HLA-DR TYPING OF WOMEN WITH RECURRENT LATE SPONTANEOUS-ABORTION AND UNSUCCESSFUL CERVICAL CERCLAGE

The release of certain cytokines, e.g, tumour necrosis factor (TNF)-al pha, in the amniotic fluid has been suggested to be a cause of preterm birth. The predisposition to excessive liberation of cytokines from p eripheral leukocytes has been shown to depend partly on the individual 's HLA-DR genotype. The HLA-DR1 and -DR3 alleles have previously been reported as being associated with a TNF-alpha high responder status an d have also been associated with unexplained recurrent spontaneous abo rtions. In the present study, HLA-DR typing was performed in 10 women who had experienced recurrent very early preterm births resulting in p erinatal death, or late spontaneous abortions under a clinical picture resembling that traditionally attributed to cervical incompetence. Al l patients had had at least one mid-trimester miscarriage in spite of the insertion of a cervical cerclage, Nine out of 10 (90%) patients ha d the HLA-DR phenotypes DR1 and/or DR3 compared with 37% in the backgr ound population (P < 0.005). The results suggest that HLA-DR-associate d immunological factors might play a part in recurrent late spontaneou s abortions and extremely preterm births under a cervical incompetence -like picture, at least in the subset of cases not treatable by cervic al cerclage.