Decoding recurrent pregnancy loss: an integrated infectious-immune and multisystem biomarker signature associated with risk stratification

Abstract

Objective: To assess associations between a panel of immunological (antinuclear antibodies [ANA], cytomegalovirus [CMV] IgM/IgG), thyroid (thyroid‑stimulating hormone [TSH], T3, T4, free T3, free T4), coagulation (D‑dimer, prothrombin time [PT], partial thromboplastin time [PTT]), haematological (haemoglobin, platelets) and metabolic (HbA1c) markers and the number of previous spontaneous abortions in women with recurrent pregnancy loss (RPL).

Methods: An analytical cross‑sectional study was conducted among 100 women aged 26–39 years (mean 31.8 ± 3.7 years) with a history of 1–5 spontaneous abortions. Blood samples were collected during the follicular phase. Statistical analyses included the Kruskal–Wallis test, Spearman correlation, and Fisher’s exact test.

Results: All continuous markers showed highly significant differences across abortion‑frequency groups (p < 0.001). Median TSH, D‑dimer, PT, PTT, and HbA1c increased progressively with more abortions, whereas haemoglobin and platelets decreased. TSH showed the strongest positive correlation with abortion number (ρ = +0.896). ANA positivity rose from 2.9% (two abortions) to 100% (four to five abortions). CMV IgM positivity increased from 5.7% to 95.8–100%. All categorical markers demonstrated highly significant associations with abortion‑frequency groups (p < 0.001).

Conclusions: This multi‑system biomarker panel exhibits strong, dose‑dependent associations with RPL severity. Prospective validation with healthy control groups is needed before clinical application.