Publication:

Association of serum cytokines IL-6, TNF-α, PTX-3 and progesterone modulation in cases of recurrent pregnancy loss

Background Cytokines are major immune regulators, which play a critical role in the pathophysiology of unexplained recurrent pregnancy loss. Th1 class of cytokines has been shown to exert deleterious effects on pregnancy causing early loss.

Methods The changeover in the levels of Th1 cytokines was studied in two major groups; Gp I (N=30) comprised of RPL subjects with two or more consecutive spontaneous miscarriages history and Gp II (N=30) comprised of normal pregnancy controls .The efficacy of oral micronized progesterone was assessed in regulation of cytokine levels ,with Gp Ia (N=15) treated with 200 mg oral micronized progesterone and Gp Ib (N=15) comprised of untreated RPL subjects and its role in improving pregnancy outcome was also determined. The present study determined the levels of cytokine TNF-α, IL-6 and PTX-3 in serum samples for all the subjects at three time points at the time of enrolment, with (GpIa) or without (Gp Ib) progesterone administration at 20 weeks or abortion if earlier and at the time of delivery.

Results The results indicated that the levels of Th1 cytokines (TNF-α [37.80 versus 78.09], IL-6 [16.93 versus 81.12] and PTX-3 [17.42 versus 73.53]) was found to be reduced at every time point in the treated cases with an RPL history as compared to untreated ones. Further, the cases treated with with oral micronized progesterone were found to have better pregnancy outcomes (p<0.005 significant number of live births).

Conclusions The levels of interlukins, TNF-α, IL-6, PTX-3 in cases of RPL may not have a major contributory role in predicting outcome, however exogenous progesterone decreases the Th1 pro inflammatory response and efficiently improves the pregnancy outcomes by modulation of cytokine levels.