Challenging the TH1/TH2 Paradigm of Pregnancy

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read the abstract:  Challenging the TH1/TH2 Paradigm of Pregnancy

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Alix Boyle: Hi this is Alix Boyle reporting for OBGYN.net. I’m here at the SMFM meeting in San Francisco 2007, with Dr. Donna Neale from Johns Hopkins University. Tell us about your research Dr. Neale.

Donna Neale, MD: My research focuses on the immune state of pregnancy. The traditional teaching is that pregnancy is an immune suppressant state, or anti-inflammatory state. This was hypothesized to explain how the fetus is able to survive a pregnancy and not be rejected by the mother. In addition, in a more layman’s explanation of this whole process is why a pregnant woman always has a cold during pregnancy? But as we know more and more about reproductive immunology we’ve come to realize that pregnancy in itself is not just a TH2 state, it’s not just an anti-inflammatory state. In fact, we recognize that in early pregnancy, it’s probably necessary for pregnancy maintenance, we actually do need an inflammatory state but it’s a much more orchestrated inflammatory state than we think of for traditional infection.

Similarly in the third trimester pregnancy there has been a lot of work looking at the initiation of labor. Out of that work has come evidence that for the initiation of labor, again we go back to a pro-inflammatory state. So my research project was really looking at what happens during normal pregnancy to the immune state as we go from first, second and third trimester of normal pregnancies.

Alix Boyle: Interesting. What were the results of your study?

Donna Neale, MD: The results of our study shows that in fact there is a unique protein profile in the first, second and third trimester pregnancies. We found that in the first trimester pregnancy the profile is really more of an inflammatory profile, but again orchestrated profile, to allow for implantation and normal placentation for a pregnancy to go forward. The second trimester pregnancy actually was described as an anti-inflammatory state and this we think is related to the necessity for growth and maintenance of a pregnancy during the second trimester. In the third trimester of pregnancy the profile then switched back to an inflammatory process, but again this is probably needed for the initiation of labor.

Alix Boyle: What does this mean for the future, how will these results be interpreted?

Donna Neale, MD: The whole goal of deciding what’s normal for pregnancy is being able to apply to adverse pregnancy outcomes. The disease process I am most interested in is preeclampsia. We know preeclampsia starts in the first trimester of pregnancy and it’s related to abnormal placentation. In fact, we have found that in those women who go on to develop preeclampsia, when we look at their first trimester protein profile it’s actually much different than the profile that we saw in the normal pregnancies. Similarly I hypothesize that this profile could also be used for other adverse pregnancy outcomes. For example, if you think about preterm labor or premature ruptured membranes, one might surmise that in the second trimester, as opposed to staying with an anti-inflammatory state, we may in fact find a more inflammatory state during this time of pregnancy. So, again we could have future applications to be able to screen for patients who are at risk for adverse pregnancy outcome.

Alix Boyle: Very interesting. Thank you for joining us today Dr Donna Neale.

Donna Neale, MD: Thank you.