Abstract
Cytotoxic T-lymphocyte antigen 4 (CTLA-4) is expressed constitutively on regulatory T cells. So far, several studies have focused on association between CTLA-4 gene polymorphisms and recurrent pregnancy loss (RPL). However, above association between the CTLA-4 gene polymorphism and RPL susceptibility is uncertain. Therefore, we performed a timely meta-analysis of all current publications to clarify this relationship. We located articles from the PubMed and Chinese language (WanFang) databases that were published up until July 25, 2018. Finally, we obtained six case–control studies, containing 2405 total cases and 2607 total controls, based on search criteria for abortion susceptibility related to the CTLA-4 +49 G/A polymorphism. The odds ratios (OR) and 95% confidence intervals (CIs) revealed association strengths. There was significantly decreased association between this polymorphism and whole population risk (e.g. AA vs. GG: OR = 0.56, 95% CI = 0.38–0.81, P=0.002). Additionally, in ethnicity subgroups, similar association was found both in China (e.g. AA vs. GG: OR = 0.49, 95% CI = 0.39–0.63, P=0.002) and non-China (e.g. AG vs. GG: OR = 0.46, 95% CI = 0.34–0.63, P<0.001). Current analysis suggested CTLA-4 +49 G/A polymorphism may weakly decrease RPL risk for women of childbearing age.
Highlights
A pregnancy loss (PL) is defined as the spontaneous demise of a pregnancy before the fetus reaches viability
The definition of Recurrent PL (RPL) and recurrent miscarriage (RM) exists some discrepancy in opinions, broadly speaking, both are classified as PL or abortion
Searches were conducted in PubMed and Chinese language (WanFang) databases using the key words ‘cytotoxic T-lymphocyte antigen 4 or Cytotoxic T-lymphocyte antigen 4 (CTLA-4)’, ‘spontaneous abortion or miscarriage or pregnancy loss’ and ‘polymorphism’ or ‘variant’
Summary
A pregnancy loss (PL) is defined as the spontaneous demise of a pregnancy before the fetus reaches viability. It includes all PLs [unexplained recurrent spontaneous abortion (RSA), RSA, recurrent miscarriage (RM), idiopathic RM] from the time of conception until 24 weeks of gestation [1,2]. Recurrent PL (RPL), named as recurrent spontaneous abortion (RSA), is defined as the loss of two or more pregnancies [1,2,4]. RM is classically defined as the loss of three or more consecutive pregnancies before the 20th weeks of gestation with or without previous live births [5]. The definition of RPL and RM exists some discrepancy in opinions, broadly speaking, both are classified as PL or abortion
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