Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands.
Department of Obstetrics, Leiden University Medical Centre, Leiden, the Netherlands.
J Reprod Immunol. 2019 Jun;133:1-6. doi: 10.1016/j.jri.2019.03.005. Epub 2019 Mar 27.
A possible way of immunomodulation of the maternal immune system before pregnancy would be exposure to paternal antigens via seminal fluid to oral mucosa. We hypothesized that women with recurrent miscarriage have had less oral sex compared to women with uneventful pregnancy. In a matched case control study, 97 women with at least three unexplained consecutive miscarriages prior to the 20 week of gestation with the same partner were included. Cases were younger than 36 years at time of the third miscarriage. The control group included 137 matched women with an uneventful pregnancy. The association between oral sex and recurrent miscarriage was assessed with conditional logistic regression, odds ratios (ORs) were estimated. Missing data were imputed using Imputation by Chained Equations. In the matched analysis, 41 out of 72 women with recurrent miscarriage had have oral sex, whereas 70 out of 96 matched controls answered positive to this question (56.9% vs. 72.9%, OR 0.50 95%CI 0.25-0.97, p = 0.04). After imputation of missing exposure data (51.7%), the association became weaker (OR 0.67, 95%CI 0.36-1.24, p = 0.21). In conclusion, this study suggests a possible protective role of oral sex in the occurrence of recurrent miscarriage in a proportion of the cases. Future studies in women with recurrent miscarriage explained by immune abnormalities should reveal whether oral exposure to seminal plasma indeed modifies the maternal immune system, resulting in more live births.
一种可能的妊娠前母体免疫系统免疫调节方法是通过精液使口腔黏膜接触父系抗原。我们假设复发性流产的女性与妊娠顺利的女性相比，进行口交的次数较少。在一项匹配的病例对照研究中，纳入了 97 名在妊娠 20 周前至少连续发生 3 次不明原因流产且与同一伴侣的女性。病例组在第三次流产时年龄小于 36 岁。对照组包括 137 名妊娠顺利的匹配女性。采用条件逻辑回归评估口交与复发性流产之间的关联，估计比值比（OR）。使用链式方程进行缺失数据的插补。在匹配分析中，72 名复发性流产女性中有 41 人有过口交，而 96 名匹配对照组中有 70 人对此问题回答为肯定（56.9% vs. 72.9%，OR 0.50 95%CI 0.25-0.97，p=0.04）。缺失暴露数据插补（51.7%）后，相关性减弱（OR 0.67，95%CI 0.36-1.24，p=0.21）。总之，本研究表明，在一部分病例中，口交可能对复发性流产的发生具有保护作用。未来在免疫异常导致复发性流产的女性中进行的研究应揭示口腔接触精液是否确实能改变母体免疫系统，从而增加活产数。
