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Grand Rounds

Are Endometriosis and Uterine Fibroids Linked to Adverse Pregnancy Outcomes?

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BACKGROUND AND PURPOSE:

  • Previous studies have found associations between endometriosis or fibroids and adverse pregnancy outcomes
    • However, many of these studies were done in the setting of fertility care and, therefore, are at risk for potential confounding
  • Farland et al. (AJOG, 2022) investigated whether women with a history of endometriosis or fibroids had a greater risk for adverse pregnancy outcomes, and whether this risk was impacted by interfertility history

METHODS:

  • Retrospective cohort study
    • Linked Delivery data from 3 databases: Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) | Massachusetts Pregnancy to Early Life Longitudinal (PELL) data system | Massachusetts all-payer claims database (APCD) 
  • Population
    • Deliveries in Massachusetts from 2013 to 2017
  • Exposures
    • Endometriosis and fibroid diagnoses before index delivery
    • Subfertility or infertility
    • Use of assisted reproductive technology (ART)
  • Study design
    • Relative risks (RRs) adjustments: Pregnancy complications (hypertension, diabetes) |  Maternal Age | BMI | Race and ethnicity | Maternal education | Plurality (singleton, multiple) | Birth year (2013–2017 ordinal categorical calendar years) | Gestational age
  • Primary outcome
    • Adverse maternal outcomes (e.g. gestational diabetes, preeclampsia, and placental abnormalities)
    • Adverse pregnancy outcomes (e.g. low birthweight, preterm birth, small for gestational age neonates, cesarean delivery, and prolonged neonatal hospital stay)

RESULTS:

  • 91,825 deliveries
    • Endometriosis: 1560 women
      • Experienced sub- or infertility: 30%
      • Utilized ART for index delivery: 34%
    • Fibroids: 4212 women
      • Experienced sub- or infertility: 26%
      • Utilized ART for index delivery: 21%
  • Women with a history of endometriosis were at a greater risk for
    • Pregnancy-induced hypertension, preeclampsia, or eclampsia
      • Endometriosis: RR 1.17 (95% CI, 1.03 to 1.33)
    • Placental abnormalities
      • Endometriosis: RR 1.65 (95% CI, 1.33 to 2.06)
      • Fibroids: RR 1.38 (95% CI, 1.19 to 1.60)
    • Cesarean delivery
      • Endometriosis: RR 1.22 (95% CI, 1.15 to 1.29)
      • Fibroids: RR 1.17 (95% CI, 1.13 to 1.21)
  • Neonates born to women with a history of endometriosis or fibroids were also at a greater risk for preterm birth
    • Endometriosis: RR 1.24 (95% CI, 1.09 to 1.41)
    • Fibroids: RR 1.17 (95% CI, 1.07 to 1.29)
  • Endometriosis and associated risk for placental abnormalities varied by fertility history
    • Risk was not but statistically significant when restricted to noninfertile women
  • Associations between fibroids and low birthweight varied by fertility status or assisted reproductive technology
    • Associations were stronger among noninfertile women
    • Results attenuated among subfertile or infertile women and women who utilized ART

CONCLUSION:

  • Endometriosis and fibroids were associated with increased risk for adverse maternal outcomes such as hypertension, preeclampsia, and cesarean delivery, and were also associated with an increased risk of preterm birth
  • The authors state

Women with a history of endometriosis and fibroids may have a greater risk for certain adverse pregnancy outcomes when compared with women without a history of these conditions

Additional research is needed to investigate whether pregnant women with a history of endometriosis or fibroids can benefit from increased screening or intervention during pregnancy before these findings can be used in clinical settings 

Learn More – Primary Sources:

Pregnancy outcomes among women with endometriosis and fibroids: registry linkage study in Massachusetts

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Related ObG Topics:

Is Preterm Birth More Common in Women with Endometriosis? 
Is There a Link Between Endometriosis and Adverse Pregnancy Outcomes?
Are Fibroids Associated with Miscarriage?
Are Fibroids Associated with an Increased Risk for Preterm Birth?

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