The Role of Adenomyosis in the Pathogenesis of Preeclampsia

Abstract

Introduction: Adenomyosis can cause defective deep placentation. Preeclampsia is known to be associated with abnormal placentation. The aim of this study was to compare the presence of adenomyosis on magnetic resonance imaging in patients with and without history of preeclampsia in order to investigate the possible role of adenomyosis in the pathogenesis of preeclampsia. Materials and Methods: This prospective, randomized study consisted of patients with (n = 35) and without (n = 34) history of preeclampsia. Direct (submucosal microcysts, adenomyoma and cystic adenomyoma) and indirect (maximal thickness of junctional zone, ratio of maximal thickness of junctional zone to myometrial thickness, junctional zone differential, focal thickening of junctional zone, globally enlarged uterus and non-uniform junctional zone contours) signs of adenomyosis were assessed by pelvic magnetic resonance imaging. Results: The prevalence of adenomyosis was found to be more common in patients with preeclampsia und fetal growth restriction compared to patients without fetal growth restriction (94.4 vs. 64.7 %; p = 0.041), respectively. There was a strong association between maximal thickness of junctional zone (9 vs. 13 mm, p = 0.005), ratio of maximal thickness of junctional zone to myometrial thickness (0.42 vs. 0.66, p = 0.001) and junctional zone differential (3 vs. 5 mm, p = 0.02) and lateonset preeclampsia. Conclusions: Presence of adenomyoma is more common in patients with preeclampsia complicated with fetal growth restriction. Indirect signs of adenomyosis detected on pelvic magnetic resonance imaging might have a role in the pathogenesis of late-onset preeclampsia.

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

“…12,15 In our study, the risk of PTB and SGA was significantly increased in women with adenomyosis, which was consistent with previous data. Adenomyosis was associated with an increased risk of PTB 9-12 and fetal growth restriction.…”

“…Adenomyosis was associated with an increased risk of PTB 9-12 and fetal growth restriction. 12,15 In our study, the risk of PTB and SGA was significantly increased in women with adenomyosis, which was consistent with previous data. Unlike previous studies, we used data from a prospective study with a large number of participants.…”

Systematic review and meta‐analysis of adverse pregnancy outcomes after uterine adenomyosis

“…The six studies were conducted between 2006 and 2018, and four were published after 2015. The studies were conducted in Japan (n=2), Turkey (n=1), Italy (n=1), Taiwan (n=1), and Korea (n=1) . The sample size ranged from 69 to 8326 women.…”

“…The number of pregnancies complicated by adenomyosis has increased in recent years, alongside the trend in delayed pregnancy and advances in infertility treatment . Furthermore, the disorder has been associated with poor pregnancy outcomes, including spontaneous abortion, preterm birth, preterm premature rupture of membranes (PPROM), pre‐eclampsia, and fetal growth restriction …”

“…2,9 Furthermore, the disorder has been associated with poor pregnancy outcomes, including spontaneous abortion, preterm birth, preterm premature rupture of membranes (PPROM), pre-eclampsia, and fetal growth restriction. [10][11][12] Several studies have investigated the maternal and neonatal complications of adenomyosis among infertile women. In addition, two systematic reviews and meta-analyses have assessed the adverse effects of adenomyosis on the success of infertility treatment and pregnancy outcomes among affected women; 4,13 however, the potential impact of adenomyosis on the outcomes of spontaneous pregnancy remains unclear.…”