Adverse effects of endometriosis on pregnancy: a case-control study

Abstract

BackgroundEndometriosis is a common disease occurring in 1–2% of all women of reproductive age. Although there is increasing evidence on the association between endometriosis and adverse perinatal outcomes, little is known about the effect of pre-pregnancy treatments for endometriosis on subsequent perinatal outcomes. Thus, this study aimed to evaluate maternal and neonatal outcomes in pregnant women with endometriosis and to investigate whether pre-pregnancy surgical treatment would affect these outcomes.MethodsThis case-control study included 2769 patients who gave birth at Nagoya University Hospital located in Japan between 2010 and 2017. Maternal and neonatal outcomes were compared between the endometriosis group (n = 80) and the control group (n = 2689). The endometriosis group was further divided into two groups: patients with a history of surgical treatment such as cystectomy for ovarian endometriosis, ablation or excision of endometriotic implants, or adhesiolysis (surgical treatment group, n = 49) and those treated with only medications or without any treatment (non-surgical treatment group, n = 31).ResultsIn the univariate analysis, placenta previa and postpartum hemorrhage were significantly increased in the endometriosis group compared to the control group (12.5% vs. 4.1%, p < 0.01 and 27.5% vs. 18.2%, p = 0.04, respectively). In the multivariate analysis, endometriosis significantly increased the odds ratio (OR) for placenta previa (adjusted OR, 3.19; 95% confidence interval [CI], 1.56–6.50, p < 0.01) but not for postpartum hemorrhage (adjusted OR, 1.14; 95% CI, 0.66–1.98, p = 0.64). Other maternal and neonatal outcomes were similar between the two groups. In patients with endometriosis, patients in the surgical treatment group were significantly associated with an increased risk of placenta previa (OR. 4.62; 95% CI, 2.11–10.10, p < 0.01); however, patients in the non-surgical treatment group were not associated with a high risk (OR, 1.63; 95% CI, 0.19–6.59, p = 0.36). Additionally, other maternal and neonatal outcomes were similar between the two groups.ConclusionWomen who have had surgical treatment for their endometriosis appear to have a higher risk for placenta previa. This may be due to the more severe stage of endometriosis often found in these patients. However, clinicians should be alert to this potential increased risk and manage these patients accordingly.

Endometriosis and Risk of Adverse Pregnancy Outcome: A Systematic Review and Meta-Analysis

“…A total of 11 cohort studies investigated hypertensive disorders in pregnancy overall [ 25 , 30 , 34 , 38 , 44 , 45 , 49 , 51 , 53 , 59 , 60 ]. Five were eligible for the main meta-analysis [ 30 , 34 , 38 , 51 , 53 ], without statistically significant difference between exposed and non-exposed to endometriosis ( Figure 2 ).…”

“…Low birth weight may occur as a result of preterm birth or SGA [ 65 ]. We identified 14 cohort studies on endometriosis and low birth weight [ 24 , 26 , 27 , 30 , 34 , 42 , 43 , 46 , 49 , 52 , 53 , 57 , 58 , 62 ]. Seven were eligible for the main meta-analysis [ 24 , 27 , 30 , 34 , 53 , 57 , 62 ], without reaching statistically significance ( Figure 5 ).…”

“…Neonatal mortality and morbidity is increased in SGA infants [ 66 ]. We identified 22 cohort studies regarding the association between endometriosis and SGA [ 24 , 26 , 27 , 28 , 30 , 31 , 32 , 33 , 35 , 36 , 37 , 42 , 43 , 45 , 46 , 47 , 48 , 49 , 50 , 54 , 56 , 57 ]. Eight of these were included in the main meta-analysis [ 24 , 27 , 28 , 30 , 32 , 37 , 56 , 57 ], without reaching statistically significance ( Figure 6 ).…”

“…Two of these received a NOS score ≥7 [ 39 , 40 ]. Six studies found no difference in gestational age between women with and without endometriosis [ 25 , 42 , 44 , 49 , 54 , 61 ]. None of these received a NOS score ≥7.…”

Placenta previa with posterior extrauterine adhesion: clinical features and management practice

“…In this study, we speculated that endometriosis was involved in ~ 75% of the patients with PP and PEUA. Several systematic reviews and retrospective studies have identified endometriosis, including endometrioma, as a significant risk factor for PP [ 27 – 29 ]. Because the development of assisted reproductive technologies has increased pregnancy rates in women with endometriosis, the number of patients with PP and endometriosis may increase in the future [ 30 , 31 ].…”