Endometriosis and adverse pregnancy outcomes: A case-control study

Background: The association between endometriosis and the outcome of pregnancy is one of the interesting topics. Endometriosis-related pain is alleviated with pregnancy; however, it is known to cause adverse outcomes in pregnancy. The main cause is systemic chronic inflammation caused by higher levels of cytokines, growth factors, and angiogenesis factors.

Objective: This study aimed to clarify the relationship between endometriosis, deep endometriosis, adenomyosis, surgical treatment, and poor maternal consequences.

Materials and Methods: In this case-control study, data from 250 women who gave birth in Hazrat Rasoul Akram hospital, Tehran, Iran from February 2015 to December 2019 was extracted from the hospital information system in January 2020. Participants were divided into 2 groups: 125 women with endometriosis and 125 women without endometriosis. We looked at how endometriosis affected mothers and newborn babies. Data on pregnancy, delivery, and newborns of both groups was extracted.

Results: The mean age of participants was 32.74 ± 4.10 and 31.7 ± 5.53 yr in endometriosis and control group, respectively. In terms of pregnancy complications, placenta previa, placenta accreta, placenta abruption, pre-eclampsia, gestational diabetes mellitus, and postpartum hemorrhage remarkably increased in the endometriosis group compared to the control group. Small for gestational age was significantly higher in rectal endometriosis than women without rectal endometriosis (p = 0.03). The neonatal intensive care unit admission rate was notably higher in infants of the endometriosis group compared to controls (40.7% vs. 24.8%, p = 0.009).

Conclusion: Our findings showed women with endometriosis are at a higher risk for important adverse maternal outcomes.

Key words: Endometriosis, Pregnancy outcomes, Pre-eclampsia, Preterm birth, Cesarean section, Small for gestational age.

[1] von Theobald P, Cottenet J, Iacobelli S, Quantin C. Epidemiology of endometriosis in France: A large, nation-wide study based on hspital discharge data. BioMed Res Int 2016; 2016: 3260952.

[2] Eisenberg VH, Weil C, Chodick G, Shalev V. Epidemiology of endometriosis: A large population-based database study from a healthcare provider with 2 million members. BJOG 2018; 125: 55-62.

[3] Bhattacharya S, Porter M, Amalraj E, Templeton A, Hamilton M, Lee AJ, et al. The epidemiology of infertility in the North East of Scotland. Hum Reprod 2009; 24: 3096-3107.

[4] Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D’Hooghe T, De Bie B, et al. ESHRE guideline: Management of women with endometriosis. Hum Reprod 2014; 29: 400-412.

[5] Kennedy S, Bergqvist A, Chapron C, D’Hooghe T, Dunselman G, Greb R, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 2005; 20: 2698-2704.

[6] Parasar P, Ozcan P, Terry KL. Endometriosis: Epidemiology, diagnosis and clinical management. Curr Obstet Gynecol Rep 2017; 6: 34-41.

[7] Miura M, Ushida T, Imai K, Wang J, Moriyama Y, Nakano-Kobayashi T, et al. Adverse effects of endometriosis on pregnancy: A case-control study. BMC Pregnancy Childbirth 2019; 19: 373.

[8] Breintoft K, Pinnerup R, Henriksen TB, Rytter D, Uldbjerg N, Forman A, et al. Endometriosis and risk of adverse pregnancy outcome: A systematic review and meta-analysis. J Clin Med 2021; 10: 667.

[9] Berlac JF, Hartwell D, Skovlund CW, Langhoff-Roos J, Lidegaard Ø. Endometriosis increases the risk of obstetrical and neonatal complications. Acta Obstet Gynecol Scand 2017; 96: 751-760.

[10] Shmueli A, Salman L, Hiersch L, Ashwal E, Hadar E, Wiznitzer A, et al. Obstetrical and neonatal outcomes of pregnancies complicated by endometriosis. J Matern Fetal Neonatal Med 2019; 32: 845-850.

[11] Harada T, Taniguchi F, Onishi K, Kurozawa Y, Hayashi K, Harada T. Obstetrical complications in women with endometriosis: A cohort study in Japan. PloS One 2016; 11: e0168476.

[12] Lalani S, Choudhry AJ, Firth B, Bacal V, Walker M, Wen SW, et al. Endometriosis and adverse maternal, fetal and neonatal outcomes, a systematic review and metaanalysis. Hum Reprod 2018; 33: 1854-1865.

[13] Berlanda N, Alio W, Angioni S, Bergamini V, Bonin C, Boracchi P, et al. Impact of endometriosis on obstetric outcome after natural conception: A multicenter Italian study. Arch Gynecol Obstet 2021; 305: 149-157.

[14] Nirgianakis K, Gasparri ML, Radan A-P, Villiger A, McKinnon B, Mosimann B, et al. Obstetric complications after laparoscopic excision of posterior deep infiltrating endometriosis: A case-control study. Fertil Steril 2018; 110: 459-466.

[15] Kobayashi H, Kawahara N, Ogawa K, Yoshimoto C. A relationship between endometriosis and obstetric complications. Reprod Sci 2020; 27: 771-778.

[16] Maggiore ULR, Ferrero S, Mangili G, Bergamini A, Inversetti A, Giorgione V, et al. A systematic review on endometriosis during pregnancy: Diagnosis, misdiagnosis, complications and outcomes. Hum Reprod Update 2016; 22: 70-103.

[17] Zullo F, Spagnolo E, Saccone G, Acunzo M, Xodo S, Ceccaroni M, et al. Endometriosis and obstetrics complications: A systematic review and meta-analysis. Fertil Steril 2017; 108: 667-672.

[18] Frincu F, Carp-Veliscu A, Petca A, Badiu D-C, Bratila E, Cirstoiu M, et al. Maternal-fetal outcomes in women with endometriosis and shared pathogenic mechanisms. Medicina 2021; 57: 1258.

[19] Petraglia F, Arcuri F, de Ziegler D, Chapron C. Inflammation: A link between endometriosis and preterm birth. Fertil Steril 2012; 98: 36-40.

[20] Maggiore ULR, Inversetti A, Schimberni M, Viganò P, Giorgione V, Candiani M. Obstetrical complications of endometriosis, particularly deep endometriosis. Fertil Steril 2017; 108: 895-912.

[21] Lin H, Leng J-H, Liu J-T, Lang J-H. Obstetric outcomes in Chinese women with endometriosis: A retrospective cohort study. Chin Med J 2015; 128: 455-458.

[22] Mannini L, Sorbi F, Noci I, Ghizzoni V, Perelli F, Di Tommaso M, et al. New adverse obstetrics outcomes associated with endometriosis: A retrospective cohort study. Arch Gynecol Obstet 2017; 295: 141-151.

[23] Vercellini P, Parazzini F, Pietropaolo G, Cipriani S, Frattaruolo MP, Fedele L. Pregnancy outcome in women with peritoneal, ovarian and rectovaginal endometriosis: A retrospective cohort study. BJOG 2012; 119: 1538-1543.

[24] Matsuzaki S, Ueda Y, Nagase Y, Matsuzaki S, Kakuda M, Kakuda S, et al. Placenta accreta spectrum disorder complicated with endometriosis: Systematic review and meta-analysis. Biomedicines 2022; 10: 390.

[25] Tuominen A, Saavalainen L, Tiitinen A, Heikinheimo O, Härkki P. Pregnancy and delivery outcomes in women with rectovaginal endometriosis treated either conservatively or operatively. Fertil Steril 2021; 115: 406-415.

[26] Lapointe M, Pontvianne M, Faller E, Lodi M, Futcher F, Lecointre L, et al. Impact of surgery for colorectal endometriosis on postoperative fertility and pregnancy outcomes. J Gynecol Obstet Hum Reprod 2022; 51: 102348.

[27] Thomin A, Belghiti J, David C, Marty O, Bornes M, Ballester M, et al. Maternal and neonatal outcomes in women with colorectal endometriosis. BJOG 2018; 125: 711-718.

留言 (0)

沒有登入
gif