STOX1 Gene and Preeclampsia Risk: A Systematic Review and Meta
Analysis
Systematic review; Preeclampsia; STOX1.
Preeclampsia (PE) is a multifactorial hypertensive disorder of pregnancy and a major
contributor to maternal and perinatal morbidity worldwide. While the pathogenesis of
PE is complex, involving abnormal placentation, endothelial dysfunction, and
inflammatory responses, growing evidence suggests a genetic component. The
STOX1 gene, particularly the Y153H and -922 T>C polymorphisms, has been
implicated in PE susceptibility, though findings remain inconsistent. This systematic
review and meta-analysis were conducted following PRISMA guidelines and
registered in PROSPERO (CRD42023465306). A comprehensive search across eight
databases included observational studies evaluating STOX1 gene polymorphisms in
pregnant women with PE versus normotensive controls. Data was extracted
independently by two reviewers. Pooled odds ratios (ORs) and 95% confidence
intervals (CIs) were calculated using fixed- or random-effects models, based on
heterogeneity assessed by the I² statistic. Study quality was evaluated using the
Newcastle-Ottawa Scale (NOS). Four studies were included, totaling 1,906 cases and
3,019 controls. Three studies examined the STOX1 Y153H variant, which showed no
statistically significant association with PE in any genetic model (dominant, recessive,
codominant, or allelic). Meta-analyses revealed high heterogeneity, particularly in the
allelic comparison (I² = 99.6%). One study on the -922 T>C promoter polymorphism
found a significant association with increased PE risk, especially in early-onset PE
(OR = 2.01, 95% CI [1.11–3.65], p = 0.02), though it was not included in the meta
analysis due to lack of comparators. This review found no consistent evidence linking
STOX1 Y153H to PE risk. However, the -922 T>C variant may contribute to
susceptibility in specific PE subtypes. Larger, multiethnic studies integrating genetic,
transcriptomic, and clinical data are needed to clarify the role of STOX1 in PE
pathogenesis.