Chromosomal analysis of couples with repeated spontaneous abortions

Structural chromosome rearrangements in couples with recurrent fetal wastage

OBJECTIVE

A review of the cytogenetic data in 1743 couples (3486 patients) with recurrent fetal wastage (RFW) who were examined for RFW at the Leuven Centre for Human Genetics in the period 1986-1995. These results were compared with a previous study in the period 1970-1985.

SUBJECTS

Patients who had at least two first trimester miscarriages or patients who had a spontaneous first trimester abortion, preceded or followed by a second or third trimester fetal death.

RESULTS

Chromosomal rearrangements were found in 5.34%. Two-thirds of these chromosomal rearrangements were autosomal balanced translocations. This finding is a 30-fold increase compared to the general population. Other chromosomal abnormalities included Robertsonian translocations, inversions and sex-chromosomal abnormalities.

DISCUSSION

The Leuven experience was compared with several other studies. Mechanisms causing these chromosomal abnormalities are presented.

CONCLUSIONS

Chromosomal analyses are an important and necessary part of the etiological investigations in couples with RFW.

Maternal fertility, reproductive loss, and defective human embryos

It is possible that many abnormal conceptuses are lost at an early stage without the mother's knowledge. To investigate this further the reproductive history of the mothers of defective embryos (neural tube defects, holoprosencephaly, cleft lip, polydactyly, and early embryonic resorption) was compared with that of the mothers of normal embryos. The frequency of prior miscarriages was higher in the case mothers than in normal controls matched for maternal age and gravidity, the difference being significant for all the anomalies except for polydactyly. The case mothers had fewer prior recognised pregnancies than control mothers matched for maternal age. There were more primigravid mothers in abnormal groups, and the difference from controls was significant for neural tube defects. It was assumed that the gravidity of the case mothers may be underestimated, possibly due to increased early abortions which are not recognised clinically. Thus, it seems that both recognised and unrecognised abortions occur more often in the mothers of defective embryos. Since many spontaneous abortuses are morphologically and/or cytogenetically abnormal, some women appear to conceive abnormal embryos repeatedly. Most of these embryos, however, may be screened out prenatally and escape clinical detection. Information on prior reproductive history of the woman should be examined carefully in genetic counselling.

Cytogenetic analysis of 688 couples experiencing multiple spontaneous abortions

We report on cytogenetic analysis of 688 couples experiencing two or more first- and/or second-trimester abortions (less than 20 weeks). The overall abnormality rate was 6.83% (47 couples). However, exclusion of those anomalies not generally accepted as being causal in spontaneous abortion leaves an abnormality rate of only 2.33% (16 couples). We discuss the significance of balanced translocations, inversions, sex chromosome aneuploidies, and mosaicisms thereof in the causation of multiple abortions.

Role of chromosome aberrations in recurrent abortion: a study of 269 balanced translocations

We have studied a sample of 5,445 couples in which the woman was ascertained to have had two or more spontaneous abortions: 396 from our Cytogenetics Unit (present series) and 5,049 from the literature (literature series). In approximately 5% of these couples one of the members was a carrier of a balanced translocation, either reciprocal (2/3 of cases) or Robertsonian (1/3). In 1% of the couples there were other chromosome anomalies, mostly gonosomal aneuploidies or mosaicisms. A pericentric inversion of the heterochromatic region of chromosome 9 was present in 3% of the couples of the present series and in 1% of the literature series. The number of female carriers exceeded significantly that of males. The probability for one member of the couple to be a carrier increased with the number of abortions at the time of ascertainment, but it does not seem modified by the concomitant presence of term pregnancies. The analysis of the cytogenetic findings in 80 cases of Robertsonian and 156 cases of reciprocal translocations suggests that some chromosomes are preferentially involved, and that in reciprocal translocations the breakpoints are not distributed at random on the chromosome arms. There is an excess of breakpoints on chromosomes 6, 7, and 22 and a dearth on chromosome 12. This distribution is significantly different from that of a sample of reciprocal translocations ascertained for a malformed child. In both samples the breakpoints seem associated with fragile sites more frequently than expected by chance. An analysis of the potential and effective chromosome imbalance suggests that in subjects with unbalanced chromosomes survival is correlated with a minimum imbalance.

Recurrent pregnancy losses and parental chromosome abnormalities: a review

A compilation of the cytogenetic results taken from 79 published surveys of couples with two or more pregnancy losses (comprising 8208 women and 7834 men) showed an overall prevalence of major chromosome abnormalities of 2.9%. This is five to six times higher than that of the general adult population. In every group of chromosome abnormalities in the parents a predominance of female to male affected was noted (2:1). Approximately 50% of all chromosome abnormalities detected were balanced reciprocal translocations, 24% were Robertsonian translocations, 12% were sex chromosomal mosaicisms in females, and the rest consisted of inversions and other sporadic abnormalities. Parents with two or more idiopathic pregnancy losses should be karyotyped to aid in management and counselling. When a translocation or other abnormality (e.g. X chromosomal mosaicism) predisposing to an abnormal zygote is found, prenatal diagnosis is indicated in future pregnancies. Even when parental karyotypes are normal, prenatal diagnosis should be considered in subsequent pregnancies of parents with two or more pregnancy losses because of the high incidence of chromosome abnormalities in spontaneous abortions. For the same reason, if a single previous pregnancy loss is known to have been chromosomally aneuploid, parental karyotypes may have to be examined (depending upon the finding in the pregnancy loss), and prenatal diagnosis should also be considered in subsequent pregnancies.

Balanced reciprocal translocations: risk factors for aneuploid segregant viability

Reciprocal translocations were studied in two groups of balanced carrier couples: 202 had 210 translocation aneuploid between (LB) infants, and 95 couples had repetitive abortions (AB) without liveborn aneuploids. The observed translocation aneuploidies in the LB group were compared to predicted potential aneuploidies in AB by frequency of chromosome involvement, meiotic segregation mode, and mean trisomic, monosomic and combined genomic imbalances. Qualitative and quantitative differences identified genomic regions and chromosomes possibly vital for in utero survivability. LB aneuploidies indicate non-random chromosome involvement, selection of least detrimental segregants and segments, and predominant transmission from maternal balanced carriers (especially in 3:1 tertiary segregation, 93.5%). For an individual with a balanced reciprocal translocation and untested reproductive capability, an approach is given for predicting whether a translocation aneuploid conceptus will be liveborn or aborted.

Cytogenetic findings in 318 couples with repeated spontaneous abortion: a review of experience in British Columbia

We studied G-banded chromosome complements on 318 couples with 2 or more spontaneous abortions. Seven chromosome abnormalities were detected. Three women and one man were identified as carriers of balanced Robertsonian translocations, t(13;14), t(13;14), t(13;21), and t(14;22), respectively. Aneuploidy: 47,XXX; 47,XX, + marker; and 45,X/46,XX/47,XXX were found in the other 3 women. The overall aberration frequency was 2.2% of couples. When a stringent criterion of greater than or equal to 3 consecutive spontaneous abortions was used, the frequency was 4.2%. In this series no chromosome aberrations were identified in couples with 2 spontaneous abortions and a live-born child with congenital anomalies; 1 of 22 couples with 2 spontaneous abortions and a still-born infant showed a chromosomal abnormality. Findings from the recent literature are compared with those from this study.

Cytogenetic survey in couples with recurrent fetal wastage

Cytogenetic studies have been performed in 1068 couples with antecedent fetal wastage, i.e., at least two spontaneous first trimester abortions or one spontaneous first trimester abortion and one late fetal death, particularly with multiple congenital malformations. Three major types: 33 reciprocal translocations (3.09%), 20 Robertsonian translocations (1.87%) and six other chromosomal abnormalities (0.56%) were found, bringing the total number of chromosomal abnormalities to 59 (5.5%) in 1068 couples under investigation. In contrast to couples with reciprocal translocations, a high excess of female over male carriers was found in the group of Robertsonian translocations. In the evaluation of chromosomal polymorphisms, only variants with particularly large paracentromeric constitutive heterochromatin blocks were taken into account, and their low frequency in the present study is therefore not comparable with that in a general population. The impact of further extensive familial investigation on genetic counseling and the follow-up of prenatal diagnosis are discussed.

Etiologic factors and subsequent reproductive performance in 195 couples with a prior history of habitual abortion

A diagnostic screening program was applied to 195 couples with a prior history of habitual abortion (i.e., three or more consecutive abortions). Abnormalities were identified in 110 (56%) of the couples. Such identification was significantly more frequent in couples with primary habitual abortion than in couples with secondary habitual abortion (p less than 0.001) and also more frequent in couples with second-trimester abortions than in those with first-trimester abortions (p approximately equal to 0.01). The abnormalities most commonly observed were anomalies of the uterine body (15%), endometrial infections (15%), and cervical incompetence (13%). Hormonal dysfunctions were detected in 5%, and there were chromosomal aberrations in 3% of the couples. The women in the group showing abnormalities were offered surgical or medical treatment, and 80% of those who subsequently conceived carried their pregnancies to term. Among the couples with no abnormal findings, women receiving specific antenatal counseling and psychological support had a pregnancy success rate of 86%, as compared to a success rate of 33% observed in women who were given no specific antenatal care (p less than 0.001).

Chromosome anomalies in 136 couples with a history of recurrent abortions

Cytogenetic studies were performed on 136 couples with a history of two or more abortions referred to us after gynaecological causes of the abortions had been excluded. Fifteen (11%) of the couples were found to have a chromosome anomaly, and when the couples were subdivided according to number of abortions, surprisingly 6 (10%) of the 59 couples with a history of only two abortions had a chromosome anomaly. An increased frequency of mosaicism for X-chromosome aneuploidy (2.2%) in the women from the 136 couples was also found. A review of the literature shows that translocations of some chromosomes (e.g. nos. 1, 7 or 22) preferentially lead to fetal wastage, while those involving, for example, chromosome nos. 5, 9, 14 or 21 are more likely to result in the birth of a handicapped child. Couples with a history of two abortions should be investigated cytogenetically. Other causes of miscarriages must, however, be excluded first.

Chromosomal findings in 164 couples with repeated spontaneous abortions: with special consideration to prior reproductive history

The cytogenetic evaluation of 164 couples who experienced repeated spontaneous abortions revealed 11 chromosomal abnormalities (10 translocations and 1 sex chromosome mosaic, 6.70%). An apparent positive relationship between the frequency of chromosome anomalies and the number of spontaneous abortions was observed. Couples with at least one normal liveborn child, in addition to the spontaneous abortions, had a significant increase in chromosomal abnormalities (17.85%) when compared with those with no liveborn offspring (4.41%) (P less than 0.005). Similarly, couples whose fetal wastage consisted of only first trimester spontaneous abortions had a greater increase in the frequency of chromosomal abnormalities (8.03% vs 0.00%).

Chromosome abnormality in couples with histories of multiple abortions. The outcome of pregnancies subsequent to ascertainment and a study of familial translocation carriers

A series of couples with histories of recurrent abortions and in whom one partner had been shown to have a major chromosomal anomaly were investigated with respect to the karyotypes of conceptions subsequent to ascertainment. The reproductive histories of translocation carriers amongst relatives were also studied. Results were compatible with previous reports of the behaviour of translocation chromosomes at meiosis with an additional previously undescribed outcome as a result of a maternal 13/14 Robertsonian translocation.

Balanced translocation karyotypes in patients with repetitive abortion. Case study and literature review

Cytogenetic studies were conducted upon 100 consecutive couples with abortions. Eight balanced carrier translocation karyotypes were discovered (8%): three cases of Robertsonian translocations and five reciprocal translocations. Two structural variant karyotypes and a poly-X mosaic were also found. A review of the literature on repetitive abortion revealed 82 balanced translocations in 1,331 couples, a rate of 6.2%. Cytogenetic studied should be routine for patients with repetitive abortion. In the pooled series, 3.7% of couples with translocation had wastage, including some with normal offspring; 9.2% had malformed offspring; 62% of the carrier couples lacked the malformation history. Seventy-four percent of the translocations were reciprocal; risk rates for imbalanced progeny were undefined for 90% of the carrier couples. Only 11 imbalanced conceptuses were demonstrated cytogenetically in 262 pregnancies of the carrier group.

Chromosome analyses in couples with repeated pregnancy loss

Cytogenetic investigations were undertaken on 120 couples in Newcastle with repeated pregnancy loss for which no anatomical or other obvious reason could be established. The level of major chromosome anomalies was high, with 6·7% of couples showing one member with an abnormal karyotype. One major anomaly occurred in a control series of 240 random newborns. The couples also showed an elevated incidence of chromosomal heteromorphisms. Similar studies in the literature are reviewed. It seems that major chromosome anomalies make an appreciable contribution to repeated reproductive loss, but proof of the involvement of minor chromosome variants though suspected is less clear.