{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T04:46:24Z","timestamp":1790138784205,"version":"4.0.1"},"reference-count":26,"publisher":"SAGE Publications","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["THC"],"published-print":{"date-parts":[[2024,11,8]]},"abstract":"<jats:p>BACKGROUND: Elevated levels of tumor necrosis factor-alpha (TNF-\u03b1) have been associated with adverse pregnancy outcomes, specifically recurrent pregnancy loss (RPL). These elevated levels may be associated with the presence of autoantibodies. Although TNF-\u03b1 inhibitors have shown promise in improving pregnancy rates, further research is needed to comprehend their impact and mechanisms in RPL patients. OBJECTIVE: This study aims to investigate the association between elevated TNF-\u03b1 levels and autoantibodies in RPL patients, as well as evaluate the effect of TNF-\u03b1 inhibition on pregnancy outcomes. METHODS: A total of 249 RPL patients were included in this study. Serum levels of TNF-\u03b1, autoantibodies, and complement were measured and monitored. Among these patients, 138 tested positive for TNF-\u03b1, while 111 tested negative. The medical records of these patients were retrospectively evaluated. Additionally, 102 patients with elevated TNF-\u03b1 levels were treated with TNF-\u03b1 inhibitors, and their pregnancy outcomes were assessed. RESULTS: TNF-\u03b1-positive RPL patients had higher levels of complement C1q, anti-cardiolipin (ACL)-IgA, ACL-IgM ,ACL-IgG, thyroglobulin antibody, and Anti-phosphatidylserine\/prothrombin IgM antibody, as well as a higher positive rate of antinuclear antibodies compared to TNF-\u03b1-negative patients (23.19% vs. 12.6%, P&lt; 0.05). Conversely, complement C3 were lower in TNF-\u03b1-positive patients (t test, P&lt; 0.05). The use of TNF-\u03b1 inhibitors led to a reduction in the early abortion rate (13.7% vs. 44.4%, P&lt; 0.001) and an improvement in term delivery rate (52.0% vs. 27.8%, P= 0.012). Furthermore, patients who used TNF-\u03b1 inhibitors before 5 weeks of pregnancy had a lower early abortion rate (7.7% vs. 24.3%, P= 0.033) and a higher term delivery rate (69.2% vs. 48.6%, P= 0.033). CONCLUSION: TNF-\u03b1 plays a role in the occurrence and development of RPL, and its expression is closely associated with autoantibodies and complements. TNF-\u03b1 inhibitors increase the term delivery rate in TNF-\u03b1-positive RPL patients, and their use before 5 weeks of pregnancy may more beneficial.<\/jats:p>","DOI":"10.3233\/thc-240757","type":"journal-article","created":{"date-parts":[[2024,7,26]],"date-time":"2024-07-26T11:03:31Z","timestamp":1721991811000},"page":"4581-4591","source":"Crossref","is-referenced-by-count":9,"title":["TNF-\u03b1-positive patients with recurrent pregnancy loss: The etiology and management"],"prefix":"10.1177","volume":"32","author":[{"given":"Zhuhua","family":"Cai","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Qilu Hospital of Shandong University, Jinan, China"},{"name":"Department of Obstetrics and Gynecology, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China"},{"name":"Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Qilu Hospital of Shandong University, Jinan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueke","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China"},{"name":"Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Qilu Hospital of Shandong University, Jinan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ge","family":"Zheng","sequence":"additional","affiliation":[{"name":"Pediatric Department, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junmiao","family":"Xiang","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingyun","family":"Liu","sequence":"additional","affiliation":[{"name":"Central Laboratory, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongmei","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohui","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Qilu Hospital of Shandong University, Jinan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","reference":[{"key":"10.3233\/THC-240757_ref1","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1007\/s13224-021-01598-4","article-title":"Outcome of Index Pregnancy in Women with Recurrent Pregnancy Loss (RPL)","volume":"72","author":"Dasari","year":"2022","journal-title":"J Obstet Gyn India."},{"issue":"6","key":"10.3233\/THC-240757_ref2","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1515\/mr-2022-0030","article-title":"Understanding recurrent pregnancy loss: recent advances on its etiology, clinical diagnosis, and management","volume":"2","author":"Cao","year":"2022","journal-title":"Med Rev."},{"issue":"3","key":"10.3233\/THC-240757_ref3","first-page":"356","article-title":"Recurrent pregnancy loss: diagnostic workup after two or three pregnancy losses","volume":"26","author":"Dijk","year":"2020","journal-title":"A systematic review of the literature and meta-analysis. 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