Recurrent miscarriage is still considered a mysterious problem that requires many efforts to find a suitable solution
Recurrent miscarriage is still considered a mysterious problem that requires many efforts to find a suitable solution. Recurrent miscarriage of unknown etiology presents a challenge to the clinician. The psychological impact for affected couples can be profound, with increased depression, anxiety and lowered self-esteem. The immunological aspect has been investigated numerous times in the past. However, it has been suggested that the main cause of recurrent miscarriage is an immunological abnormality. Even though genomic, transcriptomic and proteomic studies have already identified components of the immune response, thrombosis, steroid biosynthesis, apoptosis and angiogenesis-related genes that are associated with recurrent miscarriage. More screening studies are required for a better understanding of the underlying etiology of recurrent miscarriage. Therefore, the elucidation of the detailed functions of T helper cells and the cytokines they produce will shed light on the pathogenesis of recurrent miscarriage. It is hoped that a more comprehensive understanding of the molecular mechanisms for maintaining normal pregnancy will ultimately be of great benefit for developing efficient therapeutics for recurrent miscarriage patients. Even though various treatments, including hormonal and immunological therapies, have been applied to the treatment of women suffering from recurrent miscarriage but it is controversial whether proper evaluation of the cause of failed pregnancies has been performed. Therefore, it has been emphasized that proper evaluation and standardization for recurrent miscarriage patients is needed if the possible risks and appropriate therapeutic approaches are to be effectively assessed. More comprehensive studies at a molecular level are required in order to understand the causes of recurrent miscarriage and develop treatment protocols. In recent years, development in cytogenetics and immunogenetics along with greater understanding of implantation and maternal-embryo interactions has presented new insights into the possible causes of recurrent pregnancy loss and opened up new avenues for research into its prevention and treatment. The flux of these cytokines if observed in first and second trimester can serve as molecular marker for recurrent miscarriage and adequate treatment /precautionary measures can be taken to reduce incidence of miscarriages. Study in the flux of these cytokines and the underlying mechanistic basis can be suggestive of novel treatment regimens and drug development in future. The detection of the cytokine gene polymorphisms in women with recurrent miscarriage also will help in treating and managing the pregnancy of a carrier via immunotherapy. The population specific screening approach will also be developed that will help in establishing population / individual specific pharmacos-genomic and counseling approach.
