Endometriosis increases the risk of obstetrical and neonatal complications

Abstract

Introduction. The objective of this study was to assess obstetrical complications and neonatal outcomes in women with endometriosis as compared with women without endometriosis. Material and methods. National cohort including all delivering women and their newborns in Denmark 1997-2014. Data were extracted from the Danish Health Register and the Medical Birth Register. Logistic regression analysis provided odds ratios (OR) with 95% confidence intervals (CI). Sub-analyses were made for primiparous women with a singleton pregnancy and for women with endometriosis who underwent gynecological surgery before pregnancy. Results. In 19 331 deliveries, women with endometriosis had a higher risk of severe preeclampsia (OR 1.7, 95% CI 1.5-2.0), hemorrhage in pregnancy (OR 2.3, 95% CI 2.0-2.5), placental abruption (OR 2.0, 95% CI 1.7-2.3), placenta previa (OR 3.9, 95% CI 3.5-4.3), premature rupture of membranes (OR 1.7, 95% CI 1.5-1.8), and retained placenta (OR 3.1, 95% CI 1.4-6.6). The neonates had increased risks of preterm birth before 28 weeks (OR 3.1, 95% CI 2.7-3.6), being small for gestational age (OR 1.5, 95% CI 1.4-1.6), being diagnosed with congenital malformations (OR 1.3, 95% CI 1.3-1.4), and neonatal death (OR 1.8, 95% CI 1.4-2.1). Results were similar in primiparous women with a singleton pregnancy. Gynecological surgery for endometriosis before pregnancy carried a further increased risk. Conclusion. Women with endometriosis had a significantly higher risk of several complications, such as preeclampsia and placental complications in pregnancy and at delivery. The newborns had increased risk of being delivered preterm, having congenital malformations, and having a higher neonatal death rate. Pregnant women with endometriosis require increased antenatal surveillance.

Endometriosis and adenomyosis are associated with increased risk of preterm delivery and a small‐for‐gestational‐age child: a systematic review and meta‐analysis

“…The clinical relevance for the risk of preterm delivery in endometriosis patients is further corroborated by specific findings in two recent studies included in our material where the study size enabled a more detailed analysis. These results showed an increased risk of very preterm (<32 weeks of pregnancy) and extremely preterm delivery (<28 weeks of pregnancy) in women with endometriosis. Additionally, both endometriosis and preterm delivery are relatively frequent.…”

Maternal and Paternal Infertility Disorders and Treatments and Autism Spectrum Disorder: Findings from the Study to Explore Early Development

“…Additionally, we could not fully evaluate other potential explanations. For example, some studies indicate that endometriosis and uterine fibroids are associated with various pregnancy complications, including strong associations with placenta previa (Berlac et al 2017; Parazzini et al 2016) Placenta previa has been shown to occur more frequently in multiparous births (Ananth et al 1996). We lacked data to examine this hypothesis.…”

The ominous association between severe endometriosis, in vitro fertilisation, and placenta previa: raising awareness, limiting risks, informing women

“…Berlac et al., extracting data from the Danish Health Register and the Medical Birth Register, observed a higher risk of several obstetrical and neonatal complications in the 11 739 patients with endometriosis compared with the 615 533 women without a diagnosis of endometriosis. The highest risk was observed for pregnancies complicated by placenta praevia (2.1% versus 0.5%, respectively; OR, 3.9; 95% CI, 3.5–4.3) …”

“…A dose‐response relation of endometriosis severity with risk of placenta praevia has been observed. In the above Danish national cohort, pre‐conceptional surgery, considered as a surrogate marker of more severe endometriosis, was associated with a further increase in risk of placenta praevia (OR, 5.5; 95% CI, 4.6–6.5) . According to a Japanese cohort study conducted on women who conceived with assisted reproduction techniques (ART), the OR of placenta praevia in women with all endometriosis forms was 15.1 (95% CI, 4.4–61.7), but increased up to 39.8 (95% CI, 10.1–189.1) when only patients with severe endometriosis were considered …”

“…Endometriosis is associated with several adverse pregnancy outcomes . The most severe maternal complications are spontaneous haemoperitoneum in the second half of pregnancy and placenta praevia .…”