Genetic epidemiology of pelvic organ prolapse: a systematic review

Given current evidence supporting a genetic predisposition for pelvic organ prolapse (POP), we conducted a systematic review of published literature on the genetic epidemiology of POP. Inclusion criteria were linkage studies, candidate gene association and genome-wide association studies (GWAS) in adult women published in English and indexed in PubMed through December 2012, with no limit on date of publication. Methodology adhered to the PRISMA guidelines. Data were systematically extracted by two reviewers and graded by the Venice criteria for studies of genetic associations. A meta-analysis was performed on all single nucleotide polymorphisms (SNPs) evaluated by two or more studies with similar methodology. The meta-analysis suggests that collagen type 3 alpha 1 (COL3A1) rs1800255 genotype AA is associated with POP, OR 4.79 (95% CI 1.91 to 11.98, p= 0.001) compared to the reference genotype GG in populations of Asian and Dutch women. There was little evidence of heterogeneity for rs1800255 (p-value for heterogeneity= 0.94; proportion of variance due to heterogeneity, I2= 0.00%). There was insufficient evidence to determine whether other SNPs evaluated by two or more papers were associated with POP. An association with POP was seen in individual studies for estrogen receptor alpha (ER-α) rs2228480 GA, COL3A1 exon 31, chromosome 9q21 (HLOD score 3.41) as well as six SNPs identified by a GWAS. Overall, individual studies were of small sample size and often of poor quality. Future studies would benefit from more rigorous study design as outlined in the Venice recommendations