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Meta-Analysis
. 2018 Oct;40(10):631-641.
doi: 10.1055/s-0038-1672137. Epub 2018 Oct 23.

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

Fereshteh Aslbahar  1 , Hossein Neamatzadeh  2   3 , Razieh Sadat Tabatabaiee  4 , Mojgan Karimi-Zarchi  4 , Atiyeh Javaheri  4 , Mahta Mazaheri  2   3 , Elnaz Foroughi  5 , Rezvan Nasiri  5
Affiliations
Meta-Analysis

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

Fereshteh Aslbahar et al. Rev Bras Ginecol Obstet. 2018 Oct.

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 the meta-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: The meta-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.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
The study selection and inclusion process.
Fig. 2
Fig. 2
Forest plot of the association between ACE I/D polymorphism and RPL. (A) represents the homozygote model (II versus DD); (B) represents the recessive model (II versus ID + DD).
Fig. 3
Fig. 3
Funnel plot for publication bias in the meta-analysis of the ACE I/D polymorphism and RPL. (A) represents the allele model (I versus D); and (B) represents the dominant model (II + ID versus DD).
See this image and copyright information in PMC

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