Low mannose binding lectin level in plasma is a risk factor for recurrent pregnancy loss.

Beskrivelse

Abstract Study question: Are low or high plasma mannose binding lectin (p-MBL) levels associated with recurrent pregnancy loss (RPL) and the perinatal outcome before and after RPL diagnosis? Summary answer: While low p-MBL levels are significantly more frequent in RPL patients, high levels are significantly less frequent. No association with adverse perinatal outcomes was found. What is known already: Low p-MBL levels have been associated with RPL, while relations to high levels have been poorly studied. Reports concerning association between RPL and perinatal outcomes including birth weight and gestational age are conflicting. Some but not all studies suggest an association between low maternal p-MBL levels and reduced birthweight and gestational age, which could be an important factor for the higher frequency of preterm birth and lower birth weight often reported in pregnancies after RPL. Study design, size and duration: A combined case-control and cohort study in 248 RPL women admitted to the RPL Centre of Western Denmark from January 2016 to December 2019. At first consultation blood samples including p-MBL measurement and perinatal data from previous births were collected. Women were followed until birth or end of study. P-MBL levels were compared to those of 185 female blood donors, while perinatal outcomes were compared to all 3354 singleton births at our hospital in 2017. Participants/materials, setting, methods: All women had 3 consecutive pregnancy losses and a regular menstrual cycle, while none had significant chromosomal or uterine abnormalities. Frequencies of different subgroups of p-MBL levels in RPL patients were compared to MBL levels in the control group. Frequencies of adverse perinatal outcomes between subgroups defined by p-MBLlevels were compared. A multivariate analysis was performed identifying risk factors including low p-MBL level for adverse obstetrical outcomes in the patients. Main results and the role of chance: Significantly more RPL patients had low p-MBL levels (<500 g/l) (odds ratio [OR] = 2.45, 95% CI 1.61-3.71; p <0.001) and less had high MBL levels (>3000 g/l) (OR = 0.51; 95% CI 0.33-0.80; p=0.003) compared to controls, while comparing the intermediate p-MBL levels showed no differences (OR = 0.73, 95% CI 0.49-1.07; p = 0.11). A previous moderate (>500 ml) or severe peripartum haemorrhage (>1000 ml) (p<0.001 for both) and previous birth of a boy (p<0.001) were associated with secondary RPL (sRPL). Smoking, increasing age, BMI and number of consecutive miscarriages but not low p-MBL levels were significantly associated with no pregnancy or pregnancy loss after admission. No clear association was observed between maternal p-MBL levels and birthweight or gestational age, neither before nor after RPL. Limitations, reasons for caution: Only 93 (37.5 %) women gave birth after RPL in the follow-up period, which were too few to find any clear associations between p-MBL levels and adverse perinatal outcomes after RPL. Wider implications of findings: While low p-MBL levels are strongly associated with RPL, high levels may play a protective role. A previous large peripartum haemorrhage, previous delivery of a boy and low maternal p-MBL may predispose to a large feto-maternal transfer of fetal cells triggering an abnormal maternal immunization against fetal or trophoblast cells. Trial registration number: ID from clinicaltrials.gov is NCT04017754.

Periode	8 jul. 2020
Begivenhedstitel	36th Virtual Annual Meeting of the European Society of Human Reproduction and Embryology
Begivenhedstype	Konference
Konferencenummer	36
Grad af anerkendelse	International