Systematic review and meta‐analysis of adverse pregnancy outcomes after uterine adenomyosis

Abstract

Background Studies on the impact of adenomyosis and its pregnancy complications have yielded conflicting results. Objective To determine the likelihood of adverse pregnancy outcomes among women with adenomyosis relative to women without adenomyosis. Search strategy PubMed, Embase, Scopus, and Web of Science were searched for studies published up to June 15, 2018. Selection criteria Observational studies with medically confirmed pregnancy outcomes as endpoints. Data collection and analysis Two researchers independently screened and selected relevant studies. Dichotomous data for all adverse pregnancy outcomes were expressed as an odds ratio (OR) with 95% confidence interval (CI), and combined in a meta‐analysis by using a random‐effects model. Main results Six studies (322 cases and 9420 controls) were eligible for inclusion in the meta‐analysis. Women with adenomyosis had an increased likelihood of preterm birth (OR, 3.05; 95% CI, 2.08–4.47; P˂0.001), small for gestational age (OR, 3.22; 95% CI, 1.71–6.08; P˂0.001), and pre‐eclampsia (OR, 4.35; 95% CI, 1.07–17.72; P=0.042). Conclusion Adenomyosis seems to have a detrimental impact on pregnancy outcomes, resulting in a higher likelihood of preterm birth, small for gestational age, and pre‐eclampsia.

Endometriosis and Pregnancy: A Single Institution Experience

“…A recent Japanese study found a significant correlation between pregnancy-induced hypertension/preeclampsia and diffuse adenomyosis. The authors hypothesized that chronic inflammation induced by adenomyosis and the thickness of the junctional zone could lead to abnormal placentation, resulting in hypertensive disorders [43,44].…”

Epidemiology of Adenomyosis

“…Studies using imaging to diagnose adenomyosis have reported an association between adenomyosis and an increased risk of preterm birth, small for gestational age, and preeclampsia among pregnant women who conceive spontaneously. 8 Among women undergoing in vitro fertilization and intracytoplasmic sperm injection treatment, adenomyosis is associated with a reduced rate of pregnancy and live births as well as an increased risk of miscarriage. [9][10][11] Little information is available on the relationship between adenomyosis and nonmalignant chronic conditions.…”

Impact of endometriosis and adenomyosis on pregnancy outcomes

“…They analyzed 262 cases of adenomyosis in pregnant women from 65 institutions and found that the greater the size of the adenomyosis (major axis > 60 mm), the higher the rates of late spontaneous abortion and cervical incompetency, and that the rates of HDP and intrauterine infection were higher for women with diffuse adenomyosis compared with focal adenomyosis. 32 35) Adenomyosis in pregnancy has thus been shown not only to increase incidences of preterm delivery, SGA infants, and abnormal placental positioning (as has been demonstrated in pregnant women with endometriosis), but also to increase the rates of other obstetric complications such as late spontaneous abortion, HDP, and fetal malpresentation. 16 -18,32 -34) Since some of the previous reports on endometriosis have not excluded adenomyosis, interpretation of these data should include the consideration that adenomyosis may have been a confounding factor increasing the obstetric complications in those studies.…”