Sandyk R, Anastasiadis P G, Anninos P A, Tsagas N
Department of Psychiatry, Albert Einstein College of Medicine/Montefiore, Medical Center, Bronx, NY 10461.
Int J Neurosci. 1992 Feb;62(3-4):243-50. doi: 10.3109/00207459108999775.
Spontaneous abortion, the termination of pregnancy prior to 20 weeks of gestation, is estimated to occur in 40%-50% of all pregnancies and in 12%-15% of identified pregnancies. The causes of spontaneous abortion can be divided into two main categories: those arising from chromosomal anomalies and those arising from abnormalities in the intrauterine environment. In the following communication, we propose that deficient pineal melatonin functions in early pregnancy may be causally related to the development of spontaneous abortions in cases where chromosomal anomalies or structural abnormalities of the uterus have been excluded. This hypothesis is based on the findings that: (a) melatonin plasma levels normally increase by 200%-300% in the first 20 weeks of pregnancy; (b) melatonin decreases uterine contractility in the rat; (c) melatonin stimulates the secretion of progesterone, which decreases uterine contractility and prevents immunological rejection of the trophoblast; (d) melatonin inhibits the synthesis of prostaglandins, which are potent inducers of uterine contractility and labor, and (e) pinealectomy increases the number of spontaneous abortions in pregnant rats. In addition, since melatonin is a hormone with immunosuppressant properties, we propose that the increased melatonin production in early pregnancy may contribute to a state of "transplantation immunity" to the paternal histocompatibility antigens preventing immunological rejection of the trophoblast. If this hypothesis is correct, then plasma melatonin, levels during early pregnancy could be used as an indicator for increased risk of spontaneous abortions.(ABSTRACT TRUNCATED AT 250 WORDS)
自然流产是指妊娠在20周前终止,据估计,在所有妊娠中自然流产的发生率为40%-50%,在已确认的妊娠中为12%-15%。自然流产的原因可分为两大类:染色体异常引起的和子宫内环境异常引起的。在以下论述中,我们提出,在排除染色体异常或子宫结构异常的情况下,妊娠早期松果体褪黑素功能不足可能与自然流产的发生有因果关系。这一假说基于以下发现:(a) 妊娠前20周血浆褪黑素水平通常会增加200%-300%;(b) 褪黑素可降低大鼠子宫的收缩性;(c) 褪黑素刺激孕酮分泌,孕酮可降低子宫收缩性并防止对滋养层的免疫排斥;(d) 褪黑素抑制前列腺素的合成,前列腺素是子宫收缩和分娩的强效诱导剂;(e) 松果体切除会增加妊娠大鼠的自然流产数量。此外,由于褪黑素是一种具有免疫抑制特性的激素,我们提出妊娠早期褪黑素分泌增加可能有助于形成对父系组织相容性抗原的“移植免疫”状态,从而防止对滋养层的免疫排斥。如果这一假说正确,那么妊娠早期的血浆褪黑素水平可作为自然流产风险增加的一个指标。(摘要截选于250词)