Pregnancy is a joyous and exciting period for many women, but it can sometimes bring concerns and uncertainties, especially for those women with an atypical immunologic profile or other medical complications. Unfortunately, these complications often lead to pregnancy loss or spontaneous abortion.
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Research shows that intravenous immunoglobulin (IVIG) therapy supports a healthy pregnancy and reduces pregnancy-related complications in women. Moreover, various other studies have also demonstrated the beneficial effects of IVIG therapy in enhancing pregnancy outcomes in women with autoimmune conditions.
This article aims to provide information to pregnant women who have faced pregnancy-related complications due to their abnormal immunologic profile or an autoimmune condition. It will cover the role of IVIG in pregnancy and provide important details for those who are considering or currently undergoing IVIG treatment during pregnancy.
Before addressing the above points, it’s important for you to have a comprehensive understanding of why your immune system matters during pregnancy and how it supports pregnancy.
How Does the Immune System Support Pregnancy?
During pregnancy, the immune system of a pregnant woman undergoes fascinating adaptations so that the fetus is not rejected by her body, allowing the fetus to grow. The temporary transformation of the immune system to support the developing fetus while maintaining the mother’s overall health occurs in the following ways:
Providing Immunological Tolerance
The immune system provides temporary immunological tolerance to a fetus, which only has a partial genetic match to the mother. Since the fetus carries antigens from the father, the immune system prevents its response against the fetus by producing specialized immune cells called regulatory T cells. These cells help to establish this tolerance and suppress potentially harmful immune responses against the fetus. This way, the embryo’s survival in the uterus increases while the chances of miscarriage decrease.
A Shift in Immune Cell Balance
During pregnancy, a significant shift occurs in the balance of immune cells. For instance, there is a decrease in certain immune cells that may promote inflammatory responses, such as Th1 cells. Conversely, there is an increase in other immune cell subsets, such as Th2 cells and regulatory T cells, which are involved in immune regulation and support the maintenance of pregnancy.
Maintaining Immune Tolerance via Hormonal Changes
The level of progesterone and estrogen increases as these hormones have immunosuppressive effects and help to maintain immune tolerance and prevent immune rejection of the fetus.
Stimulating Local Immune Response to Maternal-Fetal Interface
The interface between the mother and the fetus, known as the maternal-fetal interface, is an active site of immune regulation. Immune cells, such as macrophages and dendritic cells, play critical roles in this region between the placenta and the uterus, promoting tissue remodeling and fetal development while limiting immune activation.
Furthermore, certain immune cells, particularly those involved in mucosal immunity, are present to safeguard the mother and the developing fetus from pathogens while also supporting fetal growth.
Adaptations in the Uterine Environment
The immune system also plays a critical role in shaping the uterine environment to support pregnancy. Specialized immune cells, such as uterine natural killer (uNK) cells, undergo changes in number and function during pregnancy. These cells aid in vascular remodeling, tissue growth, and the establishment of a receptive environment for implantation and placental development.
These transformative immune mechanisms ensure a successful pregnancy outcome. However, disruption in immune tolerance or dysregulation can contribute to pregnancy complications.
In some instances, pregnant women with abnormal immune profiles or autoimmune conditions often experience repeated miscarriages or spontaneous abortions. To avoid such complications, interventions like IVIG therapy are considered by healthcare providers to address immune-related challenges and promote a healthy pregnancy.
Let’s look at how IVIG supports pregnancy and reduces the risk of pregnancy-related complications in women with autoimmune disorders.
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Role of IVIG in Pregnancy-Related Complications
IVIG (intravenous immunoglobulin) therapy can play a role in pregnancy by addressing immune-related factors that may contribute to pregnancy complications or difficulties in conception. IVIG is usually recommended to support healthy pregnancy in women with recurrent pregnancy loss (RPL), autoimmune disorders, and Rh incompatibility factor.
IVIG and Recurrent Pregnancy Loss (RPL)
Recurrent pregnancy loss refers to the occurrence of two or more consecutive miscarriages or pregnancy losses. Approximately 2% – 5% of reproductive-age women experience recurrent miscarriage and up to half of them are from an unknown cause. In some cases, RPL is found to be associated with immune system abnormalities or autoimmunity. In this type of RPL, autoantibodies called antiphospholipid antibodies (APAs) in the mother’s body affect the development of the fetus and placenta.
Moreover, an imbalance in the immune cells with an increased number of Th1 cells, NK cells, and aberrant regulatory T cells also causes pregnancy loss.
IVIG therapy has been explored as a potential treatment option for these specific cases. IVIG therapy suppresses excessive immune activation and activity of auto-antibodies. It also helps improve the chances of a successful pregnancy and reduce the risk of further pregnancy losses.
IVIG and Immune-Mediated Disorders
IVIG therapy is also beneficial for certain pregnant women who have immune-mediated disorders, such as systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), or immune thrombocytopenia (ITP). Since these conditions can pose risks to both the mother and the developing baby, IVIG therapy is recommended as part of the treatment plan for managing these immune-related disorders during pregnancy.
IVIG helps suppress autoimmune responses, reduces inflammation, and stabilizes the immune system. The immunosuppressive effects of IVIG potentially improve pregnancy outcomes and reduce the risk of complications.
IVIG and Rh Incompatibility
Rh incompatibility occurs when a mother has Rh-negative blood while her baby has Rh-positive blood. In this case, the mother’s immune system may produce antibodies against the Rh factor, potentially causing harm to the baby. IVIG can be used as a preventive measure to suppress the mother’s immune response and prevent the production of Rh antibodies. This intervention aims to protect the baby from harm and reduce the risk of complications associated with Rh incompatibility.
IVIG therapy can be a valuable treatment option to support pregnancy in women with specific immunologic conditions. This therapy offers hope to women who have experienced recurrent pregnancy loss or have immune-mediated disorders. By engaging in open and thorough discussions with healthcare providers, women can make informed decisions and receive individualized care that maximizes the chances of a successful pregnancy and the birth of a healthy baby.
- Habets, D. H., Pelzner, K., Wieten, L., Spaanderman, M. E., Villamor, E., & Al-Nasiry, S. (2022). Intravenous immunoglobulins improve live birth rate among women with underlying immune conditions and recurrent pregnancy loss: A systematic review and meta-analysis. Allergy, Asthma & Clinical Immunology, 18(1), 23. https://doi.org/10.1186/s13223-022-00660-8
- D’Mello, R. J., Hsu, C. D., Chaiworapongsa, P., & Chaiworapongsa, T. (2021). Update on the use of intravenous immunoglobulin in pregnancy. NeoReviews, 22(1), e7-e24. https://doi.org/10.1542/neo.22-1-e7
- Perricone, R., De Carolis, C., Kröegler, B., Greco, E., Giacomelli, R., Cipriani, P., Fontana, L., & Perricone, C. (2008). Intravenous immunoglobulin therapy in pregnant patients affected with systemic lupus erythematosus and recurrent spontaneous abortion. Rheumatology, 47(5), 646-651. https://doi.org/10.1093/rheumatology/ken046
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- Yamada, H., Takeda, M., Maezawa, Y., Ebina, Y., Hazama, R., Tanimura, K., … & Shimada, S. (2012). A high dose intravenous immunoglobulin therapy for women with four or more recurrent spontaneous abortions. International Scholarly Research Notices, 2012. https://doi.org/10.5402/2012/512732
- Yang, X., & Meng, T. (2020). Is there a role of intravenous immunoglobulin in immunologic recurrent pregnancy loss? Journal of Immunology Research, 2020. https://doi.org/10.1155/2020/6672865
- Diejomaoh, M. F., Bello, Z., Al Jassar, W., Jirous, J., Karunakaran, K., & Mohammed, A. T. (2015). Consecutive successful pregnancies subsequent to intravenous immunoglobulin therapy in a patient with recurrent spontaneous miscarriage. International Medical Case Reports Journal, 337-344. https://doi.org/10.2147/IMCRJ.S93159
- Kwak-Kim, J., Kim, J. W., & Gilman-Sachs, A. (2006). Immunology and pregnancy losses: HLA, autoantibodies and cellular immunity. Immunology of pregnancy, 303-315. https://www.ncbi.nlm.nih.gov/books/NBK6615/
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Dr. Samantha Kaeberlein, PharmD was born and raised in Canton, OH. She received her pharmacy degree from Northeast Ohio Medical University (NEOMED) in 2020. The most rewarding part of her job is providing medical guidance so patients can make informed, well-rounded decisions regarding their healthcare. Her areas of expertise are geriatrics and long-term care. In her free time, she enjoys spending time outdoors, reading, and hunting for the best cup of coffee in America.