Adenomyosis as a Potential Risk Factor for Adverse Pregnancy Outcomes: A Multicenter Case-Control Study

Abstract

As the number of women who postpone their first pregnancy until their late 30s or early 40s is increasing, adenomyosis is more frequently encountered by obstetricians. Some studies have reported on the relationship between adenomyosis and pregnancy complications. We aimed to investigate the effect of adenomyosis on pregnancy complications and outcomes and associations between adenomyosis type and pregnancy outcomes. This multicenter retrospective 1:4 case-control study included 61 women with singleton pregnancies diagnosed with adenomyosis. The control group included women with singleton pregnancies without adenomyosis; these women were matched to those with adenomyosis using propensity scores. The incidence of obstetric complications, delivery, and neonatal outcomes were compared. The adenomyosis group (n = 61) had significantly higher incidence of preterm delivery (21.3% vs. 9.4%), hypertensive disorders of pregnancy (13.1% vs. 5.3%), cesarean delivery (46.0% vs. 20.9%), and postpartum hemorrhage (57.3% vs. 36.8%) than the control group (n = 244). Subgroup analysis by the adenomyosis type revealed that the diffuse adenomyosis group (n = 41) was significantly more likely to experience preterm labor (29.3% vs. 7.3%), hypertensive disorders of pregnancy (17.0% vs. 5.5%), severe hypertensive disorders of pregnancy (12.2% vs. 1.8%), preterm premature rupture of membranes (12.2% vs. 2.4%), cesarean delivery (61.3% vs. 18.9%), and postpartum hemorrhage (70.7% vs. 44.5%) than the control group (n = 164). The focal adenomyosis (n = 20) group was not statistically different from the control group (n = 80) with respect to obstetric complications. Women with diffuse adenomyosis require more careful perinatal management than previously thought.

The Impact of Adenomyosis on Pregnancy and Pregnancy Outcomes: A Review

“…Although some methods have been able to predict which patients are at increased risk for certain outcomes, there is no available treatment or preventative measure available at this time. Despite the established risk of adverse pregnancy 3 Horton et al 12 Nirgianakis et al 13 Vercellini et al 14 Shinohara et al 15 Hashimoto et al 16 Mochimaru et al 17 Huang et al 19 Bruun et al 20 Harada et al 21 Juang et al 22 Razavi et al 23 Scala et al 24…”

“…In 2 of the 4 studies, ART use was not statistically different between groups. 15,16 The other 2 studies did find a significant increase in the rate of ART between groups. 3,17 One common risk of pregnancies complicated by adenomyosis is an increased risk of miscarriage, which is on average 2.5 times above controls.…”

“…15,16 In one of those studies, the risk was not statistically significant. 15 The odds of postpartum hemorrhage are increased based on 3 studies. 13,16,17 Harada et al 21 found an increased risk of placental abruption, but it was no longer significant after adjusting for confounding factors.…”

Increased risk of obstetric complications in patients with adenomyosis: A narrative literature review

“…The risk of preterm birth (OR 5.24, 95% CI 2.15–12.8) and preterm PROM (OR 5.56, 95% CI, 1.42–21.7) in diffuse‐type adenomyosis was significantly increased compared with the control group. 15 Regarding obstetric complications, the risk of preterm birth in the focal‐type group was not found to be higher than that in the control group.…”

“…HDP accompanying preexisting adenomyosis developed in 8 of 61 (13.1%) subjects, and the prevalence of HDP in the control group was 5.3% (OR 2.68, 95% CI 1.06–6.80). 15 In addition, diffuse‐type adenomyosis was more likely to concur with HDP (OR 3.54, 95% CI 1.23–10.2) and severe HDP (OR 7.45, 95% CI 1.70–32.6). However, the risk of developing HDP was not significantly different between the focal‐type and control groups.…”