Do chromosomally abnormal pregnancies really preclude autoimmune etiologies of spontaneous miscarriages?

At least 60% of spontaneous pregnancy loss is considered genetic in nature. Miscarriages can, however, also be autoimmune-induced or have other etiologies. Current clinical dogma in rheumatology as well as obstetrics/gynecology holds that evidence of aneuploidy in products of conception establishes the cause of miscarriage and rules out other potential causes, including autoimmunity.

This communication reviews published evidence in potential support or repudiation of this dogma via a literature search of appropriate keywords via PubMed and Medline.

The literature suggests that maternal autoimmunity, in itself, may increase the risk towards non-dysjunctional events and, therefore, aneuploidy prevalence in abortuses and offspring.

Detection of aneuploidy in products of conception should no longer be considered conclusive evidence of a chromosomally induced miscarriage and that autoimmune evaluations should be withheld. Indeed, an opposite conclusion may have to be reached, suggesting, at least in repeat aborters, careful evaluation of autoimmune status.