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All Journal Indonesian Journal of Perinatology
Ernawati Darmawan
Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Airlangga University, Dr. Soetomo Hospital, Surabaya, Indonesia
Health Professions Medicine & Pharmacology Nursing

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Systems perinatology of autoimmunity: placental immune endophenotypes linking SLE, RA, Sjögren’s, and APS to specific obstetric complications: a systematic review and translational framework Wisnu Prabowo; I Nyoman Hariyasa Sanjaya; Wiku Andonotopo; Muhammad Adrianes Bachnas; Mochammad Besari Adi Pramono; Julian Dewantiningrum; Efendi Lukas; Anak Agung Gede Putra Wiradnyana; Anak Agung Ngurah Jaya Kusuma; Khanisyah Erza Gumilar; Ernawati Darmawan; Dudy Aldiansyah; Aloysius Suryawan; Ridwan Abdullah Putra; Cut Meurah Yeni; Nuswil Bernolian; Laksmana Adi Krista Nugraha; Waskita Ekamaheswara Kasumba Andanaputra; Wibisana Andika Krista Dharma; Niranjani
Indonesian Journal of Perinatology Vol. 7 No. 1 (2026): Available online: 1 June 2026
Publisher : The Indonesian Society of Perinatology, South Jakarta, Indonesia

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Abstract

Autoimmune diseases—including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), Sjögren’s syndrome, and antiphospholipid syndrome (APS)—confer disproportionate risk for adverse obstetric outcomes, yet the underlying placental immunopathology remains fragmented across disciplines. This systematic review integrates evidence from 2012–2025 to define reproducible placental immune endophenotypes linking maternal autoimmunity to obstetric complications. Following PRISMA 2020 guidelines, a comprehensive search of PubMed, Embase, and ClinicalTrials.gov identified 1,042 records, of which 54 studies met eligibility after duplicate removal, multi-reviewer screening, and bias appraisal (AMSTAR-2, ROBINS-I, NOS). No protocol was registered on PROSPERO. Evidence was synthesizednarratively and diagrammatically to capture mechanistic convergence across diseases. Findings delineate six immune endophenotype axes—type I interferon, complement/NETosis, B-cell/autoantibody, FcRn–IgG transport, microchimerism, and stromal–immune crosstalk—each associated with specific placental lesions (e.g., villitis, intervillositis, fibrinoid necrosis) and outcomes including preeclampsia, fetal growth restriction, preterm birth, and fetal loss. SLE and APS dominate complement-mediated patterns, whereas RA and Sjögren’s reflect IFN-driven trophoblast stress and stromal immune imbalance. Integrating histopathology, single-cell transcriptomics, and biomarker data, this framework proposes a Systems Perinatology model bridging discovery, mechanism, and clinical translation.This review reconceptualizes autoimmune pregnancy not as disease-specific, but as an endophenotype-mediated placental immune disorder amenable to precision stratification and targeted therapy. Future research should operationalize these axes for biomarker development, interventional trials, and predictive algorithms in precision obstetrics.
Microplastics in the human placenta: mechanisms, risks, and futures: a systematic review Muhammad Adrianes Bachnas; I Nyoman Hariyasa Sanjaya; Wiku Andonotopo; Wisnu Prabowo; Mochammad Besari Adi Pramono; Julian Dewantiningrum; Efendi Lukas; Anak Agung Gede Putra Wiradnyana; Anak Agung Ngurah Jaya Kusuma; Khanisyah Erza Gumilar; Ernawati Darmawan; Dudy Aldiansyah; Aloysius Suryawan; Ridwan Abdullah Putra; Cut Meurah Yeni; Nuswil Bernolian; Laksmana Adi Krista Nugraha; Waskita Ekamaheswara Kasumba Andanaputra; Wibisana Andika Krista Dharma; Niranjani
Indonesian Journal of Perinatology Vol. 7 No. 1 (2026): Available online: 1 June 2026
Publisher : The Indonesian Society of Perinatology, South Jakarta, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/inajperinatol.v7i1.92

Abstract

Background: Micro- and nanoplastics have been detected in the human placenta, raising concerns regarding fetal development, immune programming, and long-term health. This systematic review synthesized evidence on their presence in placental and perinatal compartments, mechanisms of translocation across the maternal–fetal interface, and potential biological and perinatal health effects.Methods: PubMed, Embase, Web of Science, Scopus, the Cochrane Library, trial registries, and relevant reference lists were searched from inception to September 2025 without language or publication-date restrictions. Eligible studies included human observational studies, ex vivo placental models, in vitro trophoblast or placental cell experiments, and animal models investigating micro- or nanoplastics in placental or perinatal compartments. Reviews were included for contextual synthesis. Two reviewers independently screened studies, extracted data, and appraised quality using AMSTAR-2, ROBIS, or the Newcastle–Ottawa Scale, as appropriate. Findings were synthesized narratively because of methodological heterogeneity. Results: Of 1,226 records identified, 25 studies were included: eight human detection studies, two ex vivo placental models, two in vitro studies, two animal models, and eleven systematic, scoping, or narrative reviews. Microplastics were detected in placental tissue, cord blood, and meconium across multiple regions using μ-FTIR, Raman, LD-IR, and Py-GC/MS. Mechanistic studies demonstrated placental and trophoblast uptake and reported endoplasmic reticulum stress, apoptosis, oxidative stress, inflammatory responses, vascular impairment, and endocrine disruption. Human studies were limited by small sample sizes, inconsistent contamination-control procedures, heterogeneous analytical methods, and lack of standardized dosimetry. Overall certainty of evidence was low to moderate. Conclusion: Current evidence indicates that micro- and nanoplastics can reach the maternal–fetal interface and may adversely affect placental function. However, their clinical significance and long-term consequences remain uncertain. Standardized detection protocols, environmentally relevant dose–response studies, and prospective longitudinal investigations are urgently needed.
Co-Authors Aloysius Suryawan Anak Agung Gede Putra Wiradnyana Anak Agung Ngurah Jaya Kusuma Cut Meurah Yeni Dudy Aldiansyah Efendi Lukas I Nyoman Hariyasa Sanjaya Julian Dewantiningrum Khanisyah Erza Gumilar Laksmana Adi Krista Nugraha Mochammad Besari Adi Pramono Mochammad Besari Adi Pramono Muhammad Adrianes Bachnas Niranjani Nuswil Bernolian Nuswil Bernolian Ridwan Abdullah Putra Waskita Ekamaheswara Kasumba Andanaputra Wibisana Andika Krista Dharma Wibisana Andika Krista Dharma Wiku Andonotopo Wisnu Prabowo Wisnu Prabowo