Obstetrical Complications in Women with Endometriosis: A Cohort Study in Japan

Abstract

BackgroundEndometriosis, which occurs in approximately 10% of women of reproductive age, is defined as the presence of endometrial tissue outside the uterus. Women with endometriosis are more likely to have difficulty conceiving and tend to receive infertility treatment, including assisted reproductive technology (ART) therapy. There has not yet been a prospective cohort study examining the effects of endometriosis on pregnancy outcome in pregnant Japanese women.MethodologyThis was a prospective cohort study of the incidence of obstetrical complications in women with endometriosis using data of the Japan Environment & Children’s Study (JECS). Included in this study were 9,186 pregnant women in the JECS with or without a history of endometriosis who gave birth or stillbirth or whose pregnancy was terminated with abortion between February and December 2011.Main Outcome MeasuresThe effects of endometriosis on pregnancy outcome.ResultsOf the 9,186 pregnant women in the JECS, 4,119 (44.8%) had obstetrical complications; 330 participants reported a diagnosis of endometriosis before pregnancy, and these women were at higher risk for complications of pregnancy than those without a history of endometriosis (odds ratio (OR) = 1.50; 95% confidence interval (CI) 1.20 to 1.87). Logistic regression analyses showed that the adjusted OR for obstetrical complications of pregnant women who conceived naturally and had a history of endometriosis was 1.45 (CI 1.11 to 1.90). Among pregnant women with endometriosis, the ORs of preterm premature rupture of the membranes (PROM) and placenta previa were significantly higher compared with women never diagnosed with endometriosis who conceived naturally or conceived after infertility treatment, except for ART therapy (OR 2.14, CI 1.03–4.45 and OR 3.37, CI 1.32–8.65).ConclusionsThis study showed that endometriosis significantly increased the incidence of preterm PROM and placenta previa after adjusting for confounding of the data by ART therapy.

Risk of preterm birth, low birthweight and small‐for‐gestational‐age infants in pregnancies with adenomyosis: A cohort study of the Japan Environment and Children's Study

“…In several previous studies, endometriosis also increased the risk of PTB. [16][17][18] Juang et al reported that severe menstrual pain was more prevalent in PTB cases than in term delivery cases. 10 Moreover, in women with dysmenorrhea, elevated prostaglandin levels found in the endometrial fluid were correlated with the degree of menstrual pain.…”

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

“…In the large cohort study conducted by Rombauts et al., endometriosis was shown to be an independent risk factor for placenta praevia (OR, 2.0; 95% CI, 1.2–3.3). In the population‐based Japanese study of Harada et al., the OR of placenta praevia in women with endometriosis was almost halved (from 6.4 to 3.3) when only women without infertility treatment were considered. Other investigators observed rates of placenta praevia ranging from 6.0 to 20.0% in women with endometriosis, but from 0.3 to 1.3% in women without the disease .…”

“…used data of the Japan Environment and Children's Study to evaluate obstetrical outcomes in 9186 pregnant women with ( n = 330) or without ( n = 8856) a self‐reported history of endometriosis. Placenta praevia was observed in 3.6% of women with endometriosis and 0.6% of those without the disease (adjusted OR, 6.4; 95% CI, 3.2–12.6) . Saraswat et al., using Scottish Record Linkage System data, compared late pregnancy outcomes in 4232 women with and 6707 without a diagnosis of endometriosis.…”

“…Reliable estimates of the risk of placenta praevia in women with endometriosis could be obtained by investigating large population-based national cohorts. Harada et al 2 used data of the Japan Environment and Children's Study to evaluate obstetrical outcomes in 9186 pregnant women with (n = 330) or without (n = 8856) a self-reported history of endometriosis. Placenta praevia was observed in 3.6% of women with endometriosis and 0.6% of those without the disease (adjusted OR, 6.4; 95% CI, 3.2-12.6).…”

“…Placenta praevia was observed in 3.6% of women with endometriosis and 0.6% of those without the disease (adjusted OR, 6.4; 95% CI, 3.2-12.6). 2 Saraswat et al, using Scottish Record Linkage System data, compared late pregnancy outcomes in 4232 women with and 6707 without a diagnosis of endometriosis. The rate of placenta praevia was 1.7% in the former group and 0.8% in the latter (adjusted OR, 2.2; 95% CI, 1.5-3.3).…”