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Infographic: How Immunology Can Influence Pregnancy Outcomes

Pregnancy-induced changes in the immune system are key to a successful birth. Understanding those changes could allow researchers to protect both mother and child.

Tobias R. Kollmann

Tobias R. Kollmann, MD/PhD, is a pediatric infectious disease clinician at Perth Children’s Hospital, Director of Systems Vaccinology for the Telethon Kids Institute and of Systems Immunology for the...

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Arnaud Marchant

Arnaud Marchant, MD/PhD, is co-director of the European Plotkin Institute for Vaccinology and director of the Institute for Medical Immunology of the Université libre de Bruxelles, Belgium. His work...

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Sing Sing Way

Sing Sing Way, MD/PhD, is a pediatric infectious disease clinician at Cincinnati Children’s Hospital, and directs the Center for Inflammation and Tolerance and the March of Dimes Ohio Collaborative...

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During pregnancy, the immune system adapts to support the baby’s development and coordinate birth. When immunity goes awry, so can the pregnancy, with adverse outcomes such as preterm birth and stillbirth often resulting from aberrant immune activation. Diet or maternal vaccination are examples of how to modulate the immune system to improve pregnancy outcomes.

          Illustration showing immunology during pregnancy 
the scientist staff; composite from © istock.com, Guzaliia Filimonova, VikiVectorrendixalextianSfischka

IMMUNE TOLERANCE AND RESILIENCE

Pregnant individuals must both tolerate a genetically foreign fetus (immune tolerance) and avoid overreacting to the presence of microbes with inflammatory cascades that could jeopardize the pregnancy (immune resilience). To do this, they generate exhaustion-prone T cells that selectively silence killer-cell properties as well as long-lived immunosuppressive T cells. Both appear critical to a healthy pregnancy by averting aberrant immune activation. Conversely, an imbalance in the commensal microbes of the birth canal can trigger immune responses that have been linked with prematurity and other pregnancy complications.

          Illustration showing immunology during pregnancy 
THE SCIENTIST STAFF; COMPOSITE FROM © ISTOCK.COM, GUZALIIA FILIMONOVA, VIKIVECTOR; RENDIXALEXTIAN; SFISCHKA

          Illustration showing immunology during pregnancy
THE SCIENTIST STAFF; COMPOSITE FROM © ISTOCK.COM, GUZALIIA FILIMONOVA, VIKIVECTOR; RENDIXALEXTIAN; SFISCHKA

VERTICAL TRANSFER OF MATERNAL IMMUNITY

Antibodies and other immune factors can pass across the placenta from mother to child, as well as through breast milk after birth. This means that a mother’s acquired immunity to pathogens, including through vaccination, can protect the baby after birth. In addition to providing postnatal protection against specific pathogens, maternal immune molecules transferred to the baby can regulate the fetal and newborn immune system. Such factors can support the baby’s in utero immune tolerance to the genetically foreign mother as well as its immune resilience before and after birth, avoiding excessive immune activation by commensal microbes.


          Illustration showing immunology during pregnancy
THE SCIENTIST STAFF; COMPOSITE FROM © ISTOCK.COM, GUZALIIA FILIMONOVA, VIKIVECTOR; RENDIXALEXTIAN; SFISCHKA

INFLAMMATORY CASCADE CONTROLS BIRTH TIMING

While aberrant immune activation can be disastrous, inflammation plays an important role in the process of birth. Typically initiated starting around 37 to 42 gestational weeks, these inflammatory signals can be prematurely activated and trigger the separation of the maternal and fetal placental layers, leading to preterm birth or stillbirth. Certain dietary interventions such as supplements of omega-3 fatty acids or the amino acid L-arginine have been shown to protect against preterm labor in some populations, and may act by reducing inflammatory processes.

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