Abstract
Pregnancy can be described as the symbiosis of two allogeneic individuals that live in intimate contact. Although the fetus provides a panel of MHC antigens derived from both its mother and father, it is not rejected by its mother’s immune system. The maternal immune system reacts toward the foreign tissue, but it tolerates, supports, and regulates its development instead of rejecting it. The formation of the placenta is efficiently controlled, ensuring development of the embryo and fetus. In the course of the discovery of the MHC and its role in transplantation, Medawar was the first to compare the immunologically privileged nature of the fetus with an allograft in 1953. He proposed ideas such as the anatomical separation of mother and fetus, antigenic immaturity of the fetus, and maternal immunosuppression, all of which have now been investigated and partly disproved. However, maternal tolerance of a semiallogeneic fetus is a paradox that remains a central theme in the field of reproductive immunology. Although the maternal immune system recognizes the semiallogeneic fetus, it remains in a quiescent state. The potential mechanisms underlying this phenomenon are likely to be complex and may involve several complementary or overlapping pathways to favor reproductive success. Knowledge of the immunoregulatory processes of pregnancy is necessary to understand and treat a variety of disorders that may lead to infertility, premature events, or preeclampsia. Knowledge of the structural basis of the placenta and the immunobiology of the decidua and of trophoblast are important issues to discuss before addressing disturbances in this system, including preeclampsia, preterm labor, or pregnancy loss.
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Immunology of Pregnancy
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Weissenbacher, E.R., Wirth, M., Mylonas, I., Geburtshilfe, K.f., Ledger, W.J., Witkin, S.S. (2014). Immunology in Reproductive Medicine. In: Immunology of the Female Genital Tract. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-14906-1_5
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