group and 9.40 μM (range: 4.90-37.00 μM) in the live birth group (p = 0.023). Limitations, reasons for caution A limitation of our study is its single-center nature. Additionally, we did not include a healthy control group with no history of pregnancy loss, preventing a direct comparison between the pregnancy loss group and a group unaffected by such experiences. Wider implications of the findings Our study provides valuable insights into questioning the live birth expectations of women who have experienced pregnancy loss and underscores the significance of thrombophilia in the context of pregnancy loss. Trial registration number not applicable

Pregnancy Loss and Risk of All-Cause Mortality in Chinese Women: Findings From the China Kadoorie Biobank.

Objectives: Pregnancy loss is a common obstetric complication that may be associated with maternal mortality. However, evidence is sparse and inconsistent. This study aims to investigate the association between pregnancy loss with the risk of all-cause mortality among Chinese women. Methods: Data on 299,582 women aged 30-79years old from the China Kadoorie Biobank were used. Cox proportional hazard regression was conducted to investigate the association between the occurrence of pregnancy loss and all-cause mortality. Results: Two or more pregnancy losses was associated with long-term all-cause mortality (adjusted hazard ratio (aHR) of 1.10, 95% CI: 1.03-1.18). Specifically, more than one spontaneous abortion or stillbirth was associated with long-term all-cause mortality (aHR 1.10, 95% CI: 1.01-1.21 and 1.14, 95% CI: 1.04-1.25, respectively). When stratified by the presence of cardiovascular disease or diabetes, as well as age at baseline, two or more pregnancy losses in women aged ≥50 diagnosed with cardiovascular disease (aHR 1.32, 95% CI: 1.18-1.48) or diabetes (aHR 1.30, 95% CI: 1.06-1.60) was associated with all-cause mortality. Conclusion: Recurrent pregnancy loss, in particular two or more spontaneous abortions and stillbirths were associated with increased risk of all-cause mortality. The associations between recurrent pregnancy losses and all-cause mortality were more pronounced in women aged ≥50 with cardiovascular disease or diabetes at baseline.

Economic impact of pregnancy loss in an intensive dairy farming system

Occurrence of pregnancy loss and the related economic impact were determined in an intensively managed dairy herd. A total of 3,204 cow and heifer pregnancies were included over a two year period. Pregnancy loss was considered when: (1) cows or heifers that were diagnosed as pregnant by transrectal palpation, on days 50 to 50 postinsemination returned to estrus; (2) animals were found not to be pregnant at diagnosis confirmation on day 90, day 180, or during the drying-off period; and (3) if an abortion was clinically diagnosed. Data were analyzed through descriptive epidemiology and by survival analysis with the Kaplan-Meier method. The estimated cost of a single pregnancy loss was determined by the Monte Carlo methodology. Overall, 17.2% of cows (372/2,162) and 6.5% of heifers (68/1,042) had pregnany losses; the greater risk being in the first 90 days of gestation for cows (5.3/100 and 8.3/100 pregnancies in 2012 and 2013, respectively). Occurrence of pregnancy loss in heifers was also higher during the first trimester of gestation (1.7/100) in 2013. However, the pregnancy loss incidence peaked, between days 120 and 150 of gestation (1.7/100) in 2012. The cost of a single pregnancy loss during the first trimester was estimated at $5,253.00 (Mexican pesos), between days 91 and 180 at $9,674.00; and for over 181 days at $21,984.00. In conclusion, overall pregnancy loss rate in the studied herd was 17.2% for cows and 6.5% for heifers. The highest incidence of pregnancy loss occurred during the first 90 days of pregnancy. Thus, pregnancy loss may be the main reproductive cause affecting profitability of intensive dairy farming systems.

Pregnancy incidence and outcomes among women receiving preexposure prophylaxis for HIV prevention: a randomized clinical trial.

Antiretroviral preexposure prophylaxis (PrEP), using tenofovir disoproxil fumarate (TDF) and combination emtricitabine/tenofovir disoproxil fumarate (FTC+TDF), is efficacious for prevention of human immunodeficiency virus (HIV) acquisition. PrEP could reduce periconception HIV risk, but the effect on pregnancy outcomes is not well defined. To assess pregnancy incidence and outcomes among women using PrEP during the periconception period. Randomized trial among 1785 HIV-serodiscordant heterosexual couples (the Partners PrEP Study) in which the female partner was HIV uninfected that demonstrated that PrEP was efficacious for HIV prevention, conducted between July 2008 and June 2013 at 9 sites in Kenya and Uganda. Daily oral TDF (n = 598), combination FTC+TDF (n = 566), or placebo (n = 621) through July 2011, when PrEP demonstrated efficacy for HIV prevention. Thereafter, participants continued receiving active PrEP without placebo. Pregnancy testing occurred monthly and study medication was discontinued when pregnancy was detected. Pregnancy incidence, birth outcomes (live births, pregnancy loss, preterm birth, congenital anomalies), and infant growth. A total of 431 pregnancies occurred. Pregnancy incidence was 10.0 per 100 person-years among women assigned placebo, 11.9 among those assigned TDF (incidence difference, 1.9; 95% CI, -1.1 to 4.9 [P = .22 vs placebo]), and 8.8 among those assigned FTC+TDF (incidence difference, -1.3; 95% CI, -4.1 to 1.5 [P = .39 vs placebo]). Before discontinuation of the placebo treatment group in July 2011, the occurrence of pregnancy loss (96 of 288 pregnancies) was 42.5% for women receiving FTC+TDF compared with 32.3% for those receiving placebo (difference for FTC+TDF vs placebo, 10.2%; 95% CI, -5.3% to 25.7%; P = .16) and was 27.7% for those receiving TDF alone (difference vs placebo, -4.6%; 95% CI, -18.1% to 8.9%; P = .46). After July 2011, the frequency of pregnancy loss (52 of 143 pregnancies) was 37.5% for FTC+TDF and 36.7% for TDF alone (difference, 0.8%; 95% CI, -16.8% to 18.5%; P = .92). Occurrence of preterm birth, congenital anomalies, and growth throughout the first year of life did not differ significantly for infants born to women who received PrEP vs placebo. Among HIV-serodiscordant heterosexual African couples, differences in pregnancy incidence, birth outcomes, and infant growth were not statistically different for women receiving PrEP with TDF alone or combination FTC+TDF compared with placebo at conception. Given that PrEP was discontinued when pregnancy was detected and that CIs for the birth outcomes were wide, definitive statements about the safety of PrEP in the periconception period cannot be made. These results should be discussed with HIV-uninfected women receiving PrEP who are considering becoming pregnant. clinicaltrials.gov Identifier: NCT00557245.

Combined Hysteroscopy and Laparoscopy in the Evaluation of Patients with Recurrent Pregnancy Loss

Introduction: To determine the relative frequency of gynecological pathologies in patients with recurrent pregnancy loss using combined hysteroscopy and laparoscopy, and to evaluate the potential of this combined strategy in the diagnosis of coexisting pathologies. Methods: Over 6 years, in a large referral infertility clinic and research centre in Tehran, 80 women with the diagnosis of recurrent pregnancy loss underwent hysteroscopy and laparoscopy. Results: Forty nine (61.3%) women had 3 episodes of miscarriage, 9 (11.3%) had 4 occurrence of pregnancy loss and 14 (17.5%) patients had experienced 5 abortions. Also, there were 4 (5%), 2 (2.5%) and 2 (2.5%) participants with 6, 7 and 8 miscarriages, respectively. Thirteen women (16.2%) had normal hysteroscopy, and in 52 (65%) participant's laparoscopy did not reveal abnormal findings. Septate uterus and submucous myomas together, comprised 62 (77.5%) of the recognized pathologies in hysteroscopy. Of the 28 abnormalities found in laparoscopy, 12 (43%) was endometriosis (15% overall) and the others were, pelvic and abdominal adhesions. Conclusion: Combined laparoscopy and hysteroscopy yields more satisfactory diagnostic results compared with hysteroscopy alone. Septate uterus, submucous myomas and endometriosis were common findings in patients with recurrent miscarriage. Especially, patients with recurrent pregnancy loss should be examined for the coexistence of endometriosis

Prenatal diagnosis of inherited diseases: 20 years’ experience of an Italian Regional Reference Centre

The demand for molecular prenatal diagnosis (PD) of inherited diseases to help high-risk couples make informed reproductive decisions has increased in the past decade. We provided multidisciplinary pre-test counselling to 1248 couples at high risk of having a child affected by an inherited disease. After multidisciplinary counselling, 1171 couples requested PD for one of 73 inherited diseases. Of these, 995 (85.0%) were performed on DNA from chorionic villi (CV) and 176 (15.0%) on samples from amniocentesis. The occurrence of pregnancy loss (0.6%) and major complications did not differ significantly between the two groups. We made a diagnosis in all cases (including 8 twin pregnancies) except in 4/995 cases of CV sampling (0.4%) and in 3/176 of amniocentesis (1.7%) due to insufficient DNA. In 15 cases, molecular analysis revealed non-paternity. PD by analysis of foetal DNA from CV is a reliable aid in reproduction decision-making for couples at high risk of inherited diseases. The complexity of experimental procedures and the specific expertise required for the pre- and post-test multidisciplinary counselling suggest that PD be performed in reference centres also within the framework of supranational networks.

Factors Influencing the Frequency of Pregnancy Loss among Thoroughbred Mares in Hidaka, Japan

Pregnancy loss in mares is thought to be a main problem associated with reproductive efficiency. To clarify the situation of pregnancy loss in Thoroughbred mares in Japan, the occurrence of pregnancy loss before and after 35 days of gestation was investigated with 1,476 Thoroughbred mares in Hidaka, Japan, from 2007 to 2009. Pregnancy loss on days 17-35 was determined by ultrasound examination between 17 and 35 days after the last mating. Follow-up surveys were conducted between 35 days and foaling to determine pregnancy loss on day 35 until foaling in 843 of these mares. Using multiple logistic regression analysis, we assessed the influence of mare age, reproductive status, twin pregnancy reduction, body condition score (BCS), estrus type in foaling mares (foal heat or not), progesterone therapy, and endometrial cysts on pregnancy loss rates on days 17-35 and on day 35 until foaling in this population of mares. The pregnancy loss rates on days 17-35 and on day 35 until foaling were 5.8% and 8.7%, respectively. The overall pregnancy loss rate (day 17 until foaling, including parturient losses) was 14.7%. Risk factors for pregnancy loss included decrease in BCS between 17 and 35 days, <5 BCS at day 35, mating during foal heat, and endometrial cysts. In all, 14.7% of pregnancies were lost between day 17 and birth, contributing significantly to reduced reproductive efficiency in Thoroughbred mares in Japan. These observations indicate that mares should be maintained at high BCS and should be prevented from mating in foal heat to decrease the pregnancy loss rates.

Regulation of Costimulatory Signal in Maternal–Fetal Immune Tolerance

A pregnancy is associated with modifications in the immune status of the mother, but the mechanisms are not well understood. Several observations have indicated that CD28/CTLA-4 and B7-1/B7-2 are involved in the maternal-fetal immune regulation. This review aims to recapitulate our current knowledge concerning the role of CD28/CTLA-4 and B7-1/B7-2 in maternal-fetal immune regulation. Several studies suggest that up-regulation of B7-2 and/or CD28 and/or down-regulation of CTLA-4 are correlated with the occurrence of pregnancy loss. Therefore, an accurate expression of costimulatory molecules at the maternal-fetal interface may ensure that the decidual cells do not elicit a 'danger' signal to the maternal immune system, perhaps instead contributing to the establishment of immune tolerance in vivo. It is showed that costimulation blockade with anti-B7 mAbs results in altered allogeneic T-cell response and overcomes increased maternal rejection to the fetus, which improves fetus growth in the abortion-prone system. These findings suggest that the anti-B7-treated T cells not only function as potent suppresser cells but also exert immunoregulatory effect on the maternal T cells. This procedure might be potentially useful to immunotherapy for human recurrent spontaneous abortion.