{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T11:06:28Z","timestamp":1779015988097,"version":"3.51.4"},"reference-count":21,"publisher":"Knowledge E DMCC","issue":"3","license":[{"start":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T00:00:00Z","timestamp":1778976000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":["knepublishing.com"],"crossmark-restriction":true},"short-container-title":["IJRM"],"abstract":"<jats:p>Background: Recurrent pregnancy loss (RPL) is a common pregnancy complication that significantly influences the lives of many couples worldwide. Previous studies have indicated that RPL may be associated with coagulation and inflammatory factors.\r\nObjective: This study aimed to investigate the relationship between calprotectin levels and coagulation disorders in women with RPL.\r\nMaterials and Methods: In this case-control study, a total of 100 women aged between 18 and 45 yr who had been admitted to Golestan hospital, Ahvaz, Iran from February 2024 to January 2025 enrolled. Participants were divided into 2 groups: women with RPL as the case group (n = 50), and women with no history of infertility or miscarriage as the control group (n = 50). Blood samples collected, and levels of protein C, protein S, and calprotectin measured using enzyme-linked immunosorbent assay and chromogenic assays.\r\nResults: Protein S levels were significantly lower in the RPL group compared to controls (p = 0.03), whereas protein C and calprotectin levels did not differ significantly between the 2 groups (p = 0.14, 0.17). Altered hematological parameters, including a higher prevalence of anemia, were noted in RPL cases. Logistic regression indicated that reduced protein S levels were associated with a 4.38-fold increased risk of RPL.\r\nConclusion: This study reinforces the role of protein S deficiency in RPL, suggesting that even modest reductions may predispose placental thrombosis and fetal loss. Although protein C and calprotectin levels did not differ significantly, the results underscore the importance of evaluating both coagulation profiles and inflammatory markers in RPL.<\/jats:p>","DOI":"10.18502\/ijrm.v24i3.21117","type":"journal-article","created":{"date-parts":[[2026,5,17]],"date-time":"2026-05-17T09:49:46Z","timestamp":1779011386000},"update-policy":"https:\/\/doi.org\/10.18502\/knecrossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Altered inflammatory and coagulation markers in women with a history of recurrent pregnancy loss: A case-control study"],"prefix":"10.18502","volume":"24","author":[{"given":"Fatemeh","family":"Bakhshipour","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehdi","family":"Torabizadeh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad Ali Jalali","family":"Far","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farideh","family":"Moramezi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Najmaldin","family":"Saki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"7770","published-online":{"date-parts":[[2026,5,17]]},"reference":[{"key":"331256","doi-asserted-by":"crossref","unstructured":"[1] Dimitriadis E, Menkhorst E, Saito S, Kutteh W, Brosens J. Recurrent pregnancy loss. Nat Rev Dis Primers 2020; 6: 98.","DOI":"10.1038\/s41572-020-00228-z"},{"key":"331257","doi-asserted-by":"crossref","unstructured":"[2] Nahas R, Saliba W, Elias A, Elias M. The prevalence of thrombophilia in women with recurrent fetal loss and outcome of anticoagulation therapy for the prevention of miscarriages. Clin Appl Thromb Hemost 2018; 24: 122\u2013128.","DOI":"10.1177\/1076029616675967"},{"key":"331258","doi-asserted-by":"crossref","unstructured":"[3] Coomarasamy A, Dhillon-Smith RK, Papadopoulou A, Al-Memar M, Brewin J, Abrahams VM, et al. Recurrent miscarriage: Evidence to accelerate action. Lancet 2021; 397: 1675\u20131682.","DOI":"10.1016\/S0140-6736(21)00681-4"},{"key":"331259","doi-asserted-by":"crossref","unstructured":"[4] La X, Wang W, Zhang M, Liang L. Definition and multiple factors of recurrent spontaneous abortion. Adv Exp Med Biol 2021; 1300: 231\u2013257.","DOI":"10.1007\/978-981-33-4187-6_11"},{"key":"331260","doi-asserted-by":"crossref","unstructured":"[5] Sultana S, Nallari P, Ananthapur V. Recurrent pregnancy loss (RPL): An overview. J Women\u2019s Health Dev 2020; 3: 302\u2013315.","DOI":"10.26502\/fjwhd.2644-28840038"},{"key":"331261","doi-asserted-by":"crossref","unstructured":"[6] Mukhtar B, Garg R, Ibrahim G, Batra J. Investigating protein C and S levels in pregnant women with recurrent early pregnancy loss versus normal pregnancy. J Med Life 2023; 16: 160\u2013166.","DOI":"10.25122\/jml-2022-0267"},{"key":"331262","doi-asserted-by":"crossref","unstructured":"[7] Grandone E, Piazza G. Thrombophilia, inflammation, and recurrent pregnancy loss: A case-based review. Semin Reprod Med 2021; 39: 62\u201368.","DOI":"10.1055\/s-0041-1731827"},{"key":"331263","doi-asserted-by":"crossref","unstructured":"[8] Kobayashi T, Sugiura K, Ojima T, Serizawa M, Hirai K, Morishita E. Thrombosis-related characteristics of pregnant women with antithrombin deficiency, protein C deficiency and protein S deficiency in Japan. Thromb J 2024; 22: 18.","DOI":"10.1186\/s12959-024-00581-z"},{"key":"331264","doi-asserted-by":"crossref","unstructured":"[9] Li X, Song X, Mahmood DFD, Sim MMS, Bidarian SJ, Wood JP. Activated protein C, protein S, and tissue factor pathway inhibitor cooperate to inhibit thrombin activation. Thromb Res 2023; 230: 84\u201393.","DOI":"10.1016\/j.thromres.2023.08.012"},{"key":"331265","unstructured":"[10] Alshammary HN, Almosawi HM, Hadi FS. Deficiency of protein C and protein S in recurrent pregnancy loss. Med J Babylon 2015; 12: 348\u2013356."},{"key":"331266","doi-asserted-by":"crossref","unstructured":"[11] Saha M, Tamanna JR. Association of serum protein C and protein S level in unexplained recurrent pregnancy loss. Obstet Gynecol Res 2023; 6: 260\u2013269.","DOI":"10.26502\/ogr0139"},{"key":"331267","doi-asserted-by":"crossref","unstructured":"[12] Maneta E, Aivalioti E, Tual-Chalot S, Emini Veseli B, Gatsiou A, Stamatelopoulos K, et al. Endothelial dysfunction and immunothrombosis in sepsis. Front Immunol 2023; 14: 1144229.","DOI":"10.3389\/fimmu.2023.1144229"},{"key":"331268","doi-asserted-by":"crossref","unstructured":"[13] van der Meer JH, van der Poll T, van\u2019t Veer C. TAM receptors, Gas6, and protein S: Roles in inflammation and hemostasis. Blood 2014; 123: 2460\u20132469.","DOI":"10.1182\/blood-2013-09-528752"},{"key":"331269","doi-asserted-by":"crossref","unstructured":"[14] Manfredi M, Van Hoovels L, Benucci M, De Luca R, Coccia C, Bernardini P, et al. Circulating calprotectin (cCLP) in autoimmune diseases. Autoimmun Rev 2023; 22: 103295.","DOI":"10.1016\/j.autrev.2023.103295"},{"key":"331270","doi-asserted-by":"crossref","unstructured":"[15] Rezniczek GA, F\u00f6rster C, Hilal Z, Westhoff T, Tempfer CB. Calprotectin in pregnancy and pregnancy-associated diseases: A systematic review and prospective cohort study. Arch Gynecol Obstet 2019; 299: 1567\u20131577.","DOI":"10.1007\/s00404-019-05134-8"},{"key":"331271","doi-asserted-by":"crossref","unstructured":"[16] Grimstad F, Krieg S. Immunogenetic contributions to recurrent pregnancy loss. J Assist Reprod Genet 2016; 33: 833\u2013847.","DOI":"10.1007\/s10815-016-0720-6"},{"key":"331272","doi-asserted-by":"crossref","unstructured":"[17] Weghofer A, Barad DH, Darmon SK, Kushnir VA, Albertini DF, Gleicher N. Euploid miscarriage is associated with elevated serum C-reactive protein levels in infertile women: A pilot study. Arch Gynecol Obstet 2020; 301: 831\u2013836.","DOI":"10.1007\/s00404-020-05461-1"},{"key":"331273","doi-asserted-by":"crossref","unstructured":"[18] Ahmed SK, Mahmood N, Malalla ZH, Alsobyani FM, Al-Kiyumi IS, Almawi WY. C-reactive protein gene variants associated with recurrent pregnancy loss independent of CRP serum levels: A case-control study. Gene 2015; 569: 136\u2013140.","DOI":"10.1016\/j.gene.2015.05.052"},{"key":"331274","doi-asserted-by":"crossref","unstructured":"[19] Foley JH, Conway EM. Cross talk pathways between coagulation and inflammation. Circ Res 2016; 118: 1392\u20131408.","DOI":"10.1161\/CIRCRESAHA.116.306853"},{"key":"331275","doi-asserted-by":"crossref","unstructured":"[20] Hussein A, Solouki A, Pilehvari N, Sotudeh Chafi F, Noormohamadi H, Abbasi Sourki P, et al. \u201cUnraveling the clot-miscarriage nexus: Mechanisms, management, and future directions in thrombosis-related recurrent pregnancy loss\u201d. Clin Appl Thromb Hemost 2025; 31: 10760296251339421.","DOI":"10.1177\/10760296251339421"},{"key":"331276","doi-asserted-by":"crossref","unstructured":"[21] Vomstein K, Herzog A, Voss P, Feil K, Goeggl T, Strowitzki T, et al. Recurrent miscarriage is not associated with a higher prevalence of inherited and acquired thrombophilia. 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