Autoimmunity and Pregnancy Loss

Certain autoimmune conditions, such as systemic lupus erythematosus (SLE), are associated with pregnancy loss. Almost 30 years ago, investigators published data that focused on fetal wastage in women with antiphospholipid antibodies (aPLs) and that included fetal loss as one clinical criterion for the diagnosis of antiphospholipid syndrome (APS) [1,2]. After these initial publications, interest in other autoimmune disorders as possible causes of pregnancy loss has increased. This interest prompted an ongoing effort to link the presence of a specific autoantibody or patterns of autoantibodies to recurrent pregnancy loss. A multitude of candidate autoantibodies have been evaluated, and some clinicians routinely perform assays for multiple autoantibodies in the evaluation of women with recurrent pregnancy loss; however, there is only modest evidence to support the concept that most autoantibodies cause pregnancy loss. This article discusses the potential association between several specific autoimmune conditions and recurrent pregnancy loss. Recurrent pregnancy loss may be caused by a myriad of factors, including anatomic, hormonal, thrombotic, autoimmune, genetic, infectious, or unknown causes. Most women with two or three unexplained, consecutive embryonic losses are otherwise healthy and have no other signs or symptoms that might be considered part of an autoimmune condition.