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Due to the elusive etiology and mechanisms, clinical management is exceedingly challenging. In recent years, with the progress in reproductive immunology, a growing body of evidence suggests a relationship between URSA and maternal\u2010fetal immunology, offering hope for the development of tailored treatment strategies. This article provides an immunological perspective on the pathogenesis, diagnosis, and treatment of RSA. On one hand, it comprehensively reviews the immunological mechanisms underlying RSA, including abnormalities in maternal\u2010fetal interface immune tolerance, maternal\u2010fetal interface immune cell function, gut microbiota\u2010mediated immune dysregulation, and vaginal microbiota\u2010mediated immune anomalies. On the other hand, it presents the diagnosis and existing treatment modalities for RSA. This article offers a clear knowledge framework for understanding RSA from an immunological standpoint. In conclusion, while the \u201clayers of the veil\u201d regarding immunological factors in RSA are gradually being unveiled, our current research may only scratch the surface. In terms of immunological etiology, effective diagnostic tools for RSA are currently lacking, and the efficacy and safety of immunotherapies, primarily based on lymphocyte immunotherapy and intravenous immunoglobulin, remain contentious.<\/jats:p>","DOI":"10.1111\/aji.13859","type":"journal-article","created":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T12:18:25Z","timestamp":1715257105000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Maternal\u2010fetal immunity and recurrent spontaneous abortion"],"prefix":"10.1111","volume":"91","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4560-6861","authenticated-orcid":false,"given":"Yao","family":"Yao","sequence":"first","affiliation":[{"name":"Department of Pharmacy Women's Hospital Zhejiang University School of Medicine  Hangzhou China"},{"name":"Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology  Hangzhou 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