The renin-angiotensin system (RAS) plays a crucial role in the well-being of mother and fetus. Similarly, placental RAS is involved in placental angiogenesis, proliferation and trophoblast invasion. An insertion/deletion polymorphism within the angiotensin-I converting enzyme gene (ACE-I/D) has shown to be reliably associated with differences in angiotensin-converting enzyme (ACE) activity. Previous studies on ACE and recurrent pregnancy loss (RPL) from various ethnic groups differed in their findings and there are not many studies available from India. Therefore, the present study was aimed to investigate the association of ACE I/D in predisposition of RPL in women from South India. The ACE I/D genotyping were carried out in 230 patients and 234 controls. Our findings demonstrated a significant association of ACE I/D polymorphism with RPL. Further categorization of cases into groups (A = 2 abortions and B= >2 abortions) and analysis revealed an increased frequency of DD in a group A and II in group B. These results were indicative that high or low levels of angiotensin II interfere with normal development of fetus and cause frequent miscarriages in the studied population. Hence, ACE genotyping along with Ang II intravenous infusion or treatment with ACE inhibitors in gravid women is required in order to achieve successful pregnancy.
