Adverse obstetrical outcomes for women with endometriosis and adenomyosis: A large cohort of the Japan Environment and Children’s Study

Abstract

Background Because of the increased number of diagnosed cases of endometriosis or adenomyosis resulting in infertility, many women require assisted reproductive technology (ART) to become pregnant. However, incidences of obstetric complications are increased for women who conceive using ART. There has been no prospective cohort study examining the influence of endometriosis and adenomyosis on obstetric outcomes after adjusting for the confounding influence of ART therapy. Objective This study evaluated the impact of endometriosis and adenomyosis on the incidence of adverse pregnancy outcomes. Study design Data were obtained from a prospective cohort study, known as the Japan Environment and Children’s Study (JECS), of the incidence of obstetric complications for women with endometriosis and adenomyosis. The data of 103,099 pregnancies that resulted in live birth or stillbirth or that were terminated through abortion between February 2011 and July 2014 in Japan were included. Results Women with endometriosis or adenomyosis were at increased risk for complications during pregnancy compared to those without a medical history of endometriosis (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.23 to 1.41) or adenomyosis (OR, 1.72; 95% CI, 1.37 to 2.16). Our analysis showed that the adjusted ORs for obstetric complications of pregnant women who conceived naturally or after infertility treatment that did not involve ART therapy were 1.26 (CI, 1.17 to 1.35) for pregnant women with a history of endometriosis and 1.52 (CI, 1.19 to 1.94) for those with a history of adenomyosis. Conclusions The presence of endometriosis and adenomyosis significantly increased the prevalence of obstetric complications after adjusting for the influence of ART outcomes.

Endometriosis and Risk of Adverse Pregnancy Outcome: A Systematic Review and Meta-Analysis

“…We identified 21 cohort studies regarding endometriosis and pre-eclampsia [ 24 , 26 , 27 , 28 , 29 , 31 , 32 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 50 , 52 , 54 , 55 , 56 , 61 , 62 ]. Ten of these were included in the main meta-analysis [ 24 , 27 , 28 , 32 , 37 , 38 , 39 , 40 , 56 , 62 ] ( Figure 4 ). Women with endometriosis showed to be at increased risk of pre-eclampsia (OR: 1.19, 95% CI: 1.08–1.31).…”

Endometriosis Associated Infertility: A Critical Review and Analysis on Etiopathogenesis and Therapeutic Approaches

“…While endometriosis is a chronic inflammatory disease that involves the presence of extrauterine endometrial-like tissue, adenomyosis is a benign condition that occurs at the level of uterus, within the myometrium, being characterized by the presence of ectopic endometrial tissue glands and stroma in this area [ 91 , 92 ]. This particular condition is usually diagnosed while investigating with other gynecological comorbidities such uterine fibroids and endometriosis [ 92 , 93 , 94 ].…”

“…Functional and structural changes in the eutopic endometrium and inner myometrium are characteristic of endometriosis and adenomyosis, these changes having negative consequences for female fertility. Altered endometrial receptivity in patients with endometriosis and adenomyosis is also linked to some molecular events that are associated with the process of implantation and embryo development [ 91 ].…”

“…Disorder of these processes is associated with an increased likelihood of abnormal endometrial molecular expressions of genes that are part of the homeobox (Hox) gene family, as well as other autocrine and paracrine factors, growth and transcription factors, steroid hormones, molecules cell adhesion, immune and inflammatory mediators, and other factors, including myometrial contractility and uterine peristalsis [ 91 , 102 ].…”

Pregnancy outcomes of infertile women with co-existing endometriosis and adenomyosis after laparoscopic surgery: a long-term follow-up

“…AM and EM both have adverse effects on fertility, making treatment more complicated. In addition to the impacts on reproductive performance (infertility and miscarriage) and pregnancy outcomes (preterm labor, fetal growth restriction, placenta previa and even uterine rupture) are also affected by AM [5,6] and EM [7].…”