Abstract
Pregnancy is an immunological paradox, with renowned Nobel Prize winning transplantation biologist Sir Peter Brian Medawar being the first to introduce this concept back in 1953. This concept considers how the maternal immune system can tolerate the developing fetus, which is 50% antigenically foreign to the uterus. There have been significant advances in our understanding of the immune system in regulating fertility, pregnancy and in complications of these, and what was once considered a paradox can be seen as a highly evolved system. Indeed, the complexity of the maternal–fetal interface along with our ever-advancing knowledge of immune cells and mediators means that we have a better understanding of these interactions, with gaps still present. This chapter will summarise the key aspects of the role of the immune system at each stage of pregnancy and highlight the recent advances in our knowledge.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Aagaard K, Ma J, Antony KM, Ganu R, Petrosino J, Versalovic J (2014) The placenta harbors a unique microbiome. Sci Transl Med 6:237ra65
Abrahams VM, Kim YM, Straszewski SL, Romero R, Mor G (2004) Macrophages and apoptotic cell clearance during pregnancy. Am J Reprod Immunol 51:275–282
Adams Waldorf KM, Nelson JL (2008) Autoimmune disease during pregnancy and the microchimerism legacy of pregnancy. Immunol Invest 37:631–644
Adiguzel D, Celik-Ozenci C (2021) FoxO1 is a cell-specific core transcription factor for endometrial remodeling and homeostasis during menstrual cycle and early pregnancy. Hum Reprod Update 27:570–583
Agarwal R, Loganath A, Roy AC, Wong YC, Ng SC (2001) Expression profiles of interleukin-15 in early and late gestational human placenta and in pre-eclamptic placenta. Mol Hum Reprod 7:97–101
Aghajanova L, Hamilton AE, Giudice LC (2008) Uterine receptivity to human embryonic implantation: histology, biomarkers, and transcriptomics. Semin Cell Dev Biol 19:204–211
Aldo PB, Racicot K, Craviero V, Guller S, Romero R, Mor G (2014) Trophoblast induces monocyte differentiation into CD14+/CD16+ macrophages. Am J Reprod Immunol 72:270–284
Aluvihare VR, Kallikourdis M, Betz AG (2004) Regulatory T cells mediate maternal tolerance to the fetus. Nat Immunol 5:266–271
Annual Capri Workshop G (2020) Correction to: early pregnancy loss: the default outcome for fertilized human oocytes. J Assist Reprod Genet 37:1065
Apps R, Gardner L, Hiby SE, Sharkey AM, Moffett A (2008) Conformation of human leucocyte antigen-C molecules at the surface of human trophoblast cells. Immunology 124:322–328
Apps R, Murphy SP, Fernando R, Gardner L, Ahad T, Moffett A (2009) Human leucocyte antigen (HLA) expression of primary trophoblast cells and placental cell lines, determined using single antigen beads to characterize allotype specificities of anti-HLA antibodies. Immunology 127:26–39
Atay S, Gercel-Taylor C, Taylor DD (2011) Human trophoblast-derived exosomal fibronectin induces pro-inflammatory IL-1beta production by macrophages. Am J Reprod Immunol 66:259–269
Bai K, Li X, Zhong J, Ng EHY, Yeung WSB, Lee CL, Chiu PCN (2021) Placenta-derived exosomes as a modulator in maternal immune tolerance during pregnancy. Front Immunol 12:671093
Baldeon-Vaca G, Marathe JG, Politch JA, Mausser E, Pudney J, Doud J, Nador E, Zeitlin L, Pauly M, Moench TR, Brennan M, Whaley KJ, Anderson DJ (2021) Production and characterization of a human antisperm monoclonal antibody against CD52g for topical contraception in women. EBioMedicine 69:103478
Bardos J, Fiorentino D, Longman RE, Paidas M (2019) Immunological role of the maternal uterine microbiome in pregnancy: pregnancies pathologies and alterated microbiota. Front Immunol 10:2823
Barrientos G, Fuchs D, Schrocksnadel K, Ruecke M, Garcia MG, Klapp BF, Raghupathy R, Miranda S, Arck PC, Blois SM (2009) Low levels of serum asymmetric antibodies as a marker of threatened pregnancy. J Reprod Immunol 79:201–210
Belo L, Santos-Silva A, Rocha S, Caslake M, Cooney J, Pereira-Leite L, Quintanilha A, Rebelo I (2005) Fluctuations in C-reactive protein concentration and neutrophil activation during normal human pregnancy. Eur J Obstet Gynecol Reprod Biol 123:46–51
Berkhout RP, Lambalk CB, Repping S, Hamer G, Mastenbroek S (2020) Premature expression of the decidualization marker prolactin is associated with repeated implantation failure. Gynecol Endocrinol 36:360–364
Blaschitz A, Lenfant F, Mallet V, Hartmann M, Bensussan A, Geraghty DE, le Bouteiller P, Dohr G (1997) Endothelial cells in chorionic fetal vessels of first trimester placenta express HLA-G. Eur J Immunol 27:3380–3388
Blaser MJ, Devkota S, McCoy KD, Relman DA, Yassour M, Young VB (2021) Lessons learned from the prenatal microbiome controversy. Microbiome 9:8
Bondt A, Selman MH, Deelder AM, Hazes JM, Willemsen SP, Wuhrer M, Dolhain RJ (2013) Association between galactosylation of immunoglobulin G and improvement of rheumatoid arthritis during pregnancy is independent of sialylation. J Proteome Res 12:4522–4531
Bove R, Chitnis T (2014) The role of gender and sex hormones in determining the onset and outcome of multiple sclerosis. Mult Scler 20:520–526
Brazdova A, Senechal H, Peltre G, Poncet P (2016) Immune aspects of female infertility. Int J Fertil Steril 10:1–10
Bromfield JJ (2014) Seminal fluid and reproduction: much more than previously thought. J Assist Reprod Genet 31:627–636
Bryceson YT, March ME, Ljunggren HG, Long EO (2006) Synergy among receptors on resting NK cells for the activation of natural cytotoxicity and cytokine secretion. Blood 107:159–166
Bulmer JN, Williams PJ, Lash GE (2010) Immune cells in the placental bed. Int J Dev Biol 54:281–294
Bushman FD (2019) De-discovery of the placenta microbiome. Am J Obstet Gynecol 220:213–214
Cai YJ, Huang L, Leung TY, Burd A (2014) A study of the immune properties of human umbilical cord lining epithelial cells. Cytotherapy 16:631–639
Care AS, Diener KR, Jasper MJ, Brown HM, Ingman WV, Robertson SA (2013) Macrophages regulate corpus luteum development during embryo implantation in mice. J Clin Invest 123:3472–3487
Castilla JA, Rueda R, Vargas ML, Gonzalez-Gomez F, Garcia-Olivares E (1989) Decreased levels of circulating CD4+ T lymphocytes during normal human pregnancy. J Reprod Immunol 15:103–111
Chegini N, Roberts M, Ripps B (2003) Differential expression of interleukins (IL)-13 and IL-15 in ectopic and eutopic endometrium of women with endometriosis and normal fertile women. Am J Reprod Immunol 49:75–83
Chen C, Song X, Wei W, Zhong H, Dai J, Lan Z, Li F, Yu X, Feng Q, Wang Z, Xie H, Chen X, Zeng C, Wen B, Zeng L, Du H, Tang H, Xu C, Xia Y, Xia H, Yang H, Wang J, Wang J, Madsen L, Brix S, Kristiansen K, Xu X, Li J, Wu R, Jia H (2017) The microbiota continuum along the female reproductive tract and its relation to uterine-related diseases. Nat Commun 8:875
Chen T, Darrasse-Jèze G, Bergot AS, Courau T, Churlaud G, Valdivia K, Strominger JL, Ruocco MG, Chaouat G, Klatzmann D (2013) Self-Specific Memory Regulatory T Cells Protect Embryos at Implantation in Mice. J Immunol 191(5):2273–2281
Colasanti T, Maselli A, Conti F, Sanchez M, Alessandri C, Barbati C, Vacirca D, Tinari A, Chiarotti F, Giovannetti A, Franconi F, Valesini G, Malorni W, Pierdominici M, Ortona E (2012) Autoantibodies to estrogen receptor alpha interfere with T lymphocyte homeostasis and are associated with disease activity in systemic lupus erythematosus. Arthritis Rheum 64:778–787
Coleman M, Orvis A, Wu TY, Dacanay M, Merillat S, Ogle J, Baldessari A, Kretzer NM, Munson J, Boros-Rausch AJ, Shynlova O, Lye S, Rajagopal L, Adams Waldorf KM (2020) A broad spectrum chemokine inhibitor prevents preterm labor but not microbial invasion of the amniotic cavity or neonatal morbidity in a non-human primate model. Front Immunol 11:770
Collado MC, Rautava S, Aakko J, Isolauri E, Salminen S (2016) Human gut colonisation may be initiated in utero by distinct microbial communities in the placenta and amniotic fluid. Sci Rep 6:23129
Confavreux C, Hutchinson M, Hours MM, Cortinovis-Tourniaire P, Moreau T (1998) Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in multiple sclerosis group. N Engl J Med 339:285–291
Crispin JC, Liossis SN, Kis-Toth K, Lieberman LA, Kyttaris VC, Juang YT, Tsokos GC (2010) Pathogenesis of human systemic lupus erythematosus: recent advances. Trends Mol Med 16:47–57
Crouch SP, Crocker IP, Fletcher J (1995) The effect of pregnancy on polymorphonuclear leukocyte function. J Immunol 155:5436–5443
Cullinan EB, Abbondanzo SJ, Anderson PS, Pollard JW, Lessey BA, Stewart CL (1996) Leukemia inhibitory factor (LIF) and LIF receptor expression in human endometrium suggests a potential autocrine/paracrine function in regulating embryo implantation. Proc Natl Acad Sci U S A 93:3115–3120
Daly DC, Maslar IA, Riddick DH (1983) Prolactin production during in vitro decidualization of proliferative endometrium. Am J Obstet Gynecol 145:672–678
De M, Wood GW (1990) Influence of oestrogen and progesterone on macrophage distribution in the mouse uterus. J Endocrinol 126:417–424
De M, Choudhuri R, Wood GW (1991) Determination of the number and distribution of macrophages, lymphocytes, and granulocytes in the mouse uterus from mating through implantation. J Leukoc Biol 50:252–262
de Goffau MC, Lager S, Sovio U, Gaccioli F, Cook E, Peacock SJ, Parkhill J, Charnock-Jones DS, Smith GCS (2019) Human placenta has no microbiome but can contain potential pathogens. Nature 572:329–334
Dimitriadis E, White CA, Jones RL, Salamonsen LA (2005) Cytokines, chemokines and growth factors in endometrium related to implantation. Hum Reprod Update 11:613–630
Disanto G, Ramagopalan SV (2013) On the sex ratio of multiple sclerosis. Mult Scler 19:3–4
Dominguez F, Remohi J, Pellicer A, Simon C (2002) Paracrine interactions during human implantation. Rev Endocr Metab Disord 3:97–105
Dominguez F, Galan A, Martin JJ, Remohi J, Pellicer A, Simon C (2003a) Hormonal and embryonic regulation of chemokine receptors CXCR1, CXCR4, CCR5 and CCR2B in the human endometrium and the human blastocyst. Mol Hum Reprod 9:189–198
Dominguez F, Pellicer A, Simon C (2003b) The chemokine connection: hormonal and embryonic regulation at the human maternal-embryonic interface—a review. Placenta 24(Suppl B):S48–S55
Dosiou C, Giudice LC (2005) Natural killer cells in pregnancy and recurrent pregnancy loss: endocrine and immunologic perspectives. Endocr Rev 26:44–62
Dragovic RA, Collett GP, Hole P, Ferguson DJ, Redman CW, Sargent IL, Tannetta DS (2015) Isolation of syncytiotrophoblast microvesicles and exosomes and their characterisation by multicolour flow cytometry and fluorescence nanoparticle tracking analysis. Methods 87:64–74
Druckmann R, Druckmann MA (2005) Progesterone and the immunology of pregnancy. J Steroid Biochem Mol Biol 97:389–396
Du M-R, Wang S-C, Li D-J (2014) The integrative roles of chemokines at the maternal–fetal interface in early pregnancy. Cell Mol Immunol 11:438–448
du Fosse NA, Lashley E, Anholts JDH, van Beelen E, le Cessie S, van Lith JMM, Eikmans M, van der Hoorn MLP (2022) Impaired immunomodulatory effects of seminal plasma may play a role in unexplained recurrent pregnancy loss: results of an in vitro study. J Reprod Immunol 151:103500
Dunn CL, Kelly RW, Critchley HO (2003) Decidualization of the human endometrial stromal cell: an enigmatic transformation. Reprod Biomed Online 7:151–161
Eidinger D, Garrett TJ (1972) Studies of the regulatory effects of the sex hormones on antibody formation and stem cell differentiation. J Exp Med 136:1098–1116
El-Azzamy H, Balogh A, Romero R, Xu Y, Lajeunesse C, Plazyo O, Xu Z, Price TG, Dong Z, Tarca AL, Papp Z, Hassan SS, Chaiworapongsa T, Kim CJ, Gomez-Lopez N, Than NG (2017) Characteristic changes in decidual gene expression signature in spontaneous term parturition. J Pathol Transl Med 51:264–283
El-Etr M, Vukusic S, Gignoux L, Durand-Dubief F, Achiti I, Baulieu EE, Confavreux C (2005) Steroid hormones in multiple sclerosis. J Neurol Sci 233:49–54
El-Maallem H, Fletcher J (1980) Impaired neutrophil function and myeloperoxidase deficiency in pregnancy. Br J Haematol 44:375–381
Englund JA, Chu HY (2018) Respiratory virus infection during pregnancy: does it matter? J Infect Dis 218:512–515
Faas MM, de Vos P (2017) Uterine NK cells and macrophages in pregnancy. Placenta 56:44–52
Foocharoen C, Nanagara R, Salang L, Suwannaroj S, Mahakkanukrauh A (2009) Pregnancy and disease outcome in patients with systemic lupus erythematosus (SLE): a study at Srinagarind Hospital. J Med Assoc Thai 92:167–174
Forestieri S, Marcialis MA, Migliore L, Panisi C, Fanos V (2022) Relationship between pregnancy and coronavirus: what we know. J Matern Fetal Neonatal Med 35:1997–2008
Forger F, Villiger PM (2020) Immunological adaptations in pregnancy that modulate rheumatoid arthritis disease activity. Nat Rev Rheumatol 16:113–122
Fricke WF, Ravel J (2021) Microbiome or no microbiome: are we looking at the prenatal environment through the right lens? Microbiome 9:9
Fu B, Li X, Sun R, Tong X, Ling B, Tian Z, Wei H (2013) Natural killer cells promote immune tolerance by regulating inflammatory TH17 cells at the human maternal-fetal interface. Proc Natl Acad Sci U S A 110:E231–E240
Giltay EJ, Fonk JC, von Blomberg BM, Drexhage HA, Schalkwijk C, Gooren LJ (2000) In vivo effects of sex steroids on lymphocyte responsiveness and immunoglobulin levels in humans. J Clin Endocrinol Metab 85:1648–1657
Giuliani E, Parkin KL, Lessey BA, Young SL, Fazleabas AT (2014) Characterization of uterine NK cells in women with infertility or recurrent pregnancy loss and associated endometriosis. Am J Reprod Immunol 72:262–269
Goldenberg RL, Thompson C (2003) The infectious origins of stillbirth. Am J Obstet Gynecol 189:861–873
Goldenberg RL, Hauth JC, Andrews WW (2000) Intrauterine infection and preterm delivery. N Engl J Med 342:1500–1507
Gomez-Chavez F, Canedo-Solares I, Ortiz-Alegria LB, Flores-Garcia Y, Luna-Pasten H, Figueroa-Damian R, Mora-Gonzalez JC, Correa D (2019) Maternal immune response during pregnancy and vertical transmission in human toxoplasmosis. Front Immunol 10:285
Gomez-Lopez N, Laresgoiti-Servitje E, Olson DM, Estrada-Gutierrez G, Vadillo-Ortega F (2010) The role of chemokines in term and premature rupture of the fetal membranes: a review. Biol Reprod 82:809–814
Gordon SM (2021). Interleukin-15 in outcomes of pregnancy. Int J Mol Sci 22
Guerin LR, Prins JR, Robertson SA (2009) Regulatory T-cells and immune tolerance in pregnancy: a new target for infertility treatment? Hum Reprod Update 15:517–535
Guerin LR, Moldenhauer LM, Prins JR, Bromfield JJ, Hayball JD, Robertson SA (2011) Seminal fluid regulates accumulation of FOXP3+ regulatory T cells in the preimplantation mouse uterus through expanding the FOXP3+ cell pool and CCL19-mediated recruitment. Biol Reprod 85:397–408
Gustafsson C, Mjosberg J, Matussek A, Geffers R, Matthiesen L, Berg G, Sharma S, Buer J, Ernerudh J (2008) Gene expression profiling of human decidual macrophages: evidence for immunosuppressive phenotype. PLoS ONE 3:e2078
Gutierrez G, Gentile T, Miranda S, Margni RA (2005) Asymmetric antibodies: a protective arm in pregnancy. Chem Immunol Allergy 89:158–168
Guzman-Genuino RM, Diener KR (2017) Regulatory B cells in pregnancy: lessons from autoimmunity, graft tolerance, and cancer. Front Immunol 8:172
Hackmon R, Pinnaduwage L, Zhang J, Lye SJ, Geraghty DE, Dunk CE (2017) Definitive class I human leukocyte antigen expression in gestational placentation: HLA-F, HLA-E, HLA-C, and HLA-G in extravillous trophoblast invasion on placentation, pregnancy, and parturition. Am J Reprod Immunol 77
Hammer A, Hutter H, Blaschitz A, Mahnert W, Hartmann M, Uchanska-Ziegler B, Ziegler A, Dohr G (1997) Amnion epithelial cells, in contrast to trophoblast cells, express all classical HLA class I molecules together with HLA-G. Am J Reprod Immunol 37:161–171
Hampl R, Kubatova J, Heracek J, Sobotka V, Starka L (2013) Hormones and endocrine disruptors in human seminal plasma. Endocr Regul 47:149–158
Hampton MM (2015) Congenital toxoplasmosis: a review. Neonatal Netw 34:274–278
Hanna J, Goldman-Wohl D, Hamani Y, Avraham I, Greenfield C, Natanson-Yaron S, Prus D, Cohen-Daniel L, Arnon TI, Manaster I, Gazit R, Yutkin V, Benharroch D, Porgador A, Keshet E, Yagel S, Mandelboim O (2006) Decidual NK cells regulate key developmental processes at the human fetal-maternal interface. Nat Med 12:1065–1074
Hannan NJ, Salamonsen LA (2007) Role of chemokines in the endometrium and in embryo implantation. Curr Opin Obstet Gynecol 19:266–272
Hannan NJ, Salamonsen LA (2008) CX3CL1 and CCL14 regulate extracellular matrix and adhesion molecules in the trophoblast: potential roles in human embryo implantation. Biol Reprod 79:58–65
Hannan NJ, Jones RL, White CA, Salamonsen LA (2006) The chemokines, CX3CL1, CCL14, and CCL4, promote human trophoblast migration at the feto-maternal interface. Biol Reprod 74:896–904
Hedlund M, Stenqvist AC, Nagaeva O, Kjellberg L, Wulff M, Baranov V, Mincheva-Nilsson L (2009) Human placenta expresses and secretes NKG2D ligands via exosomes that down-modulate the cognate receptor expression: evidence for immunosuppressive function. J Immunol 183:340–351
Hsu KF, Pan HA, Hsu YY, Wu CM, Chung WJ, Huang SC (2014) Enhanced myometrial autophagy in postpartum uterine involution. Taiwan J Obstet Gynecol 53:293–302
Hunt JS, Langat DL (2009) HLA-G: a human pregnancy-related immunomodulator. Curr Opin Pharmacol 9:462–469
Hviid TV (2006) HLA-G in human reproduction: aspects of genetics, function and pregnancy complications. Hum Reprod Update 12:209–232
Illsley NP, Dasilva-Arnold SC, Zamudio S, Alvarez M, Al-Khan A (2020) Trophoblast invasion: lessons from abnormally invasive placenta (placenta accreta). Placenta 102:61–66
Ishitani A, Sageshima N, Lee N, Dorofeeva N, Hatake K, Marquardt H, Geraghty DE (2003) Protein expression and peptide binding suggest unique and interacting functional roles for HLA-E, F, and G in maternal-placental immune recognition. J Immunol 171:1376–1384
Jensen F, Muzzio D, Soldati R, Fest S, Zenclussen AC (2013) Regulatory B10 cells restore pregnancy tolerance in a mouse model. Biol Reprod 89:90
Jiang L, Fei H, Jin X, Liu X, Yang C, Li C, Chen J, Yang A, Zhu J, Wang H, Fei X, Zhang S (2021) Extracellular vesicle-mediated secretion of HLA-E by trophoblasts maintains pregnancy by regulating the metabolism of decidual NK cells. Int J Biol Sci 17:4377–4395
Johansson M, Bromfield JJ, Jasper MJ, Robertson SA (2004) Semen activates the female immune response during early pregnancy in mice. Immunology 112:290–300
Jones LA, Anthony JP, Henriquez FL, Lyons RE, Nickdel MB, Carter KC, Alexander J, Roberts CW (2008) Toll-like receptor-4-mediated macrophage activation is differentially regulated by progesterone via the glucocorticoid and progesterone receptors. Immunology 125:59–69
Jorgensen N, Persson G, Hviid TVF (2019) The tolerogenic function of regulatory T cells in pregnancy and cancer. Front Immunol 10:911
Kahn DA, Baltimore D (2010) Pregnancy induces a fetal antigen-specific maternal T regulatory cell response that contributes to tolerance. Proc Natl Acad Sci U S A 107:9299–9304
Kallikourdis M, Betz AG (2007) Periodic accumulation of regulatory T cells in the uterus: preparation for the implantation of a semi-allogeneic fetus? PLoS ONE 2:e382
Kalluri R, Lebleu VS (2020) The biology, function, and biomedical applications of exosomes. Science 367
Kalok A, Abdul Cader R, Indirayani I, Abdul Karim AK, Shah SA, Mohamed Ismail NA, Omar MH, Shafiee MN (2019) Pregnancy outcomes in systemic lupus erythematosus (SLE) women. Horm Mol Biol Clin Investig 40
Kim S, Liva SM, Dalal MA, Verity MA, Voskuhl RR (1999) Estriol ameliorates autoimmune demyelinating disease: implications for multiple sclerosis. Neurology 52:1230–1238
Kindzelskii AL, Ueki T, Michibata H, Chaiworapongsa T, Romero R, Petty HR (2004) 6-Phosphogluconate dehydrogenase and glucose-6-phosphate dehydrogenase form a supramolecular complex in human neutrophils that undergoes retrograde trafficking during pregnancy. J Immunol 172:6373–6381
King A, Allan DS, Bowen M, Powis SJ, Joseph S, Verma S, Hiby SE, Mcmichael AJ, Loke YW, Braud VM (2000a) HLA-E is expressed on trophoblast and interacts with CD94/NKG2 receptors on decidual NK cells. Eur J Immunol 30:1623–1631
King A, Burrows TD, Hiby SE, Bowen JM, Joseph S, Verma S, Lim PB, Gardner L, Le Bouteiller P, Ziegler A, Uchanska-Ziegler B, Loke YW (2000b) Surface expression of HLA-C antigen by human extravillous trophoblast. Placenta 21:376–387
Kitaya K, Yasuda J, Yagi I, Tada Y, Fushiki S, Honjo H (2000) IL-15 expression at human endometrium and decidua. Biol Reprod 63:683–687
Knight M, Redman CW, Linton EA, Sargent IL (1998) Shedding of syncytiotrophoblast microvilli into the maternal circulation in pre-eclamptic pregnancies. Br J Obstet Gynaecol 105:632–640
Krop J, Heidt S, Claas FHJ, Eikmans M (2020) Regulatory T cells in pregnancy: it is not all about FoxP3. Front Immunol 11:1182
Kshirsagar SK, Alam SM, Jasti S, Hodes H, Nauser T, Gilliam M, Billstrand C, Hunt JS, Petroff MG (2012) Immunomodulatory molecules are released from the first trimester and term placenta via exosomes. Placenta 33:982–990
Kuijper EA, Ket JC, Caanen MR, Lambalk CB (2013) Reproductive hormone concentrations in pregnancy and neonates: a systematic review. Reprod Biomed Online 27:33–63
La Rocca C, Carbone F, Longobardi S, Matarese G (2014) The immunology of pregnancy: regulatory T cells control maternal immune tolerance toward the fetus. Immunol Lett 162:41–48
Lasch M, Sudan K, Paul C, Schulz C, Kolben T, Dorp JV, Eren S, Beyer S, Siniscalchi L, Mahner S, Jeschke U, Meister S (2022) Isolation of decidual macrophages and Hofbauer cells from term placenta-comparison of the expression of CD163 and CD80. Int J Mol Sci 23
Lauder AP, Roche AM, Sherrill-Mix S, Bailey A, Laughlin AL, Bittinger K, Leite R, Elovitz MA, Parry S, Bushman FD (2016) Comparison of placenta samples with contamination controls does not provide evidence for a distinct placenta microbiota. Microbiome 4:29
Leber A, Teles A, Zenclussen AC (2010) Regulatory T cells and their role in pregnancy. Am J Reprod Immunol 63:445–459
Leiby JS, McCormick K, Sherrill-Mix S, Clarke EL, Kessler LR, Taylor LJ, Hofstaedter CE, Roche AM, Mattei LM, Bittinger K, Elovitz MA, Leite R, Parry S, Bushman FD (2018) Lack of detection of a human placenta microbiome in samples from preterm and term deliveries. Microbiome 6:196
Li Z, Li R, Li X, Dai H, Han X, Wang X, Yang A (2020) LIF in embryo culture medium is a predictive marker for clinical pregnancy following IVF-ET of patients with fallopian tube obstruction. J Reprod Immunol 141:103164
Lim ES, Rodriguez C, Holtz LR (2018) Amniotic fluid from healthy term pregnancies does not harbor a detectable microbial community. Microbiome 6:87
Lima J, Martins C, Leandro MJ, Nunes G, Sousa MJ, Branco JC, Borrego LM (2016) Characterization of B cells in healthy pregnant women from late pregnancy to post-partum: a prospective observational study. BMC Pregnancy Childbirth 16:139
Lin H, Mosmann TR, Guilbert L, Tuntipopipat S, Wegmann TG (1993) Synthesis of T-helper 2-type cytokines at the maternal-fetal interface. J Immunol 151:4562–4573
Liu L, Wang Z (2013) Estrogen attenuates lipopolysaccharide-induced nitric oxide production in macrophages partially via the nongenomic pathway. Cell Immunol 286:53–58
Liu F, Guo J, Tian T, Wang H, Dong F, Huang H, Dong M (2011) Placental trophoblasts shifted Th1/Th2 balance toward Th2 and inhibited Th17 immunity at fetomaternal interface. APMIS 119:597–604
Lockwood CJ, Nemerson Y, Guller S, Krikun G, Alvarez M, Hausknecht V, Gurpide E, Schatz F (1993) Progestational regulation of human endometrial stromal cell tissue factor expression during decidualization. J Clin Endocrinol Metab 76:231–236
Loras B, Vetele F, el Malki A, Rollet J, Soufir JC, Benahmed M (1999) Seminal transforming growth factor-beta in normal and infertile men. Hum Reprod 14:1534–1539
Luppi P, Haluszczak C, Betters D, Richard CA, Trucco M, Deloia JA (2002a) Monocytes are progressively activated in the circulation of pregnant women. J Leukoc Biol 72:874–884
Luppi P, Haluszczak C, Trucco M, Deloia JA (2002b) Normal pregnancy is associated with peripheral leukocyte activation. Am J Reprod Immunol 47:72–81
Maegawa M, Kamada M, Irahara M, Yamamoto S, Yoshikawa S, Kasai Y, Ohmoto Y, Gima H, Thaler CJ, Aono T (2002) A repertoire of cytokines in human seminal plasma. J Reprod Immunol 54:33–42
Mahajan D, Sharma NR, Kancharla S, Kolli P, Tripathy A, Sharma AK, Singh S, Kumar S, Mohanty AK Jena MK (2022) Role of Natural Killer cells during pregnancy and related complications. Biomolecules 12
Manaster I, Mandelboim O (2010) The unique properties of uterine NK cells. Am J Reprod Immunol 63:434–444
Manaster I, Mizrahi S, Goldman-Wohl D, Sela HY, Stern-Ginossar N, Lankry D, Gruda R, Hurwitz A, Bdolah Y, Haimov-Kochman R, Yagel S, Mandelboim O (2008) Endometrial NK cells are special immature cells that await pregnancy. J Immunol 181:1869–1876
Mariee N, Li TC, Laird SM (2012) Expression of leukaemia inhibitory factor and interleukin 15 in endometrium of women with recurrent implantation failure after IVF; correlation with the number of endometrial natural killer cells. Hum Reprod 27:1946–1954
Markert UR, Morales-Prieto DM, Fitzgerald JS (2011) Understanding the link between the IL-6 cytokine family and pregnancy: implications for future therapeutics. Expert Rev Clin Immunol 7:603–609
Matsumoto H, Sakai K, Iwashita M (2008) Insulin-like growth factor binding protein-1 induces decidualization of human endometrial stromal cells via alpha5beta1 integrin. Mol Hum Reprod 14:485–489
Menzies FM, Henriquez FL (2009) Immunomodulation by the female sex hormones. Open Infect Dis J 3:61–72
Menzies FM, Henriquez FL, Alexander J, Roberts CW (2011) Selective inhibition and augmentation of alternative macrophage activation by progesterone. Immunology 134:281–291
Mertz D, Lo CK, Lytvyn L, Ortiz JR, Loeb M, Flurisk I (2019) Pregnancy as a risk factor for severe influenza infection: an individual participant data meta-analysis. BMC Infect Dis 19:683
Mezouar S, Ben Amara A, Chartier C, Gorvel L, Mege JL (2019) A fast and reliable method to isolate human placental macrophages. Curr Protoc Immunol 125:e77
Mezouar S, Katsogiannou M, Ben Amara A, Bretelle F, Mege JL (2021) Placental macrophages: origin, heterogeneity, function and role in pregnancy-associated infections. Placenta 103:94–103
Mikkelsen AP, Egerup P, Kolte AM, Westergaard D, Nielsen HS, Lidegaard O (2022) Pregnancy loss and risk of multiple sclerosis and autoimmune neurological disorder: a nationwide cohort study. PLoS ONE 17:e0266203
Moberg C, Bourlev V, Ilyasova N, Olovsson M (2015) Endometrial expression of LIF and its receptor and peritoneal fluid levels of IL-1alpha and IL-6 in women with endometriosis are associated with the probability of pregnancy. Arch Gynecol Obstet 292:429–437
Moldenhauer LM, Diener KR, Thring DM, Brown MP, Hayball JD, Robertson SA (2009) Cross-presentation of male seminal fluid antigens elicits T cell activation to initiate the female immune response to pregnancy. J Immunol 182:8080–8093
Monin L, Whettlock EM, Male V (2020) Immune responses in the human female reproductive tract. Immunology 160:106–115
Morandi F, Ferretti E, Bocca P, Prigione I, Raffaghello L, Pistoia V (2010) A novel mechanism of soluble HLA-G mediated immune modulation: downregulation of T cell chemokine receptor expression and impairment of chemotaxis. PLoS ONE 5:e11763
Moreno I, Codoner FM, Vilella F, Valbuena D, Martinez-Blanch JF, Jimenez-Almazan J, Alonso R, Alama P, Remohi J, Pellicer A, Ramon D, Simon C (2016) Evidence that the endometrial microbiota has an effect on implantation success or failure. Am J Obstet Gynecol 215:684–703
Moroni G, Ponticelli C (2016) Pregnancy in women with systemic lupus erythematosus (SLE). Eur J Intern Med 32:7–12
Moser G, Windsperger K, Pollheimer J, De Sousa Lopes SC, Huppertz B (2018) Human trophoblast invasion: new and unexpected routes and functions. Histochem Cell Biol 150:361–370
Muralidhara P, Sood V, Vinayak Ashok V, Bansal K (2022) Pregnancy and tumour: the parallels and differences in regulatory T cells. Front Immunol 13:866937
Murata H, Tanaka S, Okada H (2021) Immune tolerance of the human decidua. J Clin Med 10
Muzzio D, Zenclussen AC, Jensen F (2013) The role of B cells in pregnancy: the good and the bad. Am J Reprod Immunol 69:408–412
Nair S, Salomon C (2018) Extracellular vesicles and their immunomodulatory functions in pregnancy. Semin Immunopathol 40:425–437
Ng SW, Norwitz GA, Pavlicev M, Tilburgs T, Simon C, Norwitz ER (2020) Endometrial decidualization: the primary driver of pregnancy health. Int J Mol Sci 21
Ning F, Liu H, Lash GE (2016) The role of decidual macrophages during normal and pathological pregnancy. Am J Reprod Immunol 75:298–309
Oertelt-Prigione S (2012) The influence of sex and gender on the immune response. Autoimmun Rev 11:A479–A485
Ono Y, Yoshino O, Hiraoka T, Sato E, Fukui Y, Ushijima A, Nawaz A, Hirota Y, Wada S, Tobe K, Nakashima A, Osuga Y, Saito S (2020) CD206+ M2-like macrophages are essential for successful implantation. Front Immunol 11:557184
Osman I, Young A, Ledingham MA, Thomson AJ, Jordan F, Greer IA, Norman JE (2003) Leukocyte density and pro-inflammatory cytokine expression in human fetal membranes, decidua, cervix and myometrium before and during labour at term. Mol Hum Reprod 9:41–45
Paliulyte V, Drasutiene GS, Ramasauskaite D, Bartkeviciene D, Zakareviciene J, Kurmanavicius J (2017) Physiological uterine involution in primiparous and multiparous women: ultrasound study. Obstet Gynecol Int 2017:6739345
Pantos K, Grigoriadis S, Maziotis E, Pistola K, Xystra P, Pantou A, Kokkali G, Pappas A, Lambropoulou M, Sfakianoudis K, Simopoulou M (2022) The role of interleukins in recurrent implantation failure: a comprehensive review of the literature. Int J Mol Sci 23
Papuchova H, Meissner TB, Li Q, Strominger JL, Tilburgs T (2019) The dual role of HLA-C in tolerance and immunity at the maternal-fetal interface. Front Immunol 10:2730
Park DW, Yang KM (2011) Hormonal regulation of uterine chemokines and immune cells. Clin Exp Reprod Med 38:179–185
Pennell LM, Galligan CL, Fish EN (2012) Sex affects immunity. J Autoimmun 38:J282–J291
Perez-Munoz ME, Arrieta MC, Ramer-Tait AE, Walter J (2017) A critical assessment of the “sterile womb” and “in utero colonization” hypotheses: implications for research on the pioneer infant microbiome. Microbiome 5:48
Poehlmann TG, Fitzgerald JS, Meissner A, Wengenmayer T, Schleussner E, Friedrich K, Markert UR (2005) Trophoblast invasion: tuning through LIF, signalling via Stat3. Placenta 26(Suppl A):S37–S41
Prince AL, Ma J, Kannan PS, Alvarez M, Gisslen T, Harris RA, Sweeney EL, Knox CL, Lambers DS, Jobe AH, Chougnet CA, Kallapur SG, Aagaard KM (2016) The placental membrane microbiome is altered among subjects with spontaneous preterm birth with and without chorioamnionitis. Am J Obstet Gynecol, 214:627e1–627e16
Pujianto D, Hajizah H, Mansur I, Amarudin A (2018) Antisperm antibodies disrupt plasma membrane integrity and inhibit tyrosine phosphorylation in human spermatozoa. Med J Indonesia 27:3–11
Quinn KH, Lacoursiere DY, Cui L, Bui J, Parast MM (2011) The unique pathophysiology of early-onset severe preeclampsia: role of decidual T regulatory cells. J Reprod Immunol 91:76–82
Ramhorst R, Grasso E, Paparini D, Hauk V, Gallino L, Calo G, Vota D, Perez Leiros C (2016) Decoding the chemokine network that links leukocytes with decidual cells and the trophoblast during early implantation. Cell Adh Migr 10:197–207
Red-Horse K, Drake PM, Gunn MD, Fisher SJ (2001) Chemokine ligand and receptor expression in the pregnant uterus: reciprocal patterns in complementary cell subsets suggest functional roles. Am J Pathol 159:2199–2213
Red-Horse K, Drake PM, Fisher SJ (2004) Human pregnancy: the role of chemokine networks at the fetal-maternal interface. Expert Rev Mol Med 6:1–14
Roberts CW, Cruickshank SM, Alexander J (1995) Sex-determined resistance to Toxoplasma gondii is associated with temporal differences in cytokine production. Infect Immun 63:2549–2555
Robertson SA, Guerin LR, Bromfield JJ, Branson KM, Ahlstrom AC, Care AS (2009a) Seminal fluid drives expansion of the CD4+CD25+ T regulatory cell pool and induces tolerance to paternal alloantigens in mice. Biol Reprod 80:1036–1045
Robertson SA, Guerin LR, Moldenhauer LM, Hayball JD (2009b) Activating T regulatory cells for tolerance in early pregnancy—the contribution of seminal fluid. J Reprod Immunol 83:109–116
Robertson SA, Green ES, Care AS, Moldenhauer LM, Prins JR, Hull ML, Barry SC, Dekker G (2019) Therapeutic potential of regulatory T cells in preeclampsia-opportunities and challenges. Front Immunol 10:478
Robertson SA (2005) Seminal plasma and male factor signalling in the female reproductive tract. Cell Tissue Res 322:43–52
Robinson DP, Klein SL (2012) Pregnancy and pregnancy-associated hormones alter immune responses and disease pathogenesis. Horm Behav 62:263–271
Rodriguez-Martinez H, Kvist U, Ernerudh J, Sanz L, Calvete JJ (2011) Seminal plasma proteins: what role do they play? Am J Reprod Immunol 66(Suppl 1):11–22
Rolle L, Memarzadeh Tehran M, Morell-Garcia A, Raeva Y, Schumacher A, Hartig R, Costa SD, Jensen F, Zenclussen AC (2013) Cutting edge: IL-10-producing regulatory B cells in early human pregnancy. Am J Reprod Immunol 70:448–453
Romero R, Espinoza J, Goncalves LF, Kusanovic JP, Friel LA, Nien JK (2006) Inflammation in preterm and term labour and delivery. Semin Fetal Neonatal Med 11:317–326
Rowe JH, Ertelt JM, Xin L, Way SS. (2012) Pregnancy imprints regulatory memory that sustains anergy to fetal antigen. Nat 490(7418):102–106
Saito S, Nakashima A, Shima T, Ito M (2010) Th1/Th2/Th17 and regulatory T-cell paradigm in pregnancy. Am J Reprod Immunol 63:601–610
Salamonsen LA (2003) Tissue injury and repair in the female human reproductive tract. Reproduction 125:301–311
Salomon C, Guanzon D, Scholz-Romero K, Longo S, Correa P, Illanes SE, Rice GE (2017) Placental exosomes as early biomarker of preeclampsia: potential role of exosomal MicroRNAs across gestation. J Clin Endocrinol Metab 102:3182–3194
Santner-Nanan B, Peek MJ, Khanam R, Richarts L, Zhu E, Fazekas De St Groth B, Nanan R (2009) Systemic increase in the ratio between Foxp3+ and IL-17-producing CD4+ T cells in healthy pregnancy but not in preeclampsia. J Immunol 183:7023–7030
Sarker S, Scholz-Romero K, Perez A, Illanes SE, Mitchell MD, Rice GE, Salomon C (2014) Placenta-derived exosomes continuously increase in maternal circulation over the first trimester of pregnancy. J Transl Med 12:204
Schjenken JE, Robertson SA (2020) The female response to seminal fluid. Physiol Rev 100:1077–1117
Sehring J, Beltsos A, Jeelani R (2022) Human implantation: The complex interplay between endometrial receptivity, inflammation, and the microbiome. Placenta 117:179–186
Sharkey AM, Gardner L, Hiby S, Farrell L, Apps R, Masters L, Goodridge J, Lathbury L, Stewart CA, Verma S, Moffett A (2008) Killer Ig-like receptor expression in uterine NK cells is biased toward recognition of HLA-C and alters with gestational age. J Immunol 181:39–46
Sharkey DJ, Macpherson AM, Tremellen KP, Mottershead DG, Gilchrist RB, Robertson SA (2012a) TGF-beta mediates proinflammatory seminal fluid signaling in human cervical epithelial cells. J Immunol 189:1024–1035
Sharkey DJ, Tremellen KP, Jasper MJ, Gemzell-Danielsson K, Robertson SA (2012b) Seminal fluid induces leukocyte recruitment and cytokine and chemokine mRNA expression in the human cervix after coitus. J Immunol 188:2445–2454
Sharkey DJ, Tremellen KP, Briggs NE, Dekker GA, Robertson SA (2016) Seminal plasma transforming growth factor-beta, activin A and follistatin fluctuate within men over time. Hum Reprod 31:2183–2191
Shigeta N, Kumasawa K, Tanaka A, Badger wing J, Nakamura H, Sakaguchi S, Kimura T (2020) Dynamics of effector and naive regulatory T cells throughout pregnancy. J Reprod Immunol 140:103135
Shima T, Inada K, Nakashima A, Ushijima A, Ito M, Yoshino O, Saito S (2015) Paternal antigen-specific proliferating regulatory T cells are increased in uterine-draining lymph nodes just before implantation and in pregnant uterus just after implantation by seminal plasma-priming in allogeneic mouse pregnancy. J Reprod Immunol 108:72–82
Shima T, Nakashima A, Yasuda I, Ushijima A, Inada K, Tsuda S, Yoshino O, Tomura M, Saito S (2020) Uterine CD11c+ cells induce the development of paternal antigen-specific Tregs via seminal plasma priming. J Reprod Immunol 141:103165
Shobu T, Sageshima N, Tokui H, Omura M, Saito K, Nagatsuka Y, Nakanishi M, Hayashi Y, Hatake K, Ishitani A (2006) The surface expression of HLA-F on decidual trophoblasts increases from mid to term gestation. J Reprod Immunol 72:18–32
Shynlova O, Boros-Rausch A, Farine T, Adams Waldorf KM, Dunk C, Lye SJ (2021) Decidual inflammation drives chemokine-mediated immune infiltration contributing to term labor. J Immunol 207:2015–2026
Singh N, Herbert B, Sooranna GR, Orsi NM, Edey L, Dasgupta T, Sooranna SR, Yellon SM, Johnson MR (2017) Is myometrial inflammation a cause or a consequence of term human labour? J Endocrinol 235:69–83
Singh N, Herbert B, Sooranna G, Shah NM, Das A, Sooranna SR, Johnson MR (2021) Is there an inflammatory stimulus to human term labour? PLoS ONE 16:e0256545
Singh S (2016) Congenital toxoplasmosis: clinical features, outcomes, treatment, and prevention. Trop Parasitol 6:113–122
Smith R (2007) Parturition. N Engl J Med 356:271–283
Somerset DA, Zheng Y, Kilby MD, Sansom DM, Drayson MT (2004) Normal human pregnancy is associated with an elevation in the immune suppressive CD25+ CD4+ regulatory T-cell subset. Immunology 112:38–43
Stenqvist AC, Nagaeva O, Baranov V, Mincheva-Nilsson L (2013) Exosomes secreted by human placenta carry functional Fas ligand and TRAIL molecules and convey apoptosis in activated immune cells, suggesting exosome-mediated immune privilege of the fetus. J Immunol 191:5515–5523
Stewart CL, Kaspar P, Brunet LJ, Bhatt H, Gadi I, Kontgen F, Abbondanzo SJ (1992) Blastocyst implantation depends on maternal expression of leukaemia inhibitory factor. Nature 359:76–79
Stinson LF, Boyce MC, Payne MS, Keelan JA (2019) The not-so-sterile womb: evidence that the human fetus is exposed to bacteria prior to birth. Front Microbiol 10:1124
Strunz B, Bister J, Jonsson H, Filipovic I, Crona-Guterstam Y, Kvedaraite E, Sleiers N, Dumitrescu B, Brannstrom M, Lentini A, Reinius B, Cornillet M, Willinger T, Gidlof S, Hamilton RS, Ivarsson MA, Bjorkstrom NK (2021) Continuous human uterine NK cell differentiation in response to endometrial regeneration and pregnancy. Sci Immunol 6
Suman P, Malhotra SS, Gupta SK (2013) LIF-STAT signaling and trophoblast biology. JAKSTAT 2:e25155
Tang AW, Alfirevic Z, Quenby S (2011) Natural killer cells and pregnancy outcomes in women with recurrent miscarriage and infertility: a systematic review. Hum Reprod 26:1971–1980
Tannetta D, Collett G, Vatish M, Redman C, Sargent I (2017) Syncytiotrophoblast extracellular vesicles—circulating biopsies reflecting placental health. Placenta 52:134–138
Teles A, Zenclussen AC, Schumacher A (2013) Regulatory T cells are baby′s best friends. Am J Reprod Immunol 69:331–339
Telgmann R, Gellersen B (1998) Marker genes of decidualization: activation of the decidual prolactin gene. Hum Reprod Update 4:472–479
Theis KR, Romero R, Winters AD, Greenberg JM, Gomez-Lopez N, Alhousseini A, Bieda J, Maymon E, Pacora P, Fettweis JM, Buck GA, Jefferson KK, Strauss JF 3rd, Erez O, Hassan SS (2019) Does the human placenta delivered at term have a microbiota? Results of cultivation, quantitative real-time PCR, 16S rRNA gene sequencing, and metagenomics. Am J Obstet Gynecol 220:267e1–267e39
Thomson AJ, Telfer JF, Young A, Campbell S, Stewart CJ, Cameron IT, Greer IA, Norman JE (1999) Leukocytes infiltrate the myometrium during human parturition: further evidence that labour is an inflammatory process. Hum Reprod 14:229–236
Tilburgs T, Roelen DL, van der Mast BJ, De Groot-Swings GM, Kleijburg C, Scherjon SA, Claas FH (2008) Evidence for a selective migration of fetus-specific CD4+CD25bright regulatory T cells from the peripheral blood to the decidua in human pregnancy. J Immunol 180:5737–5745
Tilburgs T, Scherjon SA, Van Der Mast BJ, Haasnoot GW, Versteeg VDV-MM, Roelen DL, Van Rood JJ, Claas FH (2009) Fetal-maternal HLA-C mismatch is associated with decidual T cell activation and induction of functional T regulatory cells. J Reprod Immunol 82:148–157
Tilburgs T, Meissner TB, Ferreira LMR, Mulder A, Musunuru K, Ye J, Strominger JL (2017) NLRP2 is a suppressor of NF-kB signaling and HLA-C expression in human trophoblastsdagger, double dagger. Biol Reprod 96:831–842
Tong M, Abrahams VM, Chamley LW (2018) Immunological effects of placental extracellular vesicles. Immunol Cell Biol
Torgerson PR, Mastroiacovo P (2013) The global burden of congenital toxoplasmosis: a systematic review. Bull World Health Organ 91:501–508
Toth B, Haufe T, Scholz C, Kuhn C, Friese K, Karamouti M, Makrigiannakis A, Jeschke U (2010) Placental interleukin-15 expression in recurrent miscarriage. Am J Reprod Immunol 64:402–410
Tremellen KP, Seamark RF, Robertson SA (1998) Seminal transforming growth factor beta1 stimulates granulocyte-macrophage colony-stimulating factor production and inflammatory cell recruitment in the murine uterus. Biol Reprod 58:1217–1225
Tremellen KP, Valbuena D, Landeras J, Ballesteros A, Martinez J, Mendoza S, Norman RJ, Robertson SA, Simon C (2000) The effect of intercourse on pregnancy rates during assisted human reproduction. Hum Reprod 15:2653–2658
Tsuda S, Nakashima A, Shima T, Saito S (2019) New paradigm in the role of regulatory T cells during pregnancy. Front Immunol 10:573
Tsuda S, Nakashima A, Morita K, Shima T, Yoneda S, Kishi H, Saito S (2021) The role of decidual regulatory T cells in the induction and maintenance of fetal antigen-specific tolerance: Imbalance between regulatory and cytotoxic T cells in pregnancy complications. Hum Immunol 82:346–352
Vacca P, Moretta L, Moretta A, Mingari MC (2011) Origin, phenotype and function of human natural killer cells in pregnancy. Trends Immunol 32:517–523
Vacca P, Mingari MC, Moretta L (2013) Natural killer cells in human pregnancy. J Reprod Immunol 97:14–19
Van De Geijn FE, Wuhrer M, Selman MH, Willemsen SP, De Man YA, Deelder AM, Hazes JM, Dolhain RJ (2009) Immunoglobulin G galactosylation and sialylation are associated with pregnancy-induced improvement of rheumatoid arthritis and the postpartum flare: results from a large prospective cohort study. Arthritis Res Ther 11:R193
Vickram AS, Dhama K, Chakraborty S, Samad HA, Latheef SK, Sharun K, Khurana SK, K, A, Tiwari R, Bhatt P, K, V, Chaicumpa W (2019) Role of antisperm antibodies in infertility, pregnancy, and potential forcontraceptive and antifertility vaccine designs: research progress and pioneering vision. Vaccines 7:116
Wegmann TG, Lin H, Guilbert L, Mosmann TR (1993) Bidirectional cytokine interactions in the maternal-fetal relationship—is successful pregnancy a Th2 phenomenon. Immunol Today 14:353–356
Wilcox AJ, Weinberg CR, O'Connor JF, Baird DD, Schlatterer JP, Canfield RE, Armstrong EG, Nisula BC (1988) Incidence of early loss of pregnancy. N Engl J Med 319(4):189–194
Winship A, Correia J, Zhang JG, Nicola NA, Dimitriadis E (2015) Leukemia inhibitory factor (LIF) inhibition during mid-gestation impairs trophoblast invasion and spiral artery remodelling during pregnancy in mice. PLoS ONE 10:e0129110
Wira CR, Rodriguez-Garcia M, Patel MV (2015) The role of sex hormones in immune protection of the female reproductive tract. Nat Rev Immunol 15:217–230
Wu WX, Brooks J, Glasier AF, Mcneilly AS (1995) The relationship between decidualization and prolactin mRNA and production at different stages of human pregnancy. J Mol Endocrinol 14:255–261
Yang Y, Chu W, Geraghty DE, Hunt JS (1996) Expression of HLA-G in human mononuclear phagocytes and selective induction by IFN-gamma. J Immunol 156:4224–4231
Yasuda I, Shima T, Moriya T, Ikebuchi R, Kusumoto Y, Ushijima A, Nakashima A, Tomura M, Saito S (2020) Dynamic changes in the phenotype of dendritic cells in the uterus and uterine draining lymph nodes after coitus. Front Immunol 11:557720
Young A, Thomson AJ, Ledingham M, Jordan F, Greer IA, Norman JE (2002) Immunolocalization of proinflammatory cytokines in myometrium, cervix, and fetal membranes during human parturition at term. Biol Reprod 66:445–449
Zenclussen AC, Gentile T, Kortebani G, Mazzolli A, Margni R (2001) Asymmetric antibodies and pregnancy. Am J Reprod Immunol 45:289–294
Zenclussen ML, Thuere C, Ahmad N, Wafula PO, Fest S, Teles A, Leber A, Casalis PA, Bechmann I, Priller J, Volk HD, Zenclussen AC (2010) The persistence of paternal antigens in the maternal body is involved in regulatory T-cell expansion and fetal-maternal tolerance in murine pregnancy. Am J Reprod Immunol 63:200–208
Zhang YH, Sun HX (2020) Immune checkpoint molecules in pregnancy: focus on regulatory T cells. Eur J Immunol 50:160–169
Zhang YH, He M, Wang Y, Liao AH (2017) Modulators of the balance between M1 and M2 macrophages during pregnancy. Front Immunol 8:120
Zinaman MJ, Clegg ED, Brown CC, O’Connor J, Selevan SG (1996) Estimates of human fertility and pregnancy loss. Fertil Steril 65(3):503–509
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Menzies, F.M. (2023). Immunology of Pregnancy and Systemic Consequences. In: Klein, S.L., Roberts, C.W. (eds) Sex and Gender Differences in Infection and Treatments for Infectious Diseases. Current Topics in Microbiology and Immunology, vol 441. Springer, Cham. https://doi.org/10.1007/978-3-031-35139-6_10
Download citation
DOI: https://doi.org/10.1007/978-3-031-35139-6_10
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-35138-9
Online ISBN: 978-3-031-35139-6
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)