ArticlePloS one2011
A signature of maternal anti-fetal rejection in spontaneous preterm birth: chronic chorioamnionitis, anti-human leukocyte antigen antibodies, and C4d.
Article in PloS one, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 77 papers, 1 of them a synthesis that pooled it.
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Who cites it
77 citing papers in PubMed, 1 synthesis or guideline pooled it, 128 citations in OpenAlex.
- Meta-Analysis of Maternal and Fetal Transcriptomic Data Elucidates the Role of Adaptive and Innate Immunity in Preterm Birth.Frontiers in immunology · 2018Pooled it
- Associations of Serum Inflammatory Biomarkers During Pregnancy With Placental Pathology and Placental Gene Expression at Delivery.American journal of reproductive immunology (New York, N.Y. : 1989) · 2025Trial
- The plasma metabolome of women in early pregnancy differs from that of non-pregnant women.PloS one · 2019Trial
- The Cellular Transcriptome in the Maternal Circulation During Normal Pregnancy: A Longitudinal Study.Frontiers in immunology · 2019Trial
- Evidence that atherosis of the spiral artery represents atherosclerotic lesions similar to those of native and transplant-induced atherosclerosis: implications for understanding the pathophysiology of obstetrical syndromes and long-term cardiovascular risk.American journal of obstetrics and gynecology · 2025Article
- The single-cell immune profile throughout gestation and its potential value for identifying women at risk for spontaneous preterm birth.European journal of obstetrics & gynecology and reproductive biology: X · 2025Review
- Maternal-fetal conflict and the timing of birth.Evolution, medicine, and public health · 2025Review
- Case Report: A novel approach to prevent chronic histiocytic intervillositis and recurrent pregnancy loss by targeting maternal alloimmunity.Frontiers in immunology · 2025Article
- Clinical chorioamnionitis at term: definition, pathogenesis, microbiology, diagnosis, and treatment.American journal of obstetrics and gynecology · 2024Review
- Immunosequencing and Profiling of T Cells at the Maternal-Fetal Interface of Women with Preterm Labor and Chronic Chorioamnionitis.Journal of immunology (Baltimore, Md. : 1950) · 2023Article
- Review
- Toward a new taxonomy of obstetrical disease: improved performance of maternal blood biomarkers for the great obstetrical syndromes when classified according to placental pathology.American journal of obstetrics and gynecology · 2022Article
- Hypertensive disease, preterm birth, fetal growth restriction and chronic inflammatory disorders of the placenta: experiences in a single institution with a standardized protocol of investigation.Archives of gynecology and obstetrics · 2022Article
- Trophoblast antigens, fetal blood cell antigens, and the paradox of fetomaternal tolerance.The Journal of experimental medicine · 2022Article
- Spontaneous preterm birth: Involvement of multiple feto-maternal tissues and organ systems, differing mechanisms, and pathways.Frontiers in endocrinology · 2022Review
- Chronic Inflammatory Placental Disorders Associated With Recurrent Adverse Pregnancy Outcome.Frontiers in immunology · 2022Review
- World Prematurity Day: it takes an NIH village to prevent preterm birth and improve treatments for preterm infants.American journal of physiology. Lung cellular and molecular physiology · 2021Article
- The Distinct Immune Nature of the Fetal Inflammatory Response Syndrome Type I and Type II.ImmunoHorizons · 2021Article
- Disorders of placental villous maturation are present in one-third of cases with spontaneous preterm labor.Journal of perinatal medicine · 2021Article
- Chronic histiocytic intervillositis: A breakdown in immune tolerance comparable to allograft rejection?American journal of reproductive immunology (New York, N.Y. : 1989) · 2021Review
17 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
11 authors at 4 institutions in 3 countries.
Funding
Abstract
backgroundChronic chorioamnionitis is found in more than one-third of spontaneous preterm births. Chronic chorioamnionitis and villitis of unknown etiology represent maternal anti-fetal cellular rejection. Antibody-mediated rejection is another type of transplantation rejection. We investigated whether there was evidence for antibody-mediated rejection against the fetus in spontaneous preterm birth. METHODS AND
findingsThis cross-sectional study included women with (1) normal pregnancy and term delivery (n = 140) and (2) spontaneous preterm delivery (n = 140). We analyzed maternal and fetal sera for panel-reactive anti-HLA class I and class II antibodies, and determined C4d deposition on umbilical vein endothelium by immunohistochemistry. Maternal anti-HLA class I seropositivity in spontaneous preterm births was higher than in normal term births (48.6% vs. 32.1%, p = 0.005). Chronic chorioamnionitis was associated with a higher maternal anti-HLA class I seropositivity (p<0.01), significant in preterm and term birth. Villitis of unknown etiology was associated with increased maternal and fetal anti-HLA class I and II seropositivity (p<0.05, for each). Fetal anti-HLA seropositivity was closely related to maternal anti-HLA seropositivity in both groups (p<0.01, for each). C4d deposition on umbilical vein endothelium was more frequent in preterm labor than term labor (77.1% vs. 11.4%, p<0.001). Logistic regression analysis revealed that chronic chorioamnionitis (OR = 6.10, 95% CI 1.29-28.83), maternal anti-HLA class I seropositivity (OR = 5.90, 95% CI 1.60-21.83), and C4d deposition on umbilical vein endothelium (OR = 36.19, 95% CI 11.42-114.66) were associated with preterm labor and delivery.
conclusionsA major subset of spontaneous preterm births has a signature of maternal anti-fetal cellular and antibody-mediated rejections with links to fetal graft-versus-host disease and alloimmune reactions.
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