The role of Chlamydiales in adverse pregnancy outcome: a community-based nested case-control study.

OBJECTIVES: Over the last decades, the Chlamydiales order has expanded and a new group of Chlamydia-related bacteria has emerged, covering species such as Waddlia chondrophila associated with bovine abortion. However, it is unknown whether they compromise human reproduction such as Chlamydia trachomatis. We therefore aimed to investigate the association between vaginal colonization of selected species of the Chlamydiales order with spontaneous abortion, preterm birth, and animal exposure. METHODS: Pregnant women were enrolled at the nuchal translucency scan or when admitted for suspected miscarriage at Aarhus University Hospital, Denmark. Cases were defined as spontaneous abortion <22 weeks and preterm birth <37 weeks. Controls were defined as term birth ≥37 weeks. Vaginal samples from 1203 women were assessed using C. trachomatis, W. chondrophila, and pan-Chlamydiales-specific real-time PCRs targeting the 16S rRNA gene. RESULTS: A total of 1120 women of primarily Caucasian ancestry were enrolled, including 193 spontaneous abortions, 88 preterm births, and 839 term births. After sequencing for verification, the prevalence of Chlamydiales was 3 of 193 (1.6%; 95% CI, 0.5-4.8) in women experiencing spontaneous abortion, 2 of 88 (2.3%; 95% CI, 0.6-8.9) in women with preterm birth, and 20 of 839 (2.4%; 95% CI, 1.6-3.7) in women giving birth at term. Thus, Chlamydiales infection was neither significantly associated with spontaneous abortion (OR, 0.68; 95% CI, 0.15-2.01) nor preterm birth (OR, 1.02; 95% CI, 0.15-3.60) compared with women giving birth at term. Amplicons from the pan-Chlamydiales assay revealed close sequence homology and were primarily identified as uncultured Chlamydiales bacteria. DISCUSSION: Among Danish pregnant women, the prevalence of Chlamydiales was low and not associated with adverse pregnancy outcomes.

Functional autoantibodies against Endothelin-1 receptor type A and Angiotensin II receptor type 1 in patients with preeclampsia.

OBJECTIVES: Functional autoantibodies against Angiotensin II Receptor type 1 (AT1-AA) and Endothelin-1 Receptor type A (ETA-AA), which belong to the class of functional autoantibodies, have been discovered in patients with preeclampsia and in rodent models of pregnancy-induced hypertension. The aim of the study was to investigate the expression of these autoantibodies in relation to disease progression. STUDY DESIGN: We included 10 controls and 41 cases defined as patients with gestational-induced hypertension, preeclampsia or HELLP syndrome. MAIN OUTCOME: Serum obtained in the first trimester as well as at the time of disease development were analyzed by means of a biological assay of beating cardiomyocytes. We also measured the protein expression of IL-17A in these samples. RESULTS: 100% of samples from patients with gestational induced hypertension, preeclampsia or HELLP syndrome expressed AT1-AA when they presented with clinical symptoms but not in samples from the first trimester. 44% of samples from patients with severe preeclampsia or HELLP syndrome expressed ETA-AA but only when they presented with clinical symptoms. The controls expressed neither AT1-AA nor ETA-AA. Approximately 40% of patients with severe preeclampsia or HELLP syndrome expressed IL-17A, both at the time of the onset of symptoms and in the first trimester. CONCLUSION: Autoantibodies against the Angiotensin II receptor 1 and Endothelin receptor are developed in relation to pregnancy-induced hypertension and not present at the start of the pregnancy in these patients. IL-17A is increased in some patients with severe preeclampsia, but the expression is not related to the development of clinical symptoms.