Increased risk of preterm births among women with uterine leiomyoma: a nationwide population-based study

Abstract

background: Using a 3-year nationwide population-based database, this study examines the risk of adverse pregnancy outcomes [lower birthweight, preterm gestation and babies small for gestational age (SGA)] in pregnant women with uterine leiomyoma.methods: This study linked two data sets: Taiwan's birth certificate registry and its National Health Insurance Research Data set. A total of 5627 mothers with uterine leiomyoma and 28 135 unaffected mothers were included for analysis. After adjusting for mother and infant characteristics and monthly family income, log-binominal regression and multivariate regression analyses were conducted to examine the risks of preterm birth, SGA and lower birthweight among mothers with uterine leiomyoma and unaffected mothers.results: Women with uterine leiomyoma had a significantly higher percentage of preterm births (10.98 versus 7.78%, P , 0.001) and SGA infants (19.00 versus 17.28%, P ¼ 0.002) than unaffected mothers. The mean birthweights for mothers with and without uterine leiomyoma were 3083 and 3172 g, respectively (P , 0.001). Log-binominal regression models show that the adjusted risk ratios of preterm births and SGA infants for mothers with uterine leiomyoma were 1.32 (95% CI 1.19 -1.46) and 1.16 (95% CI 1.08 -1.26), respectively, compared with unaffected mothers. After finally adjusting for gestational age and other covariates, a multivariate regression analysis revealed that women with uterine leiomyoma had, on average, a 14.7 g lower birthweight than unaffected mothers (P ¼ 0.022).conclusions: We concluded that after adjusting for potential confounders, women with uterine leiomyoma experience a small yet significant increased risk of preterm and SGA infants. We suggest that clinicians intensively monitor women with uterine leiomyoma during pregnancy.

Adverse obstetric outcomes associated with sonographically identified large uterine fibroids

“…Preterm delivery was also more frequent in women with pregnancies complicated by large fibroids. Numerous studies have confirmed the association between uterine fibroids of any size and delivery at an earlier gestational age (6,(8)(9)(10)(11)(12). Although prior studies have not found an association between large uterine fibroids (>5 cm) and PTD (13,14), our findings suggest that large uterine fibroids >5 cm in diameter have a significant impact on earlier gestational age at delivery.…”

“…Moreover, findings may reflect an ascertainment bias because several retrospective studies identified women with fibroids on the basis of diagnosis codes or insurance records after delivery, rather than confirmation by antepartum obstetric ultrasonography (7). Nevertheless, evidence suggests that there is a trend toward delivery at an earlier gestational age in women with fibroids of any size (6,(8)(9)(10)(11)(12). Fibroids have also been reported to be associated with fetal malpresentation, intrauterine growth restriction, placenta previa, labor dystocia, placental abruption, delivery by cesarean section, retained placenta, and postpartum hemorrhage (PPH) (7).…”

Birth outcomes and pregnancy complications of women with uterine leiomyoma—a population-based case-control study

“…Birth outcomes showed controversial pattern: the previously reported somewhat higher rate of preterm birth was confirmed (e.g. [9]), but only in controls without CA and this increase was not significant. On the other hand, there was a larger mean birth weight of cases and controls born to mothers with LP, but it does not associate with a lower risk of low birthweight.…”

“…However, most studies of pregnancy complications and birth outcomes in uterine leiomyoma patients were composed of participants from only one hospital or clinic [4][5][6][7] and the results of population-based studies have been published only recently [8][9]. The objective of our study was the evaluation the possible association between maternal uterine leiomyoma in pregnancy (LP) and pregnancy complications, in addition adverse birth outcomes, particularly structural birth defects, i.e.…”

Uterine fibroids, management and effect on fertility

“…Another recent study using 3-years nationwide population-based database found an association between uterine fibroids and a small but significant increase in preterm labour and small for gestational age infants [89].…”