Monday, 10 December 2007

Recurrent Spontaneous Abortions: Thousands silently suffer in India

December 10, 2007
By Syed Akbar
Hyderabad: Thousands of young couples in India silently undergo the trauma of frequent loss of pregnancy though they are physically and biologically active and healthy. The couples do have any known causes for frequent abortions. They simply conceive but the foetus is ejected out by the time it attains the age of 20 weeks.
This unexplained loss of pregnancy that occurs quite frequently in some couples is known in the medical circles as Recurrent Spontaneous Abortions or Habitual Miscarriage. Doctors and medical researchers world-wide are perplexed at the phenomenon as the couples who suffer from the problem do not have any deformities or health related problems.
RSA is loss of two or more consecutive pregnancies before 20 weeks of gestation, which takes into consideration that a woman over 35 years is at greater risk for pregnancy loss than a 25 year old woman.
The Hyderabad-based Biological Anthropology Unit of the Indian Statistical Institute has, in its primary investigations, found that a hitherto unstudied genetic factor might be playing a crucial role in couples who lose babies before the 20th week of conception.
A team of researchers at the Indian Statistical Institute is exploring the possibility of Human Leukocyte Antigens (HLA) playing a key role in the early termination of pregnancies. The HLA genes are the main genetic determinants of the repertoire of possible immune responses of an individual. They play critical role throughout pregnancy by influencing gamete development, embryo cleavage, blastocysts and trophoblast formation, implantation, foetal development and survival.
"In some couples with RSA, where no certain diagnosis has been possible, HLA antigens might be playing a role at the maternal foetal interface. The foetus being semi-allogenic might face a rejection from the maternal antibodies if there is increased HLA sharing among the couple," points out Prof B Mohan Reddy. It is the first-ever study that links HLA antigens with the RSA factor.
Aruna Bezwada, one of the researchers involved in the study, told this correspondent that they have selected 150 couples with cases of frequent pregnancy failure and another 150 couples with at least one viable child for the controlled group. "Unlike earlier studies where research has been done only on women, we have taken couples for the present study," she points out.
In the absence of a definite diagnosis, couples of RSA problem undergo various experiments at the hands of their physicians often leading to complications. The present study will give a better understanding of the problem so that couples of RSA can go in for definite medical treatment and bear children.
At of now genetic basis of RSA is poorly understood. Single gene mutations, polygenic and cytogenetic factors are all found to show association with RSA.
"In Indian culture, having a baby is a life changing experience for the couple. There is no reliable estimate of the magnitude of abortions that take place in India but studies suggest that as women in India do not have control on their fertility and have poor health, there are very high chances that they experience abortions either spontaneous or induced more than once," they said.
Moreover, it is difficult to attain a reliable estimate on abortion frequencies in the Indian context as the registration of marriages, births and deaths are usually not complete. Many undergo treatment without actually knowing the cause. The present study will solve the problem as it will pinpoint the exact cause of abortion.

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