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One of the primary reasons of RSA is abnormal immunological circumstances at the interaction between mother and fetus. Emerging evidence highlights the critical role of immune dysregulation, particularly involving macrophages, in the pathogenesis of RSA. Macrophages, key immune cells in the decidua, exhibit phenotypic plasticity and can polarize into pro\u2010inflammatory M1 or anti\u2010inflammatory M2 subtypes, thereby influencing trophoblast invasion, placental development, and immune tolerance. How the immune system\u2019s macrophages balance impacts an embryo\u2019s development is therefore essential to study. This review elaborates on the mechanisms by which alterations in transcription factors, signaling pathways, cytokine profiles, epigenetic status, and metabolic reprogramming contribute to pregnancy loss. Such aberrations predominantly drive the polarization shift toward the M1 macrophage phenotype, characterized by an elevated M1\/M2 ratio. This imbalance triggers excessive secretion of pro\u2010inflammatory cytokines, impairs trophoblast invasion, and disrupts placental angiogenesis, thereby ultimately inducing adverse pregnancy outcomes and spontaneous abortion. By integrating findings from human studies and animal models, this review aims to provide insights into the immune mechanisms underlying RSA and highlights future research directions for improving clinical outcomes.<\/jats:p>","DOI":"10.1155\/jimr\/8862057","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T11:43:32Z","timestamp":1784893412000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Recent Developments in Macrophages Imbalance and Recurrent Spontaneous Abortion"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3614-8003","authenticated-orcid":false,"given":"Yi","family":"Xiao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fan-Yu","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Song","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3836-3304","authenticated-orcid":false,"given":"Jing-Li","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"e_1_2_15_1_2","first-page":"653","article-title":"[Chinese Expert Consensus on Diagnosis and Management of Recurrent Spontaneous Abortion (2022)]","volume":"57","author":"Obstetrics Subgroup, Chinese Society of Obstetrics and Gynecology; Chinese Medical Association; Chinese Expert Consensus Group on Diagnosis and Management of Recurrent Spontaneous Abortion","year":"2022","journal-title":"Zhonghua Fu Chan Ke Za Zhi"},{"key":"e_1_2_15_2_2","first-page":"855","article-title":"[Comparison of the Etiological Constitution of Two and Three or More Recurrent Miscarriage]","volume":"53","author":"Zhang L. 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