Benefits and Risks of IgG Transplacental Transfer

Anca Marina Ciobanu, Andreea Elena Dumitru, Nicolae Gica, Radu Botezatu, Gheorghe Peltecu, Anca Maria Panaitescu, Anca Marina Ciobanu, Andreea Elena Dumitru, Nicolae Gica, Radu Botezatu, Gheorghe Peltecu, Anca Maria Panaitescu

Abstract

Maternal passage of immunoglobulin G (IgG) is an important passive mechanism for protecting the infant while the neonatal immune system is still immature and ineffective. IgG is the only antibody class capable of crossing the histological layers of the placenta by attaching to the neonatal Fc receptor expressed at the level of syncytiotrophoblasts, and it offers protection against neonatal infectious pathogens. In pregnant women with autoimmune or alloimmune disorders, or in those requiring certain types of biological therapy, transplacental passage of abnormal antibodies may cause fetal or neonatal harm. In this review, we will discuss the physiological mechanisms and benefits of transplacental transfer of maternal antibodies as well as pathological maternal situations where this system is hijacked, potentially leading to adverse neonatal outcomes.

Keywords: alloimmune disorders; autoimmune disorders; immunoglobulin G; pregnancy; transplacental transfer; vaccine.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Transplacental passage of immunoglobulin G (IgG) and the neonatal Fc receptor. IgG from the maternal blood (left) is transferred by transcytosis at the level of syncytiotrophoblasts (STB); it is internalized within endosomes and binds to FcRn on the internal surface; the complex is then carried towards the basal cell membrane of STB and released into the fetal circulation (right). Purple arrows indicates IgG transport to the fetal blood.
Figure 2
Figure 2
Timing of IgG transfer across the placenta in pregnancy (adapted from Malek A et al., Evolution of maternofetal transport of immunoglobulins during human pregnancy, Am J Reprod Immunol, 1996) [24].
Figure 3
Figure 3
Fetal thyroid goiter (arrow) in gray-scale and power Doppler (courtesy of the Fetal Medicine Foundation).
Figure 4
Figure 4
Fetal arthrogryposis with talipes (collection of Filantropia Hospital).
Figure 5
Figure 5
Pulsed Doppler examination showing increased peak systolic velocity on the middle cerebral artery (left); When plotted on the graph (right), the peak systolic velocity on the middle cerebral artery in this case (red dot) is higher than the limit of 1.5 standard deviation (red line); the green line represents the median peak systolic velocity for gestational age (collection of Filantropia Hospital).
Figure 6
Figure 6
Pemphigoid gestationis: cutaneous bullous lesions on the upper thigh of a third trimester pregnant patient (courtesy of Prof. Călin Giurcăneanu).
Figure 7
Figure 7
Fetal ventriculomegaly due to intraventricular hemorrhage (arrow) (collection of Filantropia Hospital).

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