Department of Obstetrics and Gynecology, Hospital Universitario y Politécnico La Fe, Avenida Bulevar Sur s/n, Valencia 46026, Spain.
Department of Obstetrics and Gynecology, Hospital General Universitario, Avenida Tres Cruces 2, Valencia 46014, Spain.
J Immunol Res. 2014;2014:210241. doi: 10.1155/2014/210241. Epub 2014 Jun 2.
Maternofetal immune tolerance is essential to maintain pregnancy. The maternal immunological tolerance to the semiallogeneic fetus becomes greater in egg donation pregnancies with unrelated donors as the complete fetal genome is allogeneic to the mother. Instead of being rejected, the allogeneic fetus is tolerated by the pregnant woman in egg donation pregnancies. It has been reported that maternal morbidity during egg donation pregnancies is higher as compared with spontaneous or in vitro fertilization pregnancies. Particularly, egg donation pregnancies are associated with a higher incidence of pregnancy-induced hypertension and placental pathology. Preeclampsia, a pregnancy-specific disease characterized by the development of both hypertension and proteinuria, remains the leading cause of maternal and perinatal mortality and morbidity. The aim of this review is to characterize and relate the maternofetal immunological tolerance phenomenon during pregnancies with a semiallogenic fetus, which are the spontaneously conceived pregnancies and in vitro fertilization pregnancies, and those with an allogeneic fetus or egg donation pregnancies. Maternofetal immune tolerance in uncomplicated pregnancies and pathological pregnancies, such as those with preeclampsia, has also been assessed. Moreover, whether an inadequate maternal immunological response to the allogenic fetus could lead to a higher prevalence of preeclampsia in egg donation pregnancies has been addressed.
母体-胎儿免疫耐受对于维持妊娠至关重要。对于接受非亲缘供卵的妊娠而言，由于胎儿的完整基因组均与母体存在异体性，因此母体对胎儿的免疫耐受程度更高。与自然妊娠或体外受精妊娠不同，异体胎儿在供卵妊娠中被孕妇所耐受，而不会被排斥。有报道称，与自然妊娠或体外受精妊娠相比，供卵妊娠的孕妇发病率更高。特别是，供卵妊娠与妊娠高血压和胎盘病理的发生率更高相关。子痫前期是一种妊娠特有的疾病，其特征是同时出现高血压和蛋白尿，仍然是孕产妇和围产儿死亡率和发病率的主要原因。本综述的目的是描述和比较半同种异体胎儿（即自然妊娠和体外受精妊娠）、同种异体胎儿（即供卵妊娠）以及正常妊娠和子痫前期等病理妊娠时的母体-胎儿免疫耐受现象。还评估了正常妊娠和子痫前期等病理妊娠时的母体免疫耐受情况。此外，探讨了母体对同种异体胎儿的免疫反应不足是否会导致供卵妊娠中子痫前期的发生率更高。
