Grand Rounds

Are Fibroids Associated with Miscarriage?

BACKGROUND AND PURPOSE:

Data is conflicting as to whether uterine leiomyomas are associated with miscarriage
- Studies often include women who are obtaining fertility treatment
Sundermann et al. (Obstet Gynecol, 2017) examined the associated risk of spontaneous abortion and uterine leiomyomas in the general population

Systematic review and meta-analysis
Inclusion: Studies reporting risk of spontaneous abortion among pregnant women with leiomyomas vs pregnant women without leiomyomas
Exclusion: Studies that only included women seeking care for recurrent miscarriage, infertility, or assisted reproductive technologies
Data was extracted and reviewed by two authors independently
Primary outcome: Spontaneous abortion (definition varied across studies) among recognized pregnancies

9 studies were included in the systematic analysis and 5 studies were used for the meta-analysis
Pooled data for the meta-analysis included 21,829 women
In the leiomyoma group, 11.5% has spontaneous abortion compared to 8.0% in the non-leiomyoma group
Uterine leiomyomas were not associated with an increased risk of spontaneous abortion
- Relative risk 1.16, 95% CI 0.80–1.52
- Significant association was still absent even after adjusting for confounders

The presence of leiomyomas was not associated with increased risk of spontaneous abortion
Prior studies showing an association did not always adjust for confounders
This is the first association review that focused on a general risk population

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