Maternal serum amyloid a as a potential biomarker for primary unexplained recurrent early pregnancy loss: a case-control study in Iraq

ABSTRACT

Objective. Recurrent pregnancy loss (RPL) is a multifactorial condition where many of the proposed risk factors lack an etiologic explanation, especially in primary unexplained recurrent early pregnancy loss (REPL). Herein, the association between maternal serum amyloid A (SAA) levels and primary unexplained REPL is examined among women who presented with first-trimester miscarriage.

Materials and Methods. A cross-sectional study was conducted at the Al-Yarmook Teaching Hospital from June 2023 to June 2024. It included 140 women who were diagnosed with a case of missed miscarriage and were divided into two groups. The study cohort consisted of 70 women with more than two consecutive REPLs without previous live birth deliveries. The control group included 70 women who had delivered at least once and never experienced REPL. Complete demographic data were taken from all subjects. SAA levels in both groups were estimated using ELISA kits.

Results. Significant differences were noted in the marriage duration, parity and history of spontaneous miscarriage between cases with REPL. SAA was very highly elevated in this study group 53.52 ± 10.65 micrograms/ml as compared to the control group 11.33 ± 3.27 micrograms/ml, p < 0.0001. Moreover, SAA showed a positive significant correlation with body mass index, p = 0.041, while showing negative association with marriage duration, p = 0.921 and age, p = 0.184.

Conclusions: Elevated SAA levels in patients with primary indeterminate REPL may be associated with adverse outcomes during the first trimester. Further studies are required to establish SAA level utility in identifying women who have an increased risk of REPL, thereby further informing counseling services and guiding therapeutic interventions.

Key words

Primary indeterminate recurrent pregnancy loss; trophoblastic invasion; serum amyloid A.