Endometriosis/Adenomyosis and Pregnancy Complications

A comprehensive analysis conducted on a large-scale Japanese database has uncovered notable associations between endometriosis/adenomyosis (EA) and several pregnancy complications. This study was published in The Journal Of Obstetrics And Gynaecology Research by Kosuke Kato and colleagues.

The study, utilising data from the Japan Perinatal Registry Network Database, examined over 145,000 singleton pregnancies, shedding light on the potential impact of these conditions on maternal health.

Study Overview

The retrospective analysis focused on assessing the relationship between endometriosis/adenomyosis and pregnancy complications. Pregnant women identified with either endometriosis or adenomyosis constituted the case group (EA), while a meticulously matched control group (non-EA) was formed through propensity-score matching. Factors considered for matching included:

• Age
• Parity
• BMI
• Smoking history
• Assisted reproductive technology use

The primary outcomes investigated were placental malposition, preterm birth, and hypertensive disorders of pregnancy (HDP).

Key Findings

Upon evaluating 1203 patients from both the EA and non-EA groups, compelling associations between EA and certain pregnancy complications surfaced:

• The EA group displayed notably higher rates of placenta previa, indicating a threefold increase in risk (odds ratio [OR] 3.01; 95% confidence interval [CI] 1.84–4.92), and low-lying placenta, showcasing a twofold rise in risk (OR 2.02; 95% CI 1.06–3.86).
• The incidence of preterm birth was significantly higher in the EA group (OR 1.44; 95% CI 1.13–1.84).
• No substantial difference was observed in the occurrence of hypertensive disorders of pregnancy between the two groups (OR 1.22; 95% CI 0.90–1.66).

Conclusion

The meticulous analysis using propensity-score matching in a nationwide perinatal database in Japan illuminated a significant association between EA and increased pregnancy complications. Specifically, endometriosis/adenomyosis exhibited strong correlations with placental malposition issues like placenta previa and low-lying placenta, along with a heightened risk of preterm birth. However, contrary to some expectations, no clear link was found between EA and hypertensive disorders of pregnancy.

These findings offer crucial insights into the potential risks associated with endometriosis and adenomyosis during pregnancy. Understanding these associations can aid healthcare providers in better monitoring and managing pregnancies in individuals with these conditions, potentially improving maternal and fetal health outcomes.

Reference

Kato, K., Iriyama, T., Hara, K., Suzuki, K., Hashimoto, A., Sayama, S., Ichinose, M., Toshimitsu, M., Seyama, T., Sone, K., Kumasawa, K., Nagamatsu, T., Hirota, Y., Koga, K., & Osuga, Y. Increased risk of placenta previa and preterm birth in pregnant women with endometriosis/adenomyosis: A propensity‐score matching analysis of a nationwide perinatal database in Japan. The Journal of Obstetrics and Gynaecology Research, 2023. https://doi.org/10.1111/jog.15849