Leiomyomas in Pregnancy and Spontaneous Abortion

Abstract

Structured Summary Objective To systematically review studies reporting risk of spontaneous abortion among pregnant women of typical reproductive potential with and without uterine leiomyomas. Data Sources We searched Pub Med, Embase, Web of Science, and ClinicalTrials.gov for publications from January 1970 to December 2016. Method of Study Selection We excluded studies that did not use imaging to uniformly document leiomyoma status of all participants, did not have a comparison group without leiomyomas, or primarily included women seeking care for recurrent miscarriage, infertility care or assisted reproductive technologies. Tabulation, Integration, and Results Two authors independently reviewed eligibility, extracted data, and assigned overall quality ratings based on predetermined criteria. Of 1,469 articles identified, nine were eligible. Five enrolled general obstetric populations and four included women undergoing amniocentesis. In five studies in general obstetric populations thatincluded21,829 pregnancies (1,394 women with leiomyomas and 20,435 without), only one adjusted for potential confounders. This meta-analysis revealed no increase in risk of spontaneous abortion among those with leiomyomas compared to those without (11.5% compared with 8.0%; Risk Ratio [RR]: 1.16, 95% Confidence Interval [CI]: 0.80 to 1.52). When bias from confounding was estimated for non-adjusted studies, the aggregate calculated risk ratio was 0.83 (95% CI 0.68–0.98). Conclusion Leiomyoma presence was not associated with increased risk of spontaneous abortion in an analysis of more than 20,000pregnant women. Failure of prior studies to adjust for confounders may have led to the common clinical belief that leiomyomas are a risk factor for spontaneous abortion.

Uterine fibroids and preterm birth risk: A systematic review and meta‐analysis

“…43,44 UF growth may be related to the chorionic gonadotropin secretion, 45 although not significantly linked to the risk of miscarriage. 13 Pregnancy and delivery complications are usually more frequent in women aged more than 30 years 46 ; as was the case in the studies we meta-analyzed.…”

“…[10][11][12] Recent meta-analyses have reported that UF do not increase the risk of miscarriage. 13 Contrary to this, UF may increase the risk of placental abruption, 14 placenta previa 15 and the risk of cesarean delivery and term fetal malpresentation. 16 Preterm birth is a major obstetrical complication that may be associated with both maternal and fetal adverse events.…”

Laparoscopic Intracapsular Myomectomy in Women 40 Years Old and Over with Symptomatic Uterine Fibroids. A Pilot Study

“…Uterine fibroids can increase operative delivery rate, post-partum bleeding, and infections, sometimes requiring transfusion for post-partum hemorrhages and occasionally leading to life-threatening postpartum hemorrhage. 20 21 The topic is debated, since there are studies reporting no adverse obstetric outcome in pregnant women with fibroids. 13 22 Fibroids also have been linked to increased risk of miscarriage by approximately 60%, with some estimates of risk as much as threefold greater.…”

Series of 55 pregnancies following ulipristal acetate treatment of symptomatic uterine fibroids

“…We report 15% (n = 8/53) of spontaneous miscarriages after UPA treatment, which is in line with what has previously been described. 12 Two cases of pre-eclampsia (1 miscarriage and 1 CS at 37 weeks) were registered, but no information was collected on prior risk factors for this parameter. No malformations were registered in this retrospective study, which is in line with earlier literature on this topic.…”