Their possible effect is reviewed in the context of HLA incompatibility between mother and fetus, first in naturally conceived pregnancies, but foremost in pregnancies after oocyte donation. Here, we elaborate on the role of macrophages during early human pregnancy and at later gestation. Spatial-temporal in situ analyses during gestation have identified unique interactions of macrophages both with trophoblasts and with T cells at different trimesters of pregnancy. The new view is that this lineage represents a highly diverse phenotype and is more prevalent than previously thought. Recent multidimensional analyses have contributed to a more detailed outlook on macrophages. The consensus on macrophages at the maternal-fetal interface in pregnancy is that a major proportion have an anti-inflammatory, M2-like phenotype, that expresses scavenger receptors and is involved in tissue remodeling and the dampening of the immune reactions. This is crucial for a rapidly developing organ such as the placenta. Macrophages are important for tissue homeostasis, cleanup, and the repair of damaged tissues. Inaccurate or inadequate adaptations of the maternal immune system could lead to problems with the functioning of the placenta. In the placenta, fetal trophoblast cells come into contact with maternal immune cells. Pregnancy is a fascinating immunological paradox: the semi-allogeneic fetus generally grows without any complications.
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