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One likely candidate mechanism for maternal countermeasures is the targeting and elimination of fetal cells by maternal immune cells. Infants of 141 TdaP5/IPV-vaccinated mothers in Southern England immunized with DTaP5/IPV/Haemophilus influenzae b (Hib-TT) vaccine at 2-3-4 months, 13-valent pneumococcal vaccine (PCV13, CRM-conjugated) at 2-4 months and 1 or 2 meningococcal C vaccine (MCC-CRM- or MCC-TT) doses at 3-4 months had blood samples taken at 2 and/or 5 months of age. This presents a critical question: does conflict between maternal tissues and fetal cells escalate, de‐escalate or reach some sort of détente?

If fetal cells enhance maternal wound healing, co‐localization of immune cells and fetal cells would simply be a byproduct of the fact that both may be recruited to sites of injury. Fetal cells have been found at the sites of inflammation and are associated with many autoimmune diseases.In England, antenatal pertussis immunization using a tetanus/low-dose diphtheria/5-component acellular-pertussis/inactivated-polio (TdaP5/IPV) vaccine was introduced in October 2012. If fetal cell manipulation of the maternal brain induces maternally suboptimal levels of resource transmission to offspring, maternal countermeasures such as immune targeting of fetal cells in the brain might also be expected, which could raise levels of inflammation in the brain. Waning of vaccine-induced immunity has been cited as one of the reasons for the observed epidemiologic trend. Fetal cells also may offer important benefits to maternal tissues for wound healing or somatic maintenance due to their stem‐like nature.

For 96 households (60%), the most likely source of infection of the infant was established, being a sibling (41%), mother (38%), or father (17%). This means that there can be conflict over maternal milk supply, with offspring interests favoring higher milk supply than what is optimal for the mother 5.n. gedefinieerd als “de dood van een vrouw tijdens haar zwangerschap of binnen de 42 dagen na het beëindigen van de zwangerschap, ongeacht de duur of de lokalisatie van de zwangerschap, door iedere oorzaak gerelateerd aan of verergerd door de zwangerschap of haar gevolgen of behandeling; overlijden door ongeval of andere incidentele oorzaken zijn uitgezonderd”. In February 2012, Argentina became the first country in Latin America to have universal vaccination strategy for pregnant women against whooping cough. Antibody responses to pertussis toxin (PT), filamentous hemagglutinin (FHA), fimbriae 2 + 3 (FIMs), diphtheria, tetanus, Hib, MCC and PCV13 serotypes were compared to responses in a historical cohort of 246 infants born to mothers not vaccinated in pregnancy. One approach to understanding the function of fetal cells in maternal tissues is to consider parallels with the function of the placenta during pregnancy. Met 4 rechtstreekse maternale overlijdens, 4 onrechtstreekse maternale overlijdens, 1 onbepaald maternaal overlijden en 5 laattijdige maternale overlijdens (later dan 42 dagen, maar minder dan één jaar na de bevalling) in 2020, bedraagt de moedersterfteratio voor deze vijfjarige periode met 2018 als middelpunt 7,1 sterfgevallen per 100.

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