{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T23:30:30Z","timestamp":1792971030515,"version":"4.5.0"},"reference-count":75,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Reprod. Health"],"abstract":"<jats:p>\n                    Recurrent spontaneous abortion (RSA) affects 1%\u20135% of reproductive-age couples, and nearly 50% of cases remain unexplained. This review summarizes recent evidence to elucidate the association between gut microbiota dysbiosis and RSA. We confirm that RSA patients exhibit decreased alpha diversity, reduced levels of\n                    <jats:italic>Bacteroidetes<\/jats:italic>\n                    ,\n                    <jats:italic>Lactobacillus<\/jats:italic>\n                    , and\n                    <jats:italic>Bifidobacterium<\/jats:italic>\n                    , and elevated\n                    <jats:italic>Proteobacteria<\/jats:italic>\n                    and\n                    <jats:italic>Escherichia-Shigella<\/jats:italic>\n                    . Gut dysbiosis contributes to RSA through three core pathways: disrupted T helper 17\/regulatory T cell balance leading to maternal\u2013fetal immune intolerance; insufficient short-chain fatty acid production and elevated trimethylamine N-oxide causing metabolic disorders; and disrupted estrogen and progesterone metabolism via microbial hydroxysteroid dehydrogenases triggering endocrine dysfunction. We also clarify the bidirectional causal relationship between gut dysbiosis and RSA, summarize inconsistent findings across studies, and highlight the potential of probiotics and dietary interventions. This review provides mechanistic insights and clinical implications for microbiota-targeted strategies in unexplained RSA.\n                  <\/jats:p>","DOI":"10.3389\/frph.2026.1801173","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T05:46:29Z","timestamp":1779342389000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Unraveling the intricate link: gut microbiota and recurrent spontaneous abortion"],"prefix":"10.3389","volume":"8","author":[{"given":"Dan","family":"Li","sequence":"first","affiliation":[{"name":"Department of Nephrology, Qingdao Central Hospital, University of Health and Rehabilitation Sciences","place":["Qingdao, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqiang","family":"Liu","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Center, Qingdao Women and Children\u2019s Hospital","place":["Qingdao, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaogang","family":"Teng","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Center, Qingdao Women and Children\u2019s Hospital","place":["Qingdao, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenxi","family":"Yang","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Center, Qingdao Women and Children\u2019s Hospital","place":["Qingdao, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoxia","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Xihe County People\u2019s Hospital","place":["Longnan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Affiliated Hospital of Qingdao University","place":["Qingdao, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1658","DOI":"10.1016\/S0140-6736(21)00682-6","article-title":"Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss","volume":"397","author":"Quenby","year":"2021","journal-title":"Lancet (London, England)"},{"key":"B2","doi-asserted-by":"publisher","first-page":"l869","DOI":"10.1136\/bmj.l869","article-title":"Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study","volume":"364","author":"Magnus","year":"2019","journal-title":"BMJ (Clinical Research Ed)"},{"key":"B3","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1038\/s41572-020-00228-z","article-title":"Recurrent pregnancy loss","volume":"6","author":"Dimitriadis","year":"2020","journal-title":"Nat Rev Dis Primers"},{"key":"B4","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1093\/humrep\/dey362","article-title":"Recurrent pregnancy loss: couples\u2019 perspectives on their need for treatment, support and follow up","volume":"34","author":"Koert","year":"2019","journal-title":"Hum Reprod (Oxford, England)"},{"key":"B5","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1097\/OGX.0000000000001033","article-title":"Recent advances in treatment of recurrent spontaneous abortion","volume":"77","author":"Deng","year":"2022","journal-title":"Obstet Gynecol Surv"},{"key":"B6","doi-asserted-by":"publisher","first-page":"157","DOI":"10.5582\/ddt.2023.01010","article-title":"The association of gut microbiome with recurrent pregnancy loss: a comprehensive review","volume":"17","author":"Zhu","year":"2023","journal-title":"Drug Discov Ther"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1346035","DOI":"10.3389\/fimmu.2024.1346035","article-title":"Gut microbiota-gonadal axis: the impact of gut microbiota on reproductive functions","volume":"15","author":"Ashonibare","year":"2024","journal-title":"Front Immunol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1016\/j.cell.2016.01.013","article-title":"Are we really vastly outnumbered? 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