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Chapter 3 : Immunology and Adverse Outcome of Pregnancy Related to Sexually Transmitted Diseases

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Abstract:

Sexually transmitted diseases (STDs) pose a significant problem to maternal, fetal, and perinatal health. While many cases of adverse pregnancy outcome may have an infectious etiology, the precise organisms responsible are often not identifiable. Furthermore, not all infections are associated with adverse pregnancy outcome. Systemic immunity within the peripheral circulation may be affected by pregnancy. Immunosuppression, as indirectly measured by loss of systemic responsiveness to previously seen antigens, appears necessary for maintenance of early pregnancy. The normal human decidua is replete with many immune and inflammatory cell populations. The majority of the cells are natural killer (NK) cells (large granulated lymphocytes expressing the CD56, NK-cell phenotype). Perhaps human leukocyte antigen (HLA)-G antigens protect the placenta from NK-cell-mediated lysis and thus play a significant role in placental immunology and in the maintenance of normal pregnancy. Pregnant women also have a high prevalence of STDs and may be at increased risk of acquiring and transmitting STD pathogens due to systemic and local attenuation of immunity. Maternally acquired infections during pregnancy can lead to multiple adverse outcomes. The immunologic consequences of STDs and their potential contribution to adverse pregnancy outcome are not well characterized. Understanding host defense mechanisms including cytokine regulation in response to infectious organisms acquired or reactivated during pregnancy enable the development of cost-effective intervention strategies to prevent adverse outcomes of pregnancy. Multidisciplinary collaborative approaches combining both basic biomedical and clinical research are required to formulate and implement effective investigative strategies to answer the fundamentally important questions.

Citation: Hill J. 1999. Immunology and Adverse Outcome of Pregnancy Related to Sexually Transmitted Diseases, p 43-58. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch3
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Tables

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Table 1

Lymphocyte subpopulation values within the same individual while nonpregnant and while pregnant

Citation: Hill J. 1999. Immunology and Adverse Outcome of Pregnancy Related to Sexually Transmitted Diseases, p 43-58. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch3
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Table 2

Expression of human leukocyte antigens in human term placenta

Citation: Hill J. 1999. Immunology and Adverse Outcome of Pregnancy Related to Sexually Transmitted Diseases, p 43-58. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch3
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Table 3

Expression of complement regulatory proteins in the human term placenta

Citation: Hill J. 1999. Immunology and Adverse Outcome of Pregnancy Related to Sexually Transmitted Diseases, p 43-58. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch3
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Table 4

Potential immunoregulating factors during pregnancy

Citation: Hill J. 1999. Immunology and Adverse Outcome of Pregnancy Related to Sexually Transmitted Diseases, p 43-58. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch3
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Table 5

Risk among pregnant women of acquiring infectious diseases compared with that among nonpregnant women of childbearing age in the same community

Citation: Hill J. 1999. Immunology and Adverse Outcome of Pregnancy Related to Sexually Transmitted Diseases, p 43-58. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch3
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Table 6

Percent distribution of various infectious-disease agents according to trimester of human pregnancy

Citation: Hill J. 1999. Immunology and Adverse Outcome of Pregnancy Related to Sexually Transmitted Diseases, p 43-58. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch3
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Table 7

Prevalence of STDs in pregnant women in the United States

Citation: Hill J. 1999. Immunology and Adverse Outcome of Pregnancy Related to Sexually Transmitted Diseases, p 43-58. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch3
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Table 8

Adverse pregnancy outcomes with potential infectious etiologies

Citation: Hill J. 1999. Immunology and Adverse Outcome of Pregnancy Related to Sexually Transmitted Diseases, p 43-58. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch3
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Table 9

Percentage of pregnant women with an STD experiencing an adverse pregnancy outcome

Citation: Hill J. 1999. Immunology and Adverse Outcome of Pregnancy Related to Sexually Transmitted Diseases, p 43-58. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch3
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Table 10

Cytokine families

Citation: Hill J. 1999. Immunology and Adverse Outcome of Pregnancy Related to Sexually Transmitted Diseases, p 43-58. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch3
Generic image for table
Table 11

Research agenda questions for immunology and adverse pregnancy outcome related to STDs

Citation: Hill J. 1999. Immunology and Adverse Outcome of Pregnancy Related to Sexually Transmitted Diseases, p 43-58. In Hitchcock P, MacKay H, Wasserheit J, Binder R (ed), Sexually Transmitted Diseases and Adverse Outcomes of Pregnancy. ASM Press, Washington, DC. doi: 10.1128/9781555818210.ch3

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