Cohort of Patients Presenting Unexplained Recurrent Miscarriages and Identification of Early Miscarriage Recidivism Factors

Study Overview
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Brief Summary
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About 1 to 3% of women of childbearing age have repeated early spontaneous miscarriages (RCF) defined by at least 3 fetal losses before 14 weeks of gestation. RCFs may be related to parental chromosomal abnormalities, congenital or acquired uterine abnormalities, hormonal causes (e.g. type 1 and 2 diabetes, ovarian failure), infectious etiology, constitutional or acquired thrombophilia or sickle cell disease. The presence of antiphospholipid antibodies, antithyroid and anti-transglutaminase antibodies in approximately 10% of cases suggests an autoimmune origin for these fetal losses. The role of other antibodies, in particular unconventional antiphospholipid antibodies, remains to be established. Indeed half of RCF cases would be due to an immunological dysregulation of the mother leading to a decrease in tolerance to the fetus. Several studies have shown immune abnormalities, such as an imbalance of pro and anti-inflammatory cytokines, an increase in cytotoxic cells and a defect in regulatory cells in the blood of patients. The assessment of these immune abnormalities is not currently carried out routinely in France in women with recurrent early miscarriages. When one of these known causes is excluded, it is unexplained RCF which represents 50% of RCF. In these women with unexplained RCF, slightly more than half could be linked to aneuploidies and primary recurrent spontaneous abortions. The evaluation of the degree of aneuploidy and the genetic origin of fetal losses remains difficult, the examination of the sample of tissue from the miscarriage being rarely available, due to the spontaneous nature of the loss. The constitution of a prospective cohort of patients with RCF is an essential step in exploring the factors associated with the success of treatment.

Detailed Description
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On the day of inclusion, if the patient accepts the ancillary study, a blood sample will be taken for the biological collection If the patient becomes pregnant during the follow-up period, the blood sample for the ancillary study will be repeated each trimester of pregnancy (if applicable). At the inclusion visit and during pregnancy, the patient will complete a Baecke questionnaire and a questionnaire to measure perceived stress The study population will be followed as part of usual care, identical to all patients presenting with RCF. As part of the routine care of the internal medicine department of Saint Antoine, patients with RCF have a complete check-up in the day hospital (complete blood test, stomatologist consultation, ECG) and are seen in consultation twice a year.

Official Title
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Cohort of Patients Presenting Unexplained Recurrent Miscarriages and Identification of Early Miscarriage Recidivism Factors

Conditions
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Miscarriage

Intervention / Treatment
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* Biological: Lymphocyte immunophenotyping


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age 18 to 50 years Patients with at least 3 recurrent miscarriages Signed consent form Exclusion Criteria: - Patients who don't accept the use of their data

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 50 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Miscarriage<br>Patients with at least 3 recurrent early miscarriages (before 14 weeks of gestation) | Biological: Lymphocyte immunophenotyping<br>* If the patient accepts the ancillary study, a blood sample will be taken (1 EDTA tube of 3 ml and 2 lithium heparin tubes of 10 mL each) for lymphocyte immunophenotyping in flow cytometry on fresh blood and for the constitution of the biological collection (plasma/mononuclear cells).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To build a cohort of patients in order to describe clinical characteristics, tests carried out and medical care of patients presenting spontaneous recurrent miscarriages | Description of clinical and biological characteristics of patients presenting spontaneous recurrent miscarriages | through study completion, an average of 5 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| To describe the frequency of miscarriage recidivism | Proportion of recidivism according to number of previous miscarriages, etiologic investigation, age of conception, associated infertility factors, type of miscarriages with or without alive children and different treatments carried out. | for the length of the study | 
| To compare the efficacy of immunomodulatory drugs (corticosteroids, hydroxycholoroquin, Intravenous Immunoglobulin Therapy, intralipids, biotherapies) | Description of the efficacy of the various drugs : number of full term pregnancies | through study completion, an average of 5 years | 
| To evaluate the psychological state of patients and the impact on pregnancy | Evaluation of the patients' lifestyle using the Baecke questionnaire and medical interrogation. | through study completion, an average of 5 years | 
| to evaluate patients' lifestyle and the impact on pregnancy | through study completion, an average of 5 years | evaluation of the patients' lifestyle using the Baecke questionnaire and medical interrogation. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Miscarriage, Prognostic factors, Biological collection