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Hum. Reprod. Advance Access published online on October 28, 2004
Human Reproduction, doi:10.1093/humrep/deh516
© 2004 by European Society of Human Reproduction and Embryology
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Received June 1, 2004
Accepted August 18, 2004

Article

Impact of the sex of first child on the prognosis in secondary recurrent miscarriage

O.B. Christiansen 1*, B. Pedersen 2, H.S. Nielsen 1, and A.-M. Nybo Andersen 3

1 Fertility Clinic 4071, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
2 Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark
3 Department of Social Medicine, Institute of Public Health, University of Copenhagen, Denmark

* To whom correspondence should be addressed.
O.B. Christiansen, E-mail: obc{at}pregnancyloss.dk


  Abstract

BACKGROUND: The carriage of a male fetus often initiates maternal immunological reactions against male-specific minor histocompatibility (HY) antigens, which, in theory, could result in subsequent recurrent miscarriage (RM). METHODS: Information about subsequent pregnancy outcome was procured among 182 women with RM after a birth (secondary RM) referred since 1986 using questionnaires, telephone interviews and registers. RESULTS: Significantly more of the women had had a male first-born as compared with a female first-born (110 versus 72; P<0.02). By January 2002, 58% of those who had a male first-born had given birth to a second live infant compared with 76% of those who previously had had a female first-born (P=0.01). Women in the former group had a significantly lower chance of having a second child than those in the latter (adjusted hazard ratio 0.59; 95% confidence interval 0.41-0.86). The number of miscarriages after admission and the risk of secondary infertility were significantly greater in women with a male first-born than among those with a female first-born (P<0.001 and P=0.02; respectively). CONCLUSIONS: A male first-born seems to be associated with a less favourable reproductive potential among women with secondary RM. Maternal immunization against HY antigens may be responsible for these findings.

Keywords: abortion; cohort study; HY antigens; miscarriage; recurrent spontaneous abortion.
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