Abstract
The multifactorial basis of pre-eclampsia (PE), also known as pregnancy-induced hypertension, involves a combination of genetic risk factors that cause disease development in women during pregnancy. The prevalence of PE varies in different ethnicities from 8 to 20%. The precise etiology and pathophysiology remain unclear, and imrnunoregulatory pathway genes Forkhead Box P3 (FOXP3) and Cytotoxic T-lymphocyte associated protein 4 (CTLA4) and oxidative markers angiotensin converting enzyme (ACE) and endothelial nitric oxide synthase (eNOS) have been suggested as risk factors for PE development. This review article describes the possible synergic interactions between polymorphic variants in FOXP3, CTLA4, cNOS, and ACE, which contribute to immunoregulatory and oxidative stress in women with PE. We screened for studies describing the combinations of all four variants. Previous studies showed that all these genetic markers lower the expression and production of surface molecules, which may enhance the risk and susceptibility to PE. Based on previous studies and meta-analysis, we recommend that genetic screening of a large sample size must be carried out to confirm the roles of these variants in PE.