Paediatric and Perinatal Epidemiology, Journal Year: 2024, Volume and Issue: 38(7), P. 612 - 614
Published: Aug. 7, 2024
Miscarriage affects approximately 20% of recognised pregnancies1 and can cause severe psychological distress. A history miscarriage is associated with complications in subsequent pregnancies other adverse health outcomes.2 As many pregnancy outcomes, few established risk factors have been identified,3 preventative treatments are limited. In understanding the aetiological pathways that result idiopathic miscarriage, researchers may discover affordable accessible to intervene upon specific biological pathways. Factors disrupt maternal immune system promising targets for novel therapeutic interventions. The highly dynamic (not immunosuppressive as previously suggested) protects against ascending infections while maintaining a receptive environment ensures decidualisation, implantation placentation.4 Failures placentation linked miscarriage,5 emerging evidence indicates reproductive tract microbiota plays an essential role regulation modulation addition preventing overgrowth harmful bacteria.4 Scientific impact microbial communities on human has increased dramatically technological advances such 16S ribosomal RNA, DNA hybridisation next-generation sequencing, which overcome limitations culture-based methods. vaginal extensively studied. 'normal' determined by dominance Lactobacillus spp., controls proliferation bacterial species through production lactic acid, hydrogen peroxide bacteriocins.6 Variations stability some across menstrual cycles7 patient characteristics sexual behaviours pose challenge epidemiologic investigations. Studies suggest dysbiosis gynaecologic conditions, sexually transmitted infection acquisition, endometritis preterm delivery.8 However, association between inconsistent studies. Much this variation due differences study designs analyses, timing sampling use various molecular-based methods yield different information compositions (i.e. genus vs. strains). Of particular concern inability obtain samples before or near key processes implantation. Indeed, studies lack rationale their timing, because change markedly hormonal fluctuations, specimens sampled later gestation not represent present early pregnancy. issue Paediatric Perinatal Epidemiology, McClelland colleagues9 address prior authors nested investigation within Kenyan Microbiota Pre-term Birth (MPTB) study, preconception cohort participants who had recently discontinued contraception, measure at periconception (<28 days pregnancy) first trimester. Periconception was selected be close possible. Their measurement robust. It included evaluation relative abundance bacteria using n16s rRNA PCR informed quantitative (qPCR), method investigators used previously. results sequencing revealed abundances first-trimester were unadjusted models. primary analysis little greater concentrations Megasphaera hutchinsoni, Mageeibacillus indolicus, Mobiluncus mulieris Sneathia sanguinegens/vaginalis miscarriage. exploratory crude model found detection indolicus Mulieris miscarriage; warrants further investigation. Most epidemiological retrospective, confined pregnant prone outcome misclassification, left truncation recall selection biases. MPTB overcomes these its prospective design, enrollment, biomarker microbiome. Participants would unaware microbiome status future chances time enumeration, thereby reducing potential bias. Given exposures affect risk, better able ascertain aetiologically relevant periods. limitations. sample size only 45 cases 159 controls, reduced precision. difficulties obtaining periconceptional should considered. Lack access plagued Thus, small weighed well-designed study. While qPCR strength it including misinterpretation communities, limited measuring absolute quantities four bacteria, weakness appropriately acknowledged authors. trimester strength, from utilised. process decidualisation well placentation. also fluctuates changes, interesting know if there any changes periods into This target research. Vaginal more accessible, but data unclear regarding extent reflect upper tract. Potential mechanisms underlying fully understood, make hypotheses clear. One pathway ascension (including infections) genital tract, excessive inflammation pattern recognition receptor signalling. et al. determine Sexually measured, positive no those loss less likely Chlamydia trachomatis (4.4% 6.9%), Trichomonas vaginalis (0% 1.4%) vaginosis (33.3% 29.9%) than continue past 20 weeks gestation. On hand, endometrium fallopian tubes reported unique sterile thought.7 Mouse models endometrial receptivity mediated baseline type I interferon responses controlled local microbiota.4 Chen al.7 suggested cervical useful identify pathologies Others discordance microbiota, although low biomass contamination remain concerns investigations.8 Access tissues challenging almost impossible during Mechanistic improve our reproduction, could guide clinical animal vitro single-cell systems do experience. growing organ-on-chip replicate female promising, incorporating remains challenge.10 summary, did find strong findings discourage research area. highlights challenges area identifies areas Brandie DePaoli Taylor professor perinatal epidemiologist University Texas Medical Branch, Galveston, TX. Her examines how innate immunity success. Dr. collaborates closely basic scientists incorporate mechanistic investigations infection, immunology complications. Lauren A. Wise Boston School Public Health. She Principal Investigator Pregnancy Study Online (PRESTO), North American couples. focuses environmental, dietary lifestyle determinants serves associate editor Epidemiology. BDT took lead drafting commentary. Both contributed substantially conception work revised critically intellectual content. approve final version published agree accountable all aspects work. None. supported grants National Institutes Health (R01AI141501-01A1 R01AI143653-01A1). (R01HD086742, R01HD105863, R01ES029951 R01HD115096) Science Foundation (NSF 1914792). paid consultant AbbVie, Inc. Gates receives in-kind donations collection (PRESTO) Swiss Precision Diagnostics (home tests) Kindara.com (fertility-tracking apps). There involved
Language: Английский
