Placental insufficiency and miscarriage in patients with chronic viral infections: Immunological aspects


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Objective: to assess a role of the cytotoxic link of the immune system and proinflammatory cytokines in the genesis of placental insufficiency and miscarriage in females with chronic viral infections. Setting: Department of Obstetrics and Gynecology, Medical Prophylactic Faculty, I. M. Sechenov Moscow Medical Academy. Design: a prospective cohort study. Subjects: 81 pregnant women with chronic viral infections and 100 patients in the first, second, and third trimesters of pregnancy (a control group). Methods: plasma cell immunity parameters (CD3, CD4, CD8, CD16, and CD25) were investigated by flow cytometry and the levels of extracellular proinflammatory (IL-2, IL-6, and TNF-α) and anti-inflammatory cytokines (IL-4, IL-10) were measured by enzyme immunoassay. Placental insufficiency was diagnosed by the data of ultrasound and Doppler studies, and the level of placental hormones. Results: activation of cytotoxic immunity (CD8 +, CD16 +, CD56 +), T-lymphocytic activation markers (CD25 +) and increased synthesis of proinflammatory cytokines (IL-2 and TNF-α) were revealed in pregnant women with viral infections as compared with the control group. These changes were observed throughout pregnancy starting from early gestational periods and they were accompanied by a reduction of Th2-pathway cytokines (IL-4 and IL-10). Conclusion: stratified analysis revealed the maximum increase in the count of CDS8 +, CD56, CD25, IL-2, TNF-α, and a reduction in IL-4 and IL-10 in patients with viral infections with the development of placental insufficiency and miscarriage.

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N. V. Dolgushina

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