Immune System Issues After Miscarriage: Key Tests to Consider

Is there a problem with the immune system?

Hello doctors: Since my miscarriage last year, I have been experiencing persistent dry mouth symptoms.
No matter how much water I drink, I still feel dry throughout the day.
I have undergone immune system testing and ruled out Sjögren's syndrome and secondary dry syndrome.
What other tests can I undergo to identify my issue? This symptom has lasted for a year.
Additionally, after my second miscarriage, I had my immune system tested, and it seems that my NK and DD levels were elevated before pregnancy.
I would like to ask what immune tests should be conducted once I become pregnant? Which tests are normal when not pregnant but tend to increase during pregnancy?

Mo Mo, 30~39 year old female. Ask Date: 2020/03/26

Dr. Zeng Guosen reply Internal Medicine

Hello, internet user.

1.
There are many causes of dry mouth and dry tongue, with only a small percentage of cases attributed to immune issues.
In addition to blood tests, a commonly overlooked examination for immune problems is a salivary gland biopsy, which is necessary for diagnosis in nearly 40% of cases.
2.
There are many tests for immune issues that can lead to miscarriage, but only some related immune diseases can be detected.
It is recommended to consult with an obstetrician-gynecologist or a rheumatologist for further evaluation.
Thank you for your question.

Reply Date: 2020/03/26

More Info

Understanding immune system issues after a miscarriage can be complex, especially when symptoms like persistent dry mouth and throat arise. These symptoms can be frustrating and may indicate underlying immune system dysfunction or other health issues. Given your history of miscarriage and ongoing symptoms, it’s essential to approach this situation with a comprehensive understanding of the immune system and its role in reproductive health.

Firstly, it’s important to recognize that the immune system plays a critical role during pregnancy. It must adapt to support the developing fetus, which is genetically distinct from the mother. This adaptation can sometimes lead to immune dysregulation, which may contribute to complications such as miscarriages. In your case, the persistent dry mouth and throat could be linked to several factors, including autoimmune conditions, hormonal changes, or even stress-related issues.

Since you mentioned that previous tests for conditions like Sjögren’s syndrome (which causes dry mouth and eyes) have returned negative, it may be beneficial to explore other autoimmune markers. Some tests to consider include:
1. Antinuclear Antibodies (ANA): While you may have had this tested before, a high ANA titer can indicate autoimmune activity. It’s important to correlate this with clinical symptoms.

2. Specific Autoantibodies: Tests for specific autoantibodies such as anti-Ro/La, anti-dsDNA, and anti-Smith can help identify conditions like systemic lupus erythematosus (SLE) or Sjögren’s syndrome, even if initial tests were negative.

3. Thyroid Function Tests: Thyroid disorders can also contribute to symptoms like dry mouth and fatigue. Testing for thyroid-stimulating hormone (TSH) and thyroid antibodies can help rule out autoimmune thyroid disease.

4. Cytokine Levels: Since you mentioned elevated NK (natural killer) cells and DD (dendritic cells) prior to pregnancy, measuring cytokines involved in immune regulation could provide insight into your immune status. Elevated levels of certain cytokines may indicate an inflammatory response that could affect pregnancy.

5. Hormonal Assessments: Hormonal imbalances, particularly involving estrogen and progesterone, can impact immune function and may need to be evaluated, especially if you are considering future pregnancies.

Regarding your question about which immune tests to conduct before and during pregnancy, it’s crucial to understand that some immune markers may fluctuate based on hormonal changes. For instance, certain cytokines and immune cell populations may increase during pregnancy to support fetal development. Therefore, it’s advisable to consult with a reproductive immunologist or a specialist in maternal-fetal medicine who can guide you on the appropriate tests based on your specific situation.

In summary, while your symptoms and history of miscarriage warrant thorough investigation, it’s essential to approach this with a comprehensive testing strategy. Collaborating with healthcare providers who specialize in reproductive immunology can help tailor the testing to your needs and provide insights into managing your symptoms effectively. Remember, maintaining a healthy lifestyle, managing stress, and ensuring proper nutrition can also play significant roles in supporting your immune system and overall health as you navigate future pregnancies.

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