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The maternal immune system during pregnancy and its influence on fetal development

Authors Morelli SS, Mandal M, Goldsmith LT, Kashani BN, Ponzio NM

Received 9 January 2015

Accepted for publication 1 May 2015

Published 1 October 2015 Volume 2015:6 Pages 171—189

DOI https://doi.org/10.2147/RRB.S80652

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 5

Editor who approved publication: Professor Zvi Kelman

Video abstract presented by Sara S Morelli.

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Sara S Morelli,1 Mili Mandal,2 Laura T Goldsmith,1 Banafsheh N Kashani,1 Nicholas M Ponzio3,4

1Department of Obstetrics, Gynecology and Women's Health, New Jersey Medical School, Rutgers University, Newark, 2Department of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, 3Department of Pathology and Laboratory Medicine, New Jersey Medical School, Rutgers University, Newark, 4Graduate School of Biomedical Sciences, Rutgers University, Newark, NJ, USA

Abstract: The maternal immune system plays a critical role in the establishment, maintenance, and completion of a healthy pregnancy. However, the specific mechanisms utilized to achieve these goals are not well understood. Various cells and molecules of the immune system are key players in the development and function of the placenta and the fetus. Effector cells of the immune system act to promote and yet limit placental development. The T helper 1 (Th1)/T helper 2 (Th2) immune shift during pregnancy is well established. A fine balance between proinflammatory and anti-inflammatory influences is required. We herein review the evidence regarding maternal tolerance of fetal tissues and the underlying cell-mediated immune and humoral (hormones and cytokines) mechanisms. We also note the many unanswered questions in our understanding of these mechanisms. In addition, we summarize the clinical manifestations of an altered maternal immune system during pregnancy related to susceptibility to common viral, bacterial, and parasitic infections, as well as to autoimmune diseases.

Keywords: maternal–fetal interface, immune system, fetal tolerance, lymphocyte subsets, decidua, pregnancy

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