Maternal–Fetal Outcomes in Women with Endometriosis and Shared Pathogenic Mechanisms

Abstract

The connection between endometriosis and pregnancy outcomes is trending among the research topics. Until recently, endometriosis and its painful symptomatology were considered to be alleviated by pregnancy. However, these beliefs have shifted, as emerging literature has demonstrated the role of this condition in affecting pregnancy evolution. The underlying pathogenesis of endometriosis is still poorly understood, all the more when pregnancy complications are involved. Debatable opinions on endometriosis associated with obstetric complications exist because of the potential bias resulting from the heterogeneity of preceding evidence. This review aims to evaluate the connection between endometriosis and adverse pregnancy outcomes and their shared pathogenic mechanisms. We searched PubMed and EMBASE and focused on the studies that include placenta praevia, premature rupture of membranes, spontaneous preterm birth, gestational hypertension, preeclampsia, obstetric hemorrhages (ante- and postpartum bleeding, abruptio placentae), miscarriage, stillbirth, neonatal death, gestational diabetes mellitus, gestational cholestasis, small for gestational age, and their association with endometriosis. Not only the risks of emergence were highlighted, but also the pathogenic connections. Epigenetic alterations of some genes were found to be mirrored both in endometriosis and obstetric complications. This review issues a warning for providing increased attention to pregnant women with endometriosis and newborns as higher risks of preeclampsia, placental issues, and preterm deliveries are associated.

[Retracted] Adverse Pregnancy Outcomes Associated with Endometriosis and Its Influencing Factors

“…According to an Italian study, women with endometriosis are twice as likely to have a preterm delivery. The current study's findings are consistent with the prior research that revealed a link between endometriosis and placenta previa [ 30 ]. However, it is worth noting that the interaction between adverse pregnancy outcomes, such as placenta previa, and hypertensive disorders in pregnancy increases the risk of cesarean delivery and fetal growth restriction and may compromise the accuracy of the association between endometriosis and adverse pregnancy outcomes [ 31 ].…”

Persistent dysregulation of genes in the development of endometriosis

“…Endometriosis exerts a significant social and psychological burden on women in many respects, including quality of life, intimacy, childbearing, education and work, and emotional health ( 26 ). Furthermore, endometriosis is often related to cardiovascular and autoimmune diseases ( 27 ). Recent advances in the field of endometriosis have identified novel biomarkers that may be developed as targets for the treatment of endometriosis, including immunomodulators and inhibitors, which have been tested on animal models ( 28 ).…”

The Prevalence and Clinical Impact of Adenomyosis in Pregnancy-Related Hysterectomy

“…Furthermore, a higher frequency of placenta previa has been reported in the adenomyosis group. By altering the uterine environment through anatomical, functional and immunochemical mechanisms, adenomyosis has been proposed as a contributing factor in the pathophysiological link between endometriosis and abnormal placentation [ 9 , 29 , 30 , 31 , 32 , 33 , 34 ]. Both endometriosis and adenomyosis may disfigure the endometrial cavity and this might concur to the inefficient function of the uterus at the time of delivery.…”