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

Objective: 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. Methods: This communication reviews published evidence in potential support or repudiation of this dogma via a literature search of appropriate keywords via PubMed and Medline. Results: The literature suggests that maternal autoimmunity, in itself, may increase the risk towards non-dysjunctional events and, therefore, aneuploidy prevalence in abortuses and offspring. Conclusions: 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.