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Antimullerian hormone as a risk factor for miscarriage in naturally conceived pregnancies.

ABSTRACT: OBJECTIVE:To determine the association between antimüllerian hormone (AMH), a measure of ovarian reserve, and miscarriage among naturally conceived pregnancies. DESIGN:Prospective cohort study. SETTING:Not applicable. PATIENT(S):Women (n = 533), between 30 and 44 years of age with no known history of infertility, polycystic ovarian syndrome, or endometriosis who conceived naturally. INTERVENTION(S):None. MAIN OUTCOME MEASURE(S):Miscarriage, defined as an intrauterine pregnancy loss before 20 weeks' gestation. RESULT(S):After adjusting for maternal age, race, history of recurrent miscarriage, and obesity, risk of miscarriage decreased as AMH increased (risk ratio per unit increase in natural log of AMH = 0.83; 95% confidence interval [CI], 0.73, 0.94). Women with severely diminished ovarian reserve (AMH ? 0.4 ng/mL) miscarried at over twice the rate of women with an AMH ? 1 ng/mL (hazard ratio, 2.3; 95% CI, 1.3, 4.3). CONCLUSION(S):AMH levels are inversely associated with the risk of miscarriage. Women with severely diminished ovarian reserve are at an increased risk of miscarriage.

SUBMITTER: Lyttle Schumacher BM

PROVIDER: S-EPMC6063511 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Antimüllerian hormone as a risk factor for miscarriage in naturally conceived pregnancies.

Lyttle Schumacher Brianna M BM Jukic Anne Marie Z AMZ Steiner Anne Z AZ

Fertility and sterility 20180602 6

<h4>Objective</h4>To determine the association between antimüllerian hormone (AMH), a measure of ovarian reserve, and miscarriage among naturally conceived pregnancies.<h4>Design</h4>Prospective cohort study.<h4>Setting</h4>Not applicable.<h4>Patient(s)</h4>Women (n = 533), between 30 and 44 years of age with no known history of infertility, polycystic ovarian syndrome, or endometriosis who conceived naturally.<h4>Intervention(s)</h4>None.<h4>Main outcome measure(s)</h4>Miscarriage, defined as a ...[more]

PMID: 29871793

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Project description:IntroductionIn pregnancy, the mother and fetus differ in HLA antigens, and yet the maternal immune system generally tolerates the fetus. KIR receptors expressed by maternal uterine NK cells at the maternal-fetal interface directly interact with HLA-C on extravillous trophoblast cells for optimal placental development. In this study, we aimed to determine whether there is a preferential selection for HLA compatibility and specific KIR/HLA-C combinations in uncomplicated and preeclamptic naturally conceived pregnancies compared to what would be expected by chance.MethodsGenotyping for maternal and fetal HLA-A, -B, -C, -DR, and -DQ, and maternal KIR was performed for 451 uncomplicated pregnancies and 77 pregnancies complicated with preeclampsia. The number of HLA antigen (mis)matches between mother and fetus was calculated and compared to expected values obtained by randomization of the HLA haplotype, inherited from the father, over the existing maternal haplotype of the fetuses. A similar methodology was executed for analysis of the KIR/HLA-C data (n=309).ResultsIn uncomplicated pregnancies, the degree of maternal-fetal HLA matching was not different than expected-by-chance values. In preeclamptic pregnancies, the degree of maternal-fetal HLA matching was different in observed compared to expected-by-chance values (p=0.012). More specifically, the degree of maternal-fetal matching of HLA-C was higher in the actual preeclamptic pregnancies than was expected-by-chance (p=0.007). Preeclamptic pregnancies showed an overall tendency towards higher maternal-fetal HLA compatibility, for total HLA matches (p=0.021), HLA class I (p=0.038) and HLA-C (p=0.025) compared to uncomplicated pregnancies.ConclusionThe data suggest that there is no preferential selection of maternal-fetal HLA compatibility in uncomplicated pregnancies. In contrast, increased total HLA, HLA class I and, especially, HLA-C compatibility is associated with preeclampsia, suggestive for a role of HLA mismatches in immune regulation leading to uncomplicated pregnancy.

Dataset Information

Antimullerian hormone as a risk factor for miscarriage in naturally conceived pregnancies.

Publications

Antimüllerian hormone as a risk factor for miscarriage in naturally conceived pregnancies.

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