Endometriosis significantly linked to various adverse pregnancy outcomes

Key takeaways:

• Women with endometriosis had older average maternal age at delivery and higher rates of using assisted reproductive technology.
• Women with endometriosis had more adverse pregnancy outcomes vs. women without.

Endometriosis was significantly associated with adverse pregnancy outcomes, ranging from preterm labor and birth to antepartum and postpartum hemorrhage, researchers reported in the Journal of Clinical Medicine.

“[Previous] studies that have reported no relationship between endometriosis and pregnancy outcomes had the limitation of small sample sizes,” Hee Jeung Lim, from the department of obstetrics and gynecology at Seoul National University College of Medicine and the Seoul Metropolitan Government – Seoul National University Boramae Medical Center, South Korea, and colleagues wrote. “Regarding whether endometriosis increases the risk of hypertensive disorders, gestational diabetes and postpartum hemorrhage, past studies’ findings have been less conclusive and this topic warrant further studies.”

Lim and colleagues conducted a retrospective cohort study utilizing large-scale data from the Korean Health Insurance Review and Assessment Service database of 1,251,597 women who had a singleton birth in South Korea from 2010 to 2019. Researchers compared clinical characteristics and adverse pregnancy outcomes among women with endometriosis and women without.

Overall, 2.6% of women in this study had endometriosis. Women with endometriosis had a higher mean maternal age at delivery (33.1 vs. 31.3 years; P < .001) and higher rates of assisted reproductive technology-induced pregnancies (6.4% vs. 1.9%; P < .001) compared with women without endometriosis.

Major adverse pregnancy outcomes occurred more frequently among women with endometriosis compared with women without (P < .001 for all):

• preterm labor (23.7% vs. 16.9%);
• preterm birth (2.4% vs. 1.2%);
• gestational hypertensive disorders (3.9% vs. 2.8%);
• fetal growth restriction (3.4% vs. 2.1%);
• gestational diabetes (20.3% vs. 18.7%);
• placenta previa (4.7% vs. 1.6%);
• placental abruption (0.3% vs. 0.1%);
• cesarean delivery (55% vs. 45.3%);
• cesarean hysterectomy (0.08% vs. 0.03%);
• labor and delivery complicated by fetal distress (5% vs. 4.3%);
• malpresentation of fetus (7.7% vs. 5.1%);
• uterine artery embolization (0.5% vs. 0.2%);
• blood transfusion (1.2% vs. 0.5%);
• antepartum (1.9% vs. 1.5%) hemorrhage; and
• stillbirth (0.4% vs. 0.2%)

In a subgroup analysis, after adjusting for maternal age, parity, assisted reproductive technology and previous hypertension and diabetes, cesarean delivery rates were still significantly higher among women with endometriosis vs. women without.

“These findings emphasize the need to consider pregnancy in women with a history of endometriosis as high risk, requiring special antepartum, intrapartum and postpartum management,” the researchers wrote.