In a normal pregnancy, maternal circulatory system presents a hypercoagulable state due to the effect of hormone secretion. Even minor variations in fibrinolytic system could lead to hyper- or hypofibrinolysis, affecting placental formation, and causing adverse pregnancy outcomes. Plasminogen activator inhibitor-1 (PAI-1) restrains the fibrinolysis cascade. A controversial relationship exists regarding the role of PAI-1 in gynecological and obstetrical diseases. In this review, the authors focused on discussing the sophisticated roles of PAI-1 gene in adverse pregnancy complications and gynecological conditions, which include recurrent pregnancy loss (RPL), preeclampsia (PE), gestational diabetes mellitus (GDM), fetal growth restriction (FGR), repeated implantation failure (RIF), polycystic ovary syndrome (PCOS), and endometriosis. A pair of autonomous authors searched the literature in PUBMED, Web of Science, and Google Scholar databases from January 1, 1988 to October 1, 2021. PAI-1 4 G/5 G polymorphism plays a crucial part in the advancement of RPL via the change of metabolic, thrombotic, and immune issues. Moreover, PAI-1 may have a relationship with the occurrence and development of PE. In FGR, overexpression of PAI-1 leads to the excessive deposition of fibrin and diminished blood flow at the maternal-fetal interface, which affects the growth and development of the fetus. PAI-1 expression can be decreased by physical exercise and medical treatments, including metformin. In the future, extensive researches with rigorous inclusion standards involving diverse ethnic groups are needed to explore the functionality of PAI-1 in related gynecological and obstetrical diseases, and may be helpful to develop novel treatment methods to prevent or treat these diseases.
Keywords: Gestational diabetes mellitus; Plasminogen activator inhibitor-1; Preeclampsia; Pregnancy; Recurrent pregnancy loss.
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