Gupta Sajal, Agarwal Ashok, Banerjee Jashoman, Alvarez Juan G
Reproductive Research Center, Cleveland Clinic, Cleveland, Ohio, USA.
Obstet Gynecol Surv. 2007 May;62(5):335-47; quiz 353-4. doi: 10.1097/01.ogx.0000261644.89300.df.
Human reproduction is not considered a highly efficient biological process. Before the end of the first trimester, 30%-50% of conceptions end in spontaneous abortion. Most losses occur at the time of implantation. 15%-20% of clinical pregnancies end in spontaneous abortions. Recurrent pregnancy loss is a frustrating clinical problem both for clinicians and patients. Recurrent pregnancy loss affects 0.5%-3% of women in the reproductive age group, and between 50%-60% of recurrent pregnancy losses are idiopathic. Oxidative stress-induced damage has been hypothesized to play a role in spontaneous abortion, idiopathic recurrent pregnancy loss, hydatidiform mole, defective embryogenesis, and drug-induced teratogenicity. Some studies implicate systemic and placental oxidative stress in the pathophysiology of abortion and recurrent pregnancy loss. Oxidant-induced endothelial damage, impaired placental vascularization and immune malfunction have all been proposed to play a role in the pathophysiology of idiopathic recurrent pregnancy loss. Oxidative stress-induced placental dysfunction may be a common cause of the multifactorial and polygenic etiologies of abortion, recurrent pregnancy loss, defective embryogenesis, hydatidiform mole, and drug-induced teratogenic effects. Oxidative stress-induced modification of phospholipids has been linked to the formation of antiphospholipid antibodies in the antiphospholipid syndrome. The objective of this review was to examine the association between oxidative stress, spontaneous abortion and recurrent pregnancy loss, based on the published literature. We conducted an extensive literature search utilizing the databases of Medline, CINAHL, and Cochrane from 1986 to 2005. The following keywords were used: oxidative stress, abortion, recurrent pregnancy loss, reactive oxygen species, antioxidants, fetal development, and embryopathies. We conducted an electronic search, as well as a manual search of cross-references. We have included all studies in the English language found in the literature focusing on oxidative stress and its association with abortions, recurrent pregnancy loss and drug-induced teratogenicity. The role of antioxidant vitamins for primary prevention of oxidative stress-induced pathologies needs to be investigated further.
Obstetricians & Gynecologists, Family Physicians.
After completion of this article, the reader should be able to state that the causes of spontaneous and recurrent abortion are multifaceted, however, some of the causes may be preventable and also explain that the role of oxidative stress during pregnancy and adverse pregnancy outcomes has a basis in pathophysiology, although the role of oxidative stress and the treatment of oxidative stress during or before pregnancy remains speculative.
人类生殖并非被认为是一个高效的生物过程。在孕早期结束前，30%-50%的妊娠以自然流产告终。大多数流产发生在着床时。15%-20%的临床妊娠以自然流产结束。复发性流产对临床医生和患者来说都是一个令人沮丧的临床问题。复发性流产影响0.5%-3%的育龄妇女，且50%-60%的复发性流产是原因不明的。氧化应激诱导的损伤被认为在自然流产、原因不明的复发性流产、葡萄胎、胚胎发育缺陷和药物诱导的致畸作用中发挥作用。一些研究表明全身和胎盘氧化应激在流产和复发性流产的病理生理学中起作用。氧化诱导的内皮损伤、胎盘血管化受损和免疫功能障碍均被认为在原因不明的复发性流产的病理生理学中起作用。氧化应激诱导的胎盘功能障碍可能是流产、复发性流产、胚胎发育缺陷、葡萄胎和药物诱导的致畸作用等多因素和多基因病因的常见原因。氧化应激诱导的磷脂修饰与抗磷脂综合征中抗磷脂抗体的形成有关。本综述的目的是根据已发表的文献研究氧化应激、自然流产和复发性流产之间的关联。我们利用1986年至2005年的Medline、CINAHL和Cochrane数据库进行了广泛的文献检索。使用了以下关键词：氧化应激、流产、复发性流产、活性氧、抗氧化剂、胎儿发育和胚胎病变。我们进行了电子检索以及交叉参考文献的手工检索。我们纳入了文献中所有以英文发表的研究，这些研究聚焦于氧化应激及其与流产、复发性流产和药物诱导的致畸作用的关联。抗氧化维生素在氧化应激诱导的病理状态一级预防中的作用需要进一步研究。
妇产科医生、家庭医生。
阅读本文后，读者应能够指出自然流产和复发性流产的原因是多方面的，然而，一些原因可能是可以预防的，并且还应能够解释妊娠期间氧化应激与不良妊娠结局之间的关系在病理生理学上有依据，尽管妊娠期间或妊娠前氧化应激的作用以及氧化应激的治疗仍具有推测性。
