Glutathione S-transferase A1 polymorphism and the risk of recurrent spontaneous abortion in Chinese Han population

Shoutai pills for treating recurrent miscarriage: a systematic review and meta-analysis of the safety and clinical efficacy in 11 randomized controlled trials

Background

Despite centuries of empirical use in Traditional Chinese Medicine (TCM) for miscarriage prevention, Shoutai Pills lack comprehensive scientific validation to support their widespread clinical application. Current evidence regarding their safety profile remains limited.

Methods

Following PRISMA guidelines, we conducted a systematic review of randomized controlled trials (RCTs) from PubMed, Embase, Cochrane Library, CNKI, and Wanfang up to October 2024. Eligible studies evaluated Shoutai Pills as monotherapy or adjunctive treatment for recurrent miscarriage, reporting outcomes including safety (adverse events), live birth rate, pregnancy retention rate, TCM syndrome scores, and serum D-dimer levels. Meta-analyses were performed using random-effects or fixed-effect models, with heterogeneity assessed via I2 statistics.

Results

Eleven RCTs (n = 888 participants) met inclusion criteria. No significant difference in overall adverse events between groups (RR = 0.91, 95% CI: 0.53-1.57; p = 0.74; I2 = 0%). Subgroup analyses showed comparable risks for gastrointestinal discomfort (RR = 1.04, 95% CI: 0.53-2.05; p = 0.90), fatigue (RR = 1.21, 95% CI: 0.43-3.37; p = 0.72), and allergic reactions (RR = 1.20, 95% CI: 0.53-2.70; p = 0.67). A non-significant trend toward reduced hormonal imbalances with Shoutai Pills (RR = 0.60, 95% CI: 0.33-1.09; p = 0.10). Significantly higher live birth rates (RR = 1.88, 95% CI: 1.50-2.35; p < 0.00001) and pregnancy retention rates (RR = 0.41, 95% CI: 0.33-0.51; p < 0.00001). Clinically meaningful reductions in TCM syndrome scores (MD = -2.35, 95% CI: -3.32 to -1.39; p < 0.00001) and serum D-dimer levels (MD = -0.25, 95% CI: -0.32 to -0.19; p < 0.00001).

Conclusion

Shoutai Pills show promise as a safe and effective complementary therapy for recurrent miscarriage, significantly improving pregnancy outcomes and symptom relief.

The Progress of Research on Genetic Factors of Recurrent Pregnancy Loss

Recurrent pregnancy loss (RPL) is both mental and physical health problem affecting about 1-5% of women of childbearing age. The etiology of RPL is complex, involving chromosomal abnormalities, autoimmune diseases, metabolic disorders, and endometrial dysfunction. The causes of abortion are still unknown in more than 50% of these cases. With the development of science and technology, an increasing number of scholars focus on this field and find that genetic factors may play an essential role in unexplained RPL, such as embolism-related genes, immune factor-related genes, and chromosomal numeric, and structural variation. This review summarizes the genetic factors associated with RPL, including genetic mutations and genetic polymorphisms, chromosomal variants, and chromosomal polymorphisms. Many related genetic factors have been found to be demographically and geographically relevant, some of which can be used for risk prediction or screening for the etiology of RPL. However, it is difficult to predict and prevent RPL due to uncertain pathogenesis and highly variable clinical presentation. Therefore, the genetic factors of RPL still need plentiful research to obtain a more accurate understanding of its pathogenesis and to provide more detection means for the screening and prevention of RPL.

Effect of GSTA1 Variants on Busulfan-Based Conditioning Regimen Prior to Allogenic Hematopoietic Stem-Cell Transplantation in Pediatric Asians

Busulfan is widely used as a chemotherapy treatment before hematopoietic stem-cell transplantation (HSCT). However, the response of busulfan is highly variable and unpredictable, whereby the pharmacogenetic interference of glutathione S-transferase (GST) has strong evidence in Caucasians and some adult Asians but not in pediatric Asian patients. This study was aimed at investigating the associations of GST genetic polymorphisms with variations in the pharmacokinetic (PK) properties of busulfan in pediatric Asian patients. This retrospective cohort study recruited 92 pediatric patients. The polymorphism of GSTA1 was genotyped by Sanger sequencing, and GSTM1 and GSTP1 were genotyped by real-time PCR. Drug concentration and PK estimation were identified using an LC-MS/MS method and a noncompartmental model. Statistical analysis was performed by R software. Out of 92 patients, 48 (53%) were males, the mean age was 8.4 ± 5.12 years old, and the average weight was 26.52 ± 14.75 kg. The allele frequencies of GSTA1*B and of GSTM1 and GSTP1* deletions were 16.9%, 68.5%, and 21.2%, respectively. Patients with GSTA1*B had a statistically significant impact on the PK of busulfan, whereas those with GSTM1 and GSTP1 did not (p > 0.05). The carriers of GSTA1*B showed a significant difference compared to noncarriers in terms of t1/2 (for first dose: 161.9 vs. 134.3 min, p = 0.0016; for second dose: 156.1 vs. 129.8, p = 0.012), CL (88.74 vs. 124.23 mL/min, p = 0.0089), Cmax (4232.6 vs. 3675.5 ng/mL, p = 0.0021), and AUC (5310.6 vs. 4177.1 µM/min, p = 0.00033). The augmentation of AUC was around 27.1% in patients carrying the GSTA1*B variant. The GSTA1 polymorphism was significantly associated with variations of the pharmacokinetic properties of busulfan treatment in pediatric Asian patients.

Association of Oxidative Stress on Pregnancy

The pathophysiological mechanism underlying pregnancy complications such as congenital malformations, miscarriage, preeclampsia, or fetal growth restriction is not entirely known. However, the negative impact of the mother's body oxidative imbalance on the fetus and the course of gestation is increasingly discussed. This article is an integrative review of some original studies and review papers on the effects of oxidative stress on the adverse pregnancy outcomes mainly birth defects in fetuses. A systematic search for English language articles published from 2010 until 2020 was made, using MEDLINE data. Additionally, we analyzed the Cochrane and Scopus databases, discussions with experts, and a review of bibliography of articles from scientifically relevant and valuable sources. The main purposes are to assess the contribution of the existing literature of associations of oxidative stress on the etiology of the abovementioned conditions and to identify relevant information and outline existing knowledge. Furthermore, the authors aim to find any gaps in the research, thereby providing grounds for our own research. The key search terms were "oxidative stress in pregnancy," "oxidative stress and congenital malformations," and "oxidative stress and adverse pregnancy outcomes." Studies have confirmed that oxidative stress has a significant impact on pregnancy and is involved in the pathomechanism of adverse pregnancy outcomes.