Abstract
Objective Uterine leiomyoma is not a rare pathological condition in pregnant women; thus the aim of the study was to evaluate the recent progress in the treatment of these pregnant women on the basis of the association of leiomyoma in pregnancy (LP) with pregnancy complications and birth outcomes including structural birth defects, i.e. congenital abnormalities (CA) in the offspring. Design Cases with CA and matched controls without CA in the population-based Hungarian Case-Control Surveillan- ce System of Congenital Abnormalities (HCC SCA) were evaluated. Only women with prospectively and medically recorded LP in prenatal maternity logbook and medically recorded birth outcomes (gestational age, birth weight, CA) were included to the study. Setting the HCCSCA, 1980-1996 contained 22,843 cases with CA and 38,151 matched controls without CA. Population Hungarian pregnant women and their informative offspring: live births, stillbirths and prenatally diagnosed malformed fetuses. Methods Comparison of birth outcomes of ca- ses with matched controls and pregnancy com- plications of pregnant women with or without LP. Main outcome measures Pregnancy complications, mean gestational age at delivery and birth weight, rate of preterm birth, low birthweight, CA. Results A total of 34 (0.15%) cases had mothers with LP compared to 71 (0.19%) controls. There was a higher incidence of threatened abortion, placental disorders, mainly abruption placentae and anaemia in mothers with LP. There was no significantly higher rate of preterm birth in the newborns of women with LP but their mean birth weight was higher and it associated with a higher rate of large birthweight newborns. A higher risk of total CA was not found in cases born to mothers with LP (adjusted OR with 95% CI = 0.7, 0.5-1.1), the spe- cified groups of CAs were also assessed versus controls, but a higher occurrence of women with LP was not revealed in any CA group. Con- clusions Women with LP have a higher risk of threatened abortion, placental disorders and anaemia, but a higher rate of adverse birth outcomes including CAs was not found in their offspring.
Highlights
Uterine leiomyoma is benign, smooth muscle tumour and most common non cancerous neoplasm in women of child-bearing age
Though the onset of uterine leiomyoma is increasing with advanced maternal age, this pathological condition occurs in pregnant women as well and because leiomyoma tends to grow under the influence of estrogens, 15-30% of leiomyoma may enlarge during the first trimester of pregnancy [1]
Maternal age (< 20 yr, 20-29 yr, and 30 yr or more), birth order, employment status, influenzacommon cold, and use of folic acid supplement were included in the models as potential confounders. As it appeared at the preliminary evaluation of leiomyoma in pregnancy (LP), two groups could be differentiated: 1) prospectively and medically recorded LP in the prenatal maternity logbook, and 2) LP based on retrospective maternal information in the questionnaire
Summary
Uterine leiomyoma (fibroid) is benign, smooth muscle tumour and most common non cancerous neoplasm in women of child-bearing age. Though the onset of uterine leiomyoma is increasing with advanced maternal age, this pathological condition occurs in pregnant women as well and because leiomyoma tends to grow under the influence of estrogens, 15-30% of leiomyoma may enlarge during the first trimester of pregnancy [1]. Compressive effect of leiomyoma may distort the intrauterine cavity and alter the endometrium after conception may interfere implantation, placental development and the growth of the conceptus mechanically [2]. In addition there is an increased uterine irritability and contractility secondary to rapid fibroid growth. The direct mechanical effect and indirect alteration in oxytocinase activity may disrupt the normal progression of uterus and development of the fetus, uterine leio-. Bánhidy et al / HEALTH 2 (2010) 566-574 myoma is a cause of pregnancy loss, fetal malpresentation, intrauterine growth retardation and premature labour [3]
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