Autoimmunity in Reproductive Health and Pregnancy

摘要

The influence of pregnancy on the maternal immune system is complex and orchestrated by multiple hormonal and metabolic factors provided by the mother as well as the fetus. The modifications of the maternal immune response include changes in cell proportions, phenotypes, and their functional ability to produce cytokines and other mediators. During pregnancy, activations of pro- and anti-inflammatory responses are fluently regulated depending on the phase of pregnancy [1]. Implantation, placentation, and delivery phases are proinflammatory, while the period of rapid fetal growth and development is anti-inflammatory [1]. The model of immune suppression during pregnancy has been long accepted, yet at the present, we are aware that fetal tolerance is not caused by suppression of the maternal immune system but rather by immunomodulation and that pregnant women are very much capable of having robust immune responses [2]. An understanding of the balance between tolerance and protection of the fetus and maternal active immune response against pathogens or self-antigens may contribute to developing new approaches to the problem of autoimmunity in reproductive health and pregnancy.Autoimmune diseases are characterized by organ and tissue damage caused by self-reactive immune responses mediated by antibodies and/or T cells. These diseases may be associated with genetic and/or environmental predispositions. Thus, autoimmune disorders predominantly affect women and often occur during reproductive years and have implications for fertility and pregnancy to some extent [3, 4]. The relationships between autoimmunity and reproduction include the impact of pregnancy on the clinical course of autoimmune disorders as well as the influence of autoimmunity on pregnancy development. Thus, in this population of patients, specialized concerns in pregnancy planning and management are commonly encountered. Autoimmune diseases are usually thought to be associated with pathogenic activity of Th17-/Th1-type cells; during pregnancy, Th2-type cytokines are noted to be crucial to maintain the tolerance of the mother towards the fetal semiallograft [3, 4]. In pregnancy, immunoregulatory cytokines and cells are present in the mother's circulatory system and accumulate in the decidua and can modify autoimmune responses influencing the symptoms of autoimmune disease.