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

Abstract

Aim This study explored the association between the presence of uterine fibroids (UF), as determined by ultrasound, and preterm birth (PB) risk. Methods Medline, Embase, Cochrane, Scopus and Web of Science databases. Studies reporting women with and without UF demonstrated by an ultrasound exam. The primary outcome was the risk of PB < 37 weeks of gestation in pregnancies with UF diagnosed by an obstetric ultrasound exam. Effects for dichotomous and continuous outcomes are, respectively, reported as risk ratios (RR) or mean differences and their 95% confidence intervals (CI). Results Eighteen studies were included comprising 276 172 pregnancies to whom obstetric ultrasound assessment was performed for the presence/absence of UF. Women with UF were older (mean difference = 2.40 years, 95% CI 0.94–3.85) and were at higher risk of PB before 37 (RR = 1.43, 95% CI 1.27–1.60), 34 (RR = 1.79, 95% CI 1.32–2.42), 32 (RR = 1.94, 95% CI 1.33–2.85) and 28 (RR = 2.17, 95% CI 1.48–3.17) weeks as compared to those without UF (P < 0.01). In addition, women with UF were at higher risk of threatened preterm labor, preterm premature rupture of membranes, fetal malpresentation, placental abruption, lower gestational age and birthweight at delivery and a higher cesarean delivery rate. Conclusion Pregnant women with UF are at increased risk of PB and other adverse obstetric outcomes.

The value of MRI in management of uterine fibroids in pregnancy

“…Other fibroid-related complications during pregnancy include preterm labour, labour dystocia, malpresentation, abruption, postpartum haemorrhage and increased risk of emergency caesarean delivery 1,4 , which is often technically challenging.…”

The risk of preterm birth in women with uterine fibroids: A systematic review and meta-analysis

“…Two past reviews also found an association between fibroids and preterm birth. Klatsky et al found a preterm birth rate of 16.0% in the fibroid group and 10.8% in the control group (OR 1.5, 95% CI 1.3–1.7), and Perez-Roncero et al of 11.7% versus 9.0% (OR 1.43; 95% CI 1.27–1.60) [ 5 , 6 ]. These reviews also included studies that did not perform routine ultrasound screening during pregnancy, which are at risk of ascertainment bias, and they did not quantitatively address possible bias resulting from important confounders in their meta-analyses.…”

“…These reviews also included studies that did not perform routine ultrasound screening during pregnancy, which are at risk of ascertainment bias, and they did not quantitatively address possible bias resulting from important confounders in their meta-analyses. Furthermore, the studies did not aim to distinguish between spontaneous and medically indicated preterm birth [ 5 , 6 ].…”

“…Previous reviews have suggested that women with fibroids have an increased risk of preterm birth [ 5 , 6 ]. Both associations with spontaneous and medically indicated preterm birth have been described.…”

“…As described in women with endometriosis, this hyperinflammatory state could impair decidua/trophoblast interaction and uteroplacental development, which, in turn, could increase the risk of hypertensive disorders, placental abruption and fetal growth restriction, for which preterm birth might be medically indicated [ 15 ]. Studies have indeed shown an increased risk of these pregnancy complications in women with fibroids [ 5 , 6 , 16 – 19 ].…”