Center for Reproductive Medicine, Department of Obstetrics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China.
The First Clinical College of Zhejiang Chinese Medical University, Hangzhou, China.
Front Immunol. 2022 May 25;13:900537. doi: 10.3389/fimmu.2022.900537. eCollection 2022.
Miscarriage poses a significant threat to pregnant women globally. Recurrent miscarriages or potential poor embryonic development indicated by early drops in serum human chorionic gonadotrophin (hCG) are even more catastrophic for pregnant women. However, these patients receive either individualized medical intervention supported by limited evidence or no treatment at all. In this study, we report ten patients who shared at least one episode of an early decline of hCG in the first trimester and were treated with compassionate use of tumor necrosis factor-alpha inhibitor (TNFi). They were then followed up regularly with caution. Their hCG trajectory all resumed a normal pattern within one week and the obstetric outcomes were promising. No adverse fetal, neonatal, or maternal health issues have been observed. This case series supports current safety evidence of TNFi and provides new insight into its use in pregnancy when the embryo is in danger. Further well-designed clinical trials should be carried out to consolidate the evidence.
流产对全球孕妇构成重大威胁。反复流产或早期血清人绒毛膜促性腺激素（hCG）下降提示胚胎发育不良对孕妇来说更为灾难性。然而，这些患者要么接受有限证据支持的个体化医疗干预，要么根本不接受治疗。在这项研究中，我们报告了 10 名患者，他们至少有一次在孕早期 hCG 早期下降，并接受了肿瘤坏死因子-α抑制剂（TNFi）的同情使用。然后，我们谨慎地定期对他们进行随访。他们的 hCG 轨迹在一周内恢复正常模式，产科结局很有希望。没有观察到胎儿、新生儿或产妇健康的不良问题。本病例系列支持当前 TNFi 的安全性证据，并为在胚胎处于危险时使用 TNFi 提供了新的见解。应开展更多精心设计的临床试验来巩固证据。
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