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Immunology of Pregnancy

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Contraception and Pregnancy in Patients with Rheumatic Disease

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Abstract

Alterations in local immune function occur during the course of a woman’s menstrual cycle that result in changes in the quantity and distribution of immune cells within the female genital tract. As the uterus prepares for pregnancy and after conception occurs, additional changes in local immunity allow the maternal immune system to recognize but not react against the semi-allograft fetus. Uterine natural killer cells, a specialized immune cell subpopulation that is found within the uterus in increasing amounts during gestation, appear to be imperative for successful placental trophoblast invasion early in pregnancy. Shifts in the patterns of cytokine release by T helper cells during the course of pregnancy appear to produce changing inflammatory responses that aid in the successful continuation of pregnancy. Some changes in the maternal immune system can be seen systemically as well as locally. The frequency of flares and periods of remission of many autoimmune disorders are also affected by gestational changes in local and systemic immune responses. When the necessary immune shifts do not occur, pregnancy pathologies such as preterm labor, preeclampsia, and isolated or recurrent pregnancy loss may occur.

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Abbreviations

ADCC:

Antibody-dependent cellular cytotoxicity

ANG2:

Angiopoietin 2

CMV:

Cytomegalovirus

CSA:

Chondroitin sulfate A

CTL:

Cytotoxic T lymphocyte

DAF:

Decay-accelerating factor

DC:

Dendritic cell

EVT:

Extravillous cytotrophoblast

hCG:

Human chorionic gonadotropin

HLA:

Human leukocyte antigen

IFN:

Interferon

IL:

Interleukin

KAR:

Killer activation receptor

KIRS:

Killer immunoglobulin-like receptors

LIF:

Leukemia inhibitory factor

LIRS:

Leukocyte immunoglobulin-like receptors

MAC:

Membrane attack complex

MBL:

Mannose-binding lectin

MCP:

Membrane cofactor protein

MHC:

Major histocompatibility complex

MS:

Multiple sclerosis

NF-κB:

Nuclear factor-kappa B

NK:

Natural killer

PIBF:

Progesterone-induced binding factor

PIGF:

Placental growth factor

RA:

Rheumatoid arthritis

SLE:

Systemic lupus erythematosus

SynT:

Syncytiotrophoblast

TCR:

T cell receptor

Tfh:

Follicular helper T lymphocyte

TGF:

Transforming growth factor

Th:

T helper

TNF:

Tumor necrosis factor

Treg:

T regulatory lymphocyte

UL:

Unique long

uNK:

Uterine natural killer lymphocyte

US:

Unique short

VEGFC:

Vascular endothelial growth factor C

VZV:

Varicella zoster virus

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Authors and Affiliations

  1. Department of Obstetrics, Gynecology and Women’s Health, University of Missouri, 500 North Keene Street, Suite 203, Columbia, MO, 65203, USA

    Danny J. Schust M.D. & Amanda J. Stephens M.D.

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  1. Danny J. Schust M.D.
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  2. Amanda J. Stephens M.D.
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Correspondence to Danny J. Schust M.D. .

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Editors and Affiliations

  1. Division of Rheumatology, Hospital for Special Surgery Weill Cornell Medical College, New York, New York, USA

    Lisa R. Sammaritano

  2. Division of Rheumatology, Brigham and Women's Hospital, Boston, Massachusetts, USA

    Bonnie L. Bermas

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Schust, D.J., Stephens, A.J. (2014). Immunology of Pregnancy. In: Sammaritano, L., Bermas, B. (eds) Contraception and Pregnancy in Patients with Rheumatic Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0673-4_1

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