Uterine fibroids increase the risk of hypertensive disorders of pregnancy: a prospective cohort study

Chen, Yequn; Lin, Mengyue; Guo, Pi; Xiao, Jiaxin; Huang, Xiansheng; Xu, Lan; Xiong, Nianling; O'Gara, Mary Clare; O’Meara, Michael; Tan, Xuerui

doi:10.1097/hjh.0000000000002729

Cited by 25 publications

(26 citation statements)

References 34 publications

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“…However, the association between uterine fibroids and PE has rarely been explored. Chen et al recently reported in a cohort study that uterine fibroids in early pregnancy were associated with an increased risk of hypertensive disorders of pregnancy ( 25 ). Our study, which specifically focused on PE as defined by ISSHP recommendations, reconfirmed this association and extended the generalization of the results.…”

Section: Discussionmentioning

confidence: 99%

Uterine fibroids are associated with increased risk of pre-eclampsia: A case-control study

Gong

Li²,

Shi³

et al. 2022

Front. Cardiovasc. Med.

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PurposeUterine fibroids are associated with hypertension in non-pregnant women. We aimed to evaluate the association between uterine fibroids and pre-eclampsia (PE).Patients and methodsParticipants were pregnant women who delivered in the Department of Obstetrics of the People's Hospital of Xinjiang Uygur Autonomous Region between January and December 2021. Patients with PE were identified as the case group, whereas those without PE were selected as the control group, using age-matching and a ratio of 1:5. Ultrasound examination during early pregnancy was used to detect uterine fibroids. Multivariable logistic regression was applied to evaluate the association between uterine fibroids and PE.ResultsIn total, 121 cases with PE and 578 controls without PE were included, with mean age of 32.9 years and gestational age of 37.7 weeks. Time of ultrasound examination was 12.0 ± 2.6 weeks. The case group had a significantly higher exposure rate of uterine fibroids than the control group (14.0 vs. 6.9%, P = 0.009). Multivariable Logistic regression models adjusted for potential confounding factors, including gestational age and blood pressure in early gestation, showed that pregnant women with uterine fibroids in early pregnancy exhibited three-fold higher odds for PE (OR, 3.02; 95% CI, 1.20–7.60; P = 0.019). Sensitivity analysis, which excluded those with gestational diabetes, further confirmed the robustness of the results. The association between uterine fibroids and PE was stronger in pregnant women aged ≥35 years and multiparas.ConclusionUterine fibroids are significantly associated with an increased risk of PE in pregnant women. Uterine fibroids may serve as a new factor for identifying pregnant women at high risk of PE, and the effect of myomectomy before pregnancy on prevention of PE is worth further exploring.

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Section: Discussionmentioning

confidence: 99%

Uterine fibroids are associated with increased risk of pre-eclampsia: A case-control study

Gong

Li²,

Shi³

et al. 2022

Front. Cardiovasc. Med.

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“…37 Gynecological conditions, such as fibroids and PCOS, have been shown to be associated with a greater risk for adverse pregnancy outcomes, including preeclampsia. [39][40][41][42] While the gastrointestinal and gynecological systems are physically close, there is a lack of literature on how they interact. Our results may indicate that individually, gynecological conditions do not increase risk for preeclampsia, however their interaction with gastrointestinal conditions increases risk regardless of obesity.…”

Section: C1 Further Discussion Of Interaction Effectsmentioning

confidence: 99%

Racial/ethnic differences in pre-pregnancy conditions and adverse maternal outcomes in the nuMoM2b cohort: a population-based cohort study

Meredith

Steimle

Platner

et al. 2022

Preprint

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Background: Adverse maternal outcomes and multimorbidity affect a growing proportion of pregnant individuals in the United States and with racial and ethnic disparities in the rates of multimorbidity. There is limited research on multimorbidity, measured as the co-occurrence of two or more chronic conditions, and how it impacts adverse maternal outcomes. Objectives: We sought to: (1) determine how pre-pregnancy conditions and their combined effects contribute to racial disparities in adverse maternal outcomes; and (2) incorporate conditions and their combined effects into predictive modeling algorithms to improve risk prediction using information available in the first trimester, specifically for racial minority subgroups. Study Design: We used data from the 'Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be' (nuMoM2b) observational cohort study. We defined multimorbidity as the co-occurrence of two or more pre-pregnancy conditions. The primary outcomes of interest were severe preeclampsia, postpartum readmission, and blood transfusion during pregnancy or up to 14 days postpartum. We used weighted Poisson regression with robust variance to estimate adjusted risk ratios and 95% confidence intervals, and we used mediation analysis to evaluate the contribution of the combined effects of pre-pregnancy conditions to racial/ethnic disparities. We also evaluated the performance of our models by racial subgroup using the area under the receiver operating characteristic curve (AUC) metric. Results: In the nuMoM2b cohort (n=8729), 3.6% (n=318) experienced severe preeclampsia, 1.8% (n=157) experienced blood transfusion, and 1.8% (n=154) experienced postpartum readmission. 22.8% of all participants experienced two or more co-occurring pre-pregnancy conditions. Cardiovascular conditions were associated with an increased relative risk for severe preeclampsia (aRR, 1.71; CI, 1.59-1.84), and this risk was additionally exacerbated when hematologic conditions were co-occurring with cardiovascular conditions (aRR, 1.34; CI, 1.12-1.60). The mediation analysis results were not statistically significant; however, cardiovascular conditions explained 36.6% of non-Hispanic Black individuals' association with increased risk for severe preeclampsia (p=0.07). The addition of pre-pregnancy conditions increased AUC for the prediction of blood transfusion and severe preeclampsia, and moreover, the multiracial subgroup experienced the greatest improvement in predictive performance of blood transfusion due to this addition (an increase in AUC 0.51 to 0.69). The best subgroup performance was in predicting severe preeclampsia in multiracial individuals using confounders and condition types, with an AUC of 0.74. Conclusion: Though there is a greater burden of some pre-pregnancy conditions and co-occurring conditions among minority individuals, these conditions alone do not fully explain the higher rates of adverse maternal outcomes. However, some conditions and their combined effects are associated with adverse maternal outcomes. The incorporation of pre-pregnancy multimorbidity improves the performance of some risk prediction models, especially for correctly classifying individuals of minority race.

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“…Some of these risk factors are age, race, body mass index, genetic, reproductive factors, sex hormones, obesity, lifestyle (diet, caffeine, alcohol use, physical activity, and stress), environmental factors and underlying diseases (hypertension and infection). [ 1 5 6 ]…”

Section: Introductionmentioning

confidence: 99%

The association between chronic endometritis and uterine fibroids

Etezadi

Kabodmehri

Sharami

et al. 2022

Journal of Family Medicine and Primary Care

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Background: Some studies reported the association between fibroids with uterine inflammation. By considering this hypothesis, the formation and recurrence of uterine fibroids can be prevented by diagnosis and treatment of inflammation, and complications and costs can be reduced. This study aimed to evaluate the association between chronic endometritis and uterine fibroids in non-menopausal women. Materials and Methods: This prospective case-control study was performed on non-menopausal women referred to Al-Zahra Hospital in Rasht during April 2019-April 2020. Non- menopausal women of reproductive age (20-55 years old) with abnormal uterine bleeding who were candidates for hysteroscopy based on medical history and ultrasound reports were included in this study. The case group with fibroids were divided into two groups of intramural and subserosal myoma group and submucosal group based on the location of fibroids. The control group was patients with abnormal uterine bleeding complaints and no uterine fibroid. Endometrial specimens were examined by a pathologist for histological and immunochemistry assessments. In interpreting the results of endometrial biopsy, a positive result was indicated by the presence of one or more plasma cells per 10 high power field. Data were gathered by a form including age, parity, history of recurrent miscarriage, patient’s complaint (abnormal uterine bleeding), hysteroscopic results (submucosal myoma-polyp-normal), uterine histology (polyp, endometritis, and hyperplasia) and prevalence of chronic endometritis based on plasma cell in the biopsy. Data were analyzed by SPSS software version 21. Data were reported by descriptive statistics including number, percent, mean and standard deviation. The normality of quantitative data was assessed by the Kolmogorov- Smirnov test. Mann-Whitney U test, Chi-square and Fisher exact tests were used to compare groups and logistic regression was used to control the effect of confounders. Results: The incidence of chronic endometritis was 39% (38 out of 97) and a higher incidence of chronic endometritis was noted in the case group than the control group (46% vs. 31%), No significant difference was observed between the two groups ( P > 0.05). However, the incidence of chronic endometritis in women with submucosal myoma was higher than the intramural and subserosal groups (64% vs. 37%) ( P = 0.04). To control the effect of age on the rate of chronic endometritis in both groups, no significant effect was observed in logistic regression. Conclusions: The results showed the overall incidence of chronic endometritis was higher than previous studies and also the incidence was higher and more significant in women with submucosal myoma than in the intramural and subserosal group. As in this study, authors assessed the association between chronic endometritis and uterine fibroids, further studies assessing...

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Uterine fibroids increase the risk of hypertensive disorders of pregnancy: a prospective cohort study

Cited by 25 publications

References 34 publications

Uterine fibroids are associated with increased risk of pre-eclampsia: A case-control study

Uterine fibroids are associated with increased risk of pre-eclampsia: A case-control study

Racial/ethnic differences in pre-pregnancy conditions and adverse maternal outcomes in the nuMoM2b cohort: a population-based cohort study

The association between chronic endometritis and uterine fibroids

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