High-risk pregnancy and hypoluteoidism in the bitch

High-risk pregnancies are those in which the prevalence of maternal, fetal and/or perinatal morbidity or mortality is likely to be higher than that of the general obstetrical population. Some maternal characteristics associated with risk to maternal, fetal and/or perinatal health are readily identifiable prior to conception, such as advanced maternal age, brachycephalic breed, or a previous history of pregnancy loss. Others, such as gestational diabetes or a singleton litter, are recognized after conception. Early recognition of the problem (i.e. the risk), anticipation of the potential sequelae, and development of an aggressive management scheme are essential for a successful outcome of a high-risk pregnancy. A previous history of pregnancy loss is a high-risk factor for recurrence during subsequent pregnancies. Infection is a common cause. In some instances, recurrent pregnancy loss is associated with low serum concentrations of progesterone. Although the mechanism(s) by which this occurs is not fully understood, the situation has been called hypoluteoidism. Whatever the cause of the risks to pregnancy, the goals of managing high-risk pregnancies are to optimize maternal, fetal and perinatal health, so as to maintain maternal health throughout pregnancy and lactation and maximize the number of healthy pups surviving to weaning age.     

Pregnancy management in the bitch

Pregnancy management to optimize maternal and neonatal health begins with breeding management and the selection of normal, healthy brood stock in ideal body condition. After breeding, a commercial diet appropriate for reproduction and lactation should be fed. Typically these contain 29-32% protein of animal source, at least 18% fat, 20-30% carbohydrate, and essential vitamins, minerals and fatty acids. Pregnancy is confirmed approximately 25 d after breeding. A "maternity ward" and whelping box should be provided. Steady increases in caloric intake and body weight are expected as pregnancy progresses. Weight loss should not occur. Throughout pregnancy, changes in the bitch's attitude, activity, appetite, body weight, and physical findings should be monitored by the owner. If appetite and body weight do not continue to increase, or if any signs of illness develop, maternal health should be assessed with a complete physical examination and a CBC, biochemical profile, and free-catch urinalysis. Fetal health should be assessed with ultrasonography. Maternal or fetal abnormalities will put the pregnancy at risk. Impending parturition and the progress of labor and delivery can be monitored by assessing rectal temperature, serum concentrations of progesterone, and/or uterine and fetal monitors. This article reviews the physiology of canine pregnancy and parturition, and typical schemes used to manage normal canine pregnancy to optimize maternal and puppy health.     

Time related changes in luteal prostaglandin synthesis and steroidogenic capacity during pregnancy, normal and antiprogestin induced luteolysis in the bitch

In nonpregnant and pregnant dogs the corpora lutea (CL) are the only source of progesterone (P4) which shows an almost identical secretion pattern until the rapid decrease of P4 prior to parturition. For the nonpregnant dog clear evidence has been obtained that physiological luteal regression is devoid of a functional role of the PGF2α-system and seems to depend on the provision of StAR. Yet in pregnant dogs the rapid prepartal luteal regression, coinciding with an increase of PGF2α, may be indicative for different regulatory mechanisms. To assess this situation and by applying semi-quantitative Real Time (Taq Man) RT-PCR, expression patterns were determined for the following factors in CL of pregnant and prepartal dogs and of mid-pregnant dogs treated with the antiprogestin Aglepristone: cyclooxygenase 2 (Cox2), prostaglandin E2 synthase (PGES), prostaglandin F2α synthase (PGFS), its receptors (EP2, EP4 an FP), the steroidogenic acute regulatory protein (StAR), 3β-hydroxysteroid-dehydrogenase (3βHSD) and the progesterone receptor (PR). Peripheral plasma P4 concentrations were determined by RIA. CL were collected via ovariohysterectomy from pregnant bitches (n = 3–5) on days 8–12 (Group 1, pre-implantation period), days 18–25 (Group 2, post-implantation period), days 35–40 (Group 3, mid-gestation period) and during the prepartal progesterone decline (Group 4). Additionally, CL were obtained from groups of 5 mid-pregnant dogs (days 40–45) 24 h, respectively 72 h after the second treatment with Aglepristone. Expression of Cox2 and PGES was highest during the pre-implantation period, that of PGFS and FP during the post-implantation period. EP4 and EP2 revealed a constant expression pattern throughout pregnancy with a prepartal upregulation of EP2. 3βHSD and StAR decreased significantly from the pre-implatation period to prepartal luteolysis, it was matched by the course of P4 concentrations. Expression of the PR was higher during mid-gestation and prepartal luteolysis than in the two preceding periods. After application of Aglepristone the overall mRNA-expression resembled the situation during prepartal luteolysis except for EP2, which remained unchanged.These data suggest that – as in the nonpregnant bitch – also in the pregnant bitch luteal production of prostaglandins is associated with luteal support rather than luteolysis. On the other hand induction of luteolysis by the PR blocker Aglepristone points to a role of luteal P4 as an autocrine factor in a positive loop feedback system controlling the availability of P4, StAR and 3βHSD.     

Clinical evaluation of different applications of misoprostol and aglepristone for induction of abortion in bitches

The aim of the present study was to compare the clinical and endocrinological effects of different applications of misoprostol (MIS) and aglepristone (AGL) for the induction of abortion in bitches. For this purpose, 28 healthy pregnant bitches from different breeds, ages, body weights (Body weigt, BWs, 10–40 kg), and between Days 25 to 35 of gestation were used. Bitches were randomly assigned to four groups. In group 1 (GI, n = 7), AGL (10 mg/kg BW, s.c. on 2 consecutive days); in group 2 (GII, n = 7), AGL (as in GI), intravaginal MIS (IVag, 200 μg for bitches with ≤20 kg BW, 400 μg for bitches with >20 kg BW, daily intravaginally until completion of abortion); in group 3 (GIII, n = 7), AGL (as in GI), ICVag (as in GII), per os MIS (400 μg for bitches with ≤20 kg BW, 800 μg for bitches with >20 kg BW, daily orally, until completion of abortion); in group 4 (GIV, n = 7), AGL (as in GI), per os MIS (as GIII) were used. Clinical, vaginal, and ultrasonographic examinations were performed daily until abortion was completed. For measurement of serum progesterone, blood samples were collected in all groups immediately after the first AGL administration and every other day until completion of abortion. No statistical differences were found between groups concerning the duration until completion of abortion after treatment (nonsignificant); however, in GII, one bitch completed abortion 2 days after the start of treatment.     

高危儿随访情况分析及其父母生命质量调查研究

目的:了解高危儿随访情况并对其父母生命质量进行调查。方法:选取2017年5月~2019年5月于西安交通大学医学院附属三二〇一医院儿童保健科就诊的400例高危儿作为研究对象,分析400例高危儿的高危因素,统计随访次数,分析随访次数1~2次的高危儿的失访原因,同时采用SF-36量表评估高危儿父母与正常儿父母的生命质量。结果:按照占比从高到低的顺序,400例高危儿的高危因素分别为早产、低出生体重、高胆红素血症、窒息和(或)缺氧缺血性脑病、颅内出血、母亲高危因素、吸入性肺炎及其他,占比分别为74.00%、18.50%、13.25%、6.75%、2.75%、2.50%、1.25%、2.00%。400例高危儿中随访次数1~2次183例,占比45.75%,3~5次57例,占比14.25%,≥6次人数160例,占比40.00%。183例随访次数1~2次高危儿失访原因主要是有问题再来医院、孩子正常、不了解随访重要性、自己有育儿经验、孩子小,不方便等。高危儿父母生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能、精神健康评分均低于正常儿父母(均P<0.05)。结论:高危儿的随访失访率相对较高,其主要原因可能与父母的主观意识有关,此外,高危儿父母生命质量降低,临床工作中可通过加强高危儿系统管理以及对高危儿父母的宣教力度,从而降低失访率,提高高危儿父母的生命质量。     

Modifications of the G6G timed-AI protocol improved pregnancy per AI and reduced pregnancy loss in lactating dairy cows

In dairy cows, subjected to a G6G protocol, objectives were to determine effects of (1) extending the interval from prostaglandin F2α (PGF2α) to gonadotropin-releasing hormone (GnRH) during presynchronization; and (2) adding a second PGF2α treatment before artificial insemination (AI), on ovarian response, plasma progesterone (P4) concentrations and pregnancy per AI (P/AI). In a 2×2 factorial design, lactating cows were randomly assigned to one of four timed AI (TAI) protocols: (1) G6G (n=149), one injection of PGF2α, GnRH 2 days later and a 7-day Ovsynch (GnRH, 7 days, PGF2α, 56 h, GnRH, 16 h, TAI) was initiated 6 days later; (2) G6GP (n=144), an additional PGF2α treatment (24 h after the first) during Ovsynch of the G6G protocol; (3) MG6G, one injection of PGF2α, GnRH 4 days later before initiation of the G6G protocol; and (4) MG6GP, an additional PGF2α treatment (24 h after the first) during Ovsynch of the MG6G protocol. Blood samples were collected (subset of 200 cows) at first GnRH and PGF2α of the Ovsynch, and at TAI to measure P4. Ultrasound examinations were performed in a subset of 406 cows to evaluate ovarian response at various times of Ovsynch, and in all cattle to determine pregnancy status at 32 and 60 days after TAI. Extending the interval by 2 days between PGF2α and GnRH during presynchronization increased (P<0.01) ovulatory response to first GnRH of Ovsynch, circulating P4 during Ovsynch, and P/AI at 32 and 60 days after TAI. Adding a second PGF2α treatment before AI increased the proportion of cows with luteal regression (P=0.04), improved P/AI at 60 days after TAI (P=0.05), and reduced pregnancy loss between 30 and 60 days after TAI (P=0.04). In summary, extending the interval from PGF2α to GnRH during presynchronization increased response to first GnRH of Ovsynch and P4 concentrations during Ovsynch, whereas adding a second PGF2α treatment before AI enhanced luteal regression. Both modifications of the G6G protocol improved fertility in lactating dairy cows.     

肠道菌群与妊娠期甲状腺疾病患者的常见不良妊娠结局

目前, 肠道菌群被认为是影响机体内环境的潜在因素, 一旦失调, 可能导致多系统的疾病。妊娠期妇女由于机体代谢及免疫状态的变化, 是罹患妊娠期甲状腺疾病的高危人群。而妊娠期甲状腺疾病可导致流产、早产和出生体质量过低等常见不良妊娠结局, 对产妇、新生儿及其家庭造成十分恶劣的影响。妊娠期妇女作为特殊群体, 其肠道菌群的研究备受关注, 但目前关于妊娠期甲状腺疾病的肠道菌群研究仍较少。为更好地指导临床以及寻求改善妊娠期甲状腺疾病患者常见不良妊娠结局, 本文对肠道菌群与妊娠期甲状腺疾病患者的常见不良妊娠结局的相关研究进行综述。

     

孕期增重过多对孕妇肠道菌群及妊娠结局的影响

目的 探讨孕期增重过多对孕妇肠道菌群及妊娠结局的影响。方法 选取2016年10月至2017年7月中国人民解放军联勤保障部队第九六七医院行产前检查并住院分娩的孕妇及其新生儿配对,共69对,根据孕期体质量增长情况,分为孕期体质量增长正常组和孕期体质量增长过多组,收集孕妇孕晚期粪便样本,分析孕妇粪便菌群的变化;比较两组孕妇妊娠期并发症、空腹血糖水平、血脂指标［总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）］、新生儿出生体质量和新生儿并发症等数据。结果 （1）与孕期增重正常组相比,增重过多组孕妇肠道内肠杆菌、酵母高于增重正常组,而双歧杆菌、乳杆菌、拟杆菌低于增重正常组（Ps<0.05）;（2）增重过多组血清TC、TG和LDL-C水平明显增高,HDL-C水平降低（Ps<0.05）;（3）增重过多组妊娠期并发症发生率增加（P<0.05）;（4）增重过多组新生儿体质量明显增加,导致巨大儿发生率明显升高,高胆红素血症的发生率也增加（P<0.05）。结论 孕期增重过多孕妇肠道内菌群出现异常改变,导致母亲及子代并发症发生率增加,尽早进行干预治疗可能为降低发病率提供契机。     

Influence of day of postpartum breeding on pregnancy rate, pregnancy loss rate, and foaling rate in Thoroughbred mares

Records (years 2005-2007) were analyzed from a Thoroughbred stud farm in central Kentucky. Data from all breeding cycles of foaling mares were tabulated (3184 cycles of 2003 foaling mares bred between 7 and 163 days postpartum). A multiple logistic regression model employing Bayesian statistics was used to adjust for factors that significantly affected outcome; odds ratios (ORs) for pregnancy rate, pregnancy loss rate, and foaling rate were determined to examine the influence of day of postpartum breeding on these parameters. Mares bred before Day 22 (Day 0 = day of foaling) postpartum had a decreased OR for becoming pregnant (P < 0.05); the median OR for becoming pregnant (1.00) was not reached until Day 46 postpartum. Mares bred before Day 13 postpartum had an increased OR for pregnancy loss (P < 0.05). The median OR for pregnancy loss did not decline below 1.00 until Day 78 postpartum. Mares bred before Day 20 postpartum had a decreased OR for producing a foal (P < 0.05). The median OR for producing a foal (1.00) was not reached until Day 75 postpartum. We concluded that fertility (in terms of a higher OR for becoming pregnant and a lower OR for pregnancy loss, resulting in a higher OR for producing a foal) continued to improve in Thoroughbred mares for approximately 2.5 mo postpartum. These findings are of importance to management strategies directed at early postpartum breeding, and explain some of the reported drift in subsequent foaling dates of Thoroughbred mares, despite management practices that employ early postpartum breeding.     

Calcium, parathyroid hormone, oxytocin and pH profiles in the whelping bitch

Despite the high prevalence of primary uterine inertia in whelping bitches, the underlying pathogenesis remains unclear. The objectives were to i) determine serum concentrations of total calcium, ionized calcium (iCa), parathyroid hormone (PTH), and blood pH in normally whelping bitches throughout the peri-parturient period; and ii) investigate relationships among iCa, PTH, and acid-base status, and the role that they and oxytocin may have in the underlying pathogenesis of canine uterine inertia. Bitches were randomly selected from a population of German Shepherd Dog bitches with a history of uncomplicated parturition (Group 1; n = 10), and from a population of Labrador bitches with a clinical history of an increased incidence of uterine inertia and stillbirths (Group 2; n = 20). Jugular blood samples were collected daily from -4 d to the onset of whelping (t = 0 h), and then every 4 h until the last pup was born. Overall, bitches from Group 2 had higher mean ± SEM serum concentrations of PTH (4.72 ± 2.45 pmol/L, P < 0.001), lower iCa (1.31 ± 0.08 pmol/L, P < 0.05), and higher venous pH (7.41 ± 0.03, P < 0.005) than bitches from Group 1 (2.9 ± 1.44 pmol/L, 1.38 ± 0.06 mmol/L, and 7.33 ± 0.02, respectively) during the periparturient period. However, there was no significant difference between Groups 1 and 2 for serum oxytocin concentrations during the periparturient period (45.5 ± 40 and 65.5 ± 82 pg/mL). We inferred that low iCa resulting from a rising pH and decreasing PTH during the periparturient period may have contributed to decreased uterine contractility and increased risk of stillbirths. Therefore, manipulating the cationic/anionic difference in diets of pregnant bitches, similar to the bovine model for hypocalcamia, may reduce the incidence of stillbirths in the bitch.     

妊娠中晚期阴道微生态失调及乳酸菌胶囊干预对不良妊娠结局的作用

目的 观察妊娠中晚期妇女阴道微生态状况,探讨应用乳杆菌活菌胶囊纠正阴道微生态失调对不良妊娠结局的预防价值。方法 选择孕13~36周单胎妊娠期妇女560例,取其阴道分泌物,经革兰染色后油镜下观察,进行阴道微生态（阴道菌群的密集度、多样性、优势菌、炎症反应等）状况评价,检测阴道分泌物成分、阴道病原菌类型。对阴道微生态失调孕妇,根据是否接受乳杆菌活菌胶囊治疗分为治疗组和对照组,治疗组给予乳杆菌活菌胶囊,对照组不采用药物干预。追踪随访所有孕妇的妊娠情况,比较阴道微生态正常组、微生态失调治疗组及微生态失调对照组的不良妊娠结局。结果 560例研究对象中,阴道微生态正常 335 例（59.82%）,微生态失调225例（40.18%）。225例微生态失调孕妇中,细菌性阴道病（bacterial vaginosis,BV）32例（14.22%）,阴道假丝酵母菌病（vulvovaginal candidiasis,VVC）56例（24.89%）,滴虫性阴道炎（triehomonal vaginitis,TV）11例（4.89%）,BV和VVC混合感染4例（1.78%）,BV和TV混合感染3例（1.33%）,菌群增殖过度75例（33.33%）,菌群抑制44例（19.56%）。微生态失调组pH值>4.5、过氧化氢、白细胞酯酶、唾液酸苷酶、脯氨酸氨基肽酶、乙酰氨基葡萄糖苷酶阳性比例均明显高于微生态正常组（χ2=55.59~340.06,Ps0.05）。结论 妊娠中晚期容易导致阴道微生态失调,造成不良妊娠结局,乳杆菌活菌胶囊纠正阴道微生态失调对于改善不良妊娠结局有较好的预防作用。     

妊娠晚期阴道B族链球菌的感染对肠道菌群和妊娠结局的影响

目的探究妊娠晚期阴道B族链球菌(group B Streptococcus,GBS)的感染对肠道菌群和妊娠结局的影响。方法选取2018年3月至2019年11月大连市中心医院孕检并分娩的妊娠妇女744人为对象,调查并统计B族链球菌的感染率;筛选有和没有B族链球菌感染妊娠妇女各47人,调查不良妊娠结局的发生率;选取信息匹配的妊娠晚期阴道B族链球菌感染和未感染的妊娠妇女,采集粪便样本,提取菌群DNA,用16S rDNA方法分析菌群变化。结果744名妊娠妇女中B族链球菌检出49例,感染率为6.59%;B族链球菌感染组总的不良妊娠发生比例为76.6%,正常组发生比例为27.7%(χ^2=5.491,P<0.05)。B族链球菌感染组妊娠妇女胎膜早破(χ^2=16.177,P<0.01)、难产(χ^2=21.134,P<0.01)和羊水异常(χ^2=22.989,P<0.05)的发生率与未感染组比较显著增高。B族链球菌感染组妊娠妇女肠道菌群发生显著变化。结论妊娠晚期阴道B族链球菌的感染可能引起肠道菌群紊乱,增加不良妊娠结局。     

Estrogen-alpha and progesterone receptor expression in cystic endometrial hyperplasia and pyometra in the bitch

Estrogen-alpha receptor (ER) and progesterone receptor (PR) were examined immunohistochemically in uteri of normal bitches, in uteri of bitches with cystic endometrial hyperplasia-mucometra (CEH-M) and in uteri of bitches with endometritis-pyometra (E-P), under exogenous progesterone treatment.In the CEH-M group, the ER- and PR-scores of all uterine cell types were higher than the ER- and PR-scores of normal uteri, although these differences were not always statistically significant. The ER-scores of E-P group were significantly lower than the ER-scores of the normal uteri and CEH-M group. The PR-scores of the E-P group tended to be higher than the PR-scores of the normal uteri, except for the surface epithelium, although these differences were not statistically significant. Exogenous progesterone treated bitches with CEH-M or E-P showed reduced ER- and PR-scores in the different uterine cell types, compared with the corresponding nontreated CEH-M or E-P group.The differences in ER and PR expression between CEH-M and E-P suggest different factors in the pathogenesis of both entities. Although, these changes in ER and PR expression do not seem to be directly involved in the pathogenesis of CEH-M and E-P. It is suggested that for CEH-M and progestin induced CEH-M a hormone dependent pathway is responsible. For P, the trigger may be bacterial infection.     

Factors affecting pregnancy loss for single and twin pregnancies in a high-producing dairy herd

Our objective was to determine the magnitude of, and factors affecting, pregnancy loss for lactating Holstein cows on a commercial dairy farm when diagnosed with twin (n = 98) or single (n = 518) pregnancies using transrectal ultrasonography. Pregnancy losses were assessed with records of non-viable embryos at first pregnancy examination and embryo losses between the first (25-40 d after AI) and second (48 and 82 d after AI) post-breeding pregnancy examinations. Among cows diagnosed with single pregnancies, 3.7% were diagnosed with a non-viable embryo at first pregnancy examination, and 4.6% of those diagnosed with a viable embryo underwent pregnancy loss by the second examination. A total of 11.2% of cows diagnosed with twins experienced a single embryo reduction, whereas 13.3% lost both embryos. Overall, the total proportion of cows experiencing pregnancy loss or experiencing embryo reduction was greater for cows diagnosed with twin than single pregnancies (odds ratio; OR = 3.6), resulting in an embryo survival rate of 91.9% for cows diagnosed with single compared to 75.5% for cows diagnosed with twin pregnancies. Season of breeding and milk production were associated with pregnancy loss for single pregnancies, whereas CL number was associated negatively with embryo reduction and pregnancy loss for twin pregnancies. The risk of twinning and double ovulation among pregnant cows increased with days in milk (DIM), and the risk of double ovulation was greater for cows diagnosed with ovarian cysts and lacking a CL at initiation of an Ovsynch protocol. We concluded that in this herd, embryo reduction and pregnancy loss during early gestation was greater for lactating Holstein cows diagnosed with twin compared to single pregnancies. In addition, cows diagnosed with ovarian cysts and lacking a CL had an increased risk for double ovulation.     

T helper cell mediated-tolerance towards fetal allograft in successful pregnancy

Trophoblast HLA-C antigens from paternal origins, which liken the trophoblast to a semiallograft, could be presented by the maternal APCs to the specific maternal CD4+ T helper cells, which could release various cytokines in response to these alloantigens. On the basis of the cytokines produced, these cells can be classified in Th1, Th2 and Th17 cells. Th1 and Th17 cells, known to be responsible for acute allograft rejection, could be involved in miscarriage and Th2 cells together with regulatory CD4+ T cells, known to be involved in allograft tolerance, could be responsible, at least in part, for the success of pregnancy. In this review we focus the role effector CD4+ T cells Th1, Th2 and Th17 cells on the fetal allograft tolerance.     

Bacterial and protozoal causes of pregnancy loss in the bitch and queen

Several bacterial species have been implicated in canine and feline pregnancy loss. Brucella canis is one of the more important bacterial infectious agents that cause pregnancy loss in the bitch. Brucella has been documented in the queen but in general infectious abortion from bacteria and protozoal agents is uncommon in the species. Protozoal causes of pregnancy loss in the bitch and queen are less common than in other species. Etiology, clinical signs, diagnosis and treatment of bacterial and protozoal causes of pregnancy loss in the bitch and queen are reviewed. Veterinary practitioners should be aware that many of these organisms have zoonotic potential.     

Observed and expected combined effects of clinical mastitis and low body condition on pregnancy loss in dairy cows

The objective was to compare the observed and expected combined effects of clinical mastitis before timed artificial insemination (TAI) and low body condition at 70 d postpartum (dpp) on pregnancy loss in dairy cows. Cows were examined for pregnancy by ultrasonographic examination 28-32 d after TAI; the presence of an embryo with a heartbeat was the criterion used to determine pregnancy. Cows diagnosed pregnant were re-examined by transrectal palpation of the uterus and its contents 28 d later to confirm pregnancy status and to identify pregnancy loss. Eighty-eight (17%) of 512 cows were diagnosed with pregnancy loss. Cows affected with clinical mastitis before insemination and a body condition score (BCS) ≤ 2.75 at 70 dpp were 2.03 times more likely to experience pregnancy loss, compared to cows without clinical mastitis and with a BCS > 2.75 (RR = 2.03; 95% CI = 1.15, 3.60; P = 0.01). This observed combined effect for pregnancy loss (RR = 2.03) was higher than the expected combined effect based on adding (RR = 1.39) or multiplying (RR = 1.42) absolute independent excesses due to clinical mastitis or low body condition.     

Decreased NDRG1 expression is associated with pregnancy loss in mice and attenuates the in vitro decidualization of endometrial stromal cells

Embryo implantation is an essential step for a successful pregnancy, and any defect in this process can lead to a range of pregnancy pathologies. The objective of this study was to explore the role of N‐myc downregulated gene 1 (NDRG1) in embryo implantation. It was found that uterine NDRG1 expression has a dynamic pattern during the estrous cycle in nonpregnant mice and that uterine NDRG1 expression was elevated during the implantation process in pregnant mice. The distinct accumulation of NDRG1 protein signals was observed in the primary decidual zone adjacent to the implanting embryo during early pregnancy. Furthermore, uterine NDRG1 expression could be induced by activated implantation or artificial decidualization in mice. Decreased uterine NDRG1 expression was associated with pregnancy loss in mice and was associated with recurrent miscarriages in humans. The in vitro decidualization of both mouse and human endometrial stromal cells (ESCs) was accompanied by increased NDRG1 expression and downregulated NDRG1 expression in ESCs effectively inhibited decidualization. Collectively, these data suggest that NDRG1 plays an important role in decidualization during the implantation process, and the abnormal expression of NDRG1 may be involved in pregnancy loss.