Association of Angiotensin-Converting Enzyme Insertion/Deletion Polymorphism with Recurrent Pregnancy Loss: a Meta-Analysis of 26 Case-Control Studies

• Main Authors: Fereshteh Aslbahar (Author), Hossein Neamatzadeh (Author), Razieh Sadat Tabatabaiee (Author), Mojgan Karimi-Zarchi (Author), Atiyeh Javaheri (Author), Mahta Mazaheri (Author), Elnaz Foroughi (Author), Rezvan Nasiri (Author)
• Format: Book
• Published: Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2018-10-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 0100-7203; 10.1055/s-0038-1672137
• Keywords: miscarriage; pregnancy loss; angiotensinconverting enzyme; polymorphism; meta-analysis; Gynecology and obstetrics; RG1-991
• Source: Revista Brasileira de Ginecologia e Obstetrícia, Vol 40, Iss 10, Pp 631-641 (2018)

Abstract Objective Previous studies investigating the association between angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and recurrent pregnancy loss (RPL) risk has provided inconsistent results. The aim of our study was to assess the association between the ACE I/D polymorphism and risk of RPL. Methods All studies published up to January 30, 2018 on the association of ACE I/D polymorphism with RPL were identified by searching the PubMed, Web of Knowledge, and Google scholar databases. Results A total of 26 case-control studies with 3,140 RPL cases and 3,370 controls were included in themeta-analysis. Overall, there was a significant association between ACE I/D polymorphism and RPL risk under the allele model (I versus D: odds ratio [OR] = 0.538, 95% confidence interval [CI] = 0.451-0.643, p 0.001), the homozygote model (II versus DD: OR = 0.766, 95% CI = 0.598-0.981, p = 0.035) and the recessive model (II versus ID + DD: OR = 0.809, 95% CI = 0.658-0.994, p = 0.044). Subgroup analysis by ethnicity showed that there was a significant association between ACE I/D polymorphism and increased risk of RPL in Caucasian and West-Asian populations, but not in East-Asians. When stratified by number of recurrent miscarriages (RMs), a significant association between ACE I/D polymorphism and increased risk of RPL was detected in the group of studies with ≥ 2 RMs, but not in studies with ≥ 3 RMs. Conclusion Themeta-analysis suggests that ACE I/D polymorphism is associated with increased risk of RPL. The ACE I/D polymorphism may be a risk factor for RPL in Caucasian and West-Asian populations, but not in East-Asians.