Endometriosis and Risk of Adverse Pregnancy Outcome: A Systematic Review and Meta-Analysis.

Kjerstine Breintoft,Linn Håkonsen Arendt,Tine Brink Henriksen,Axel Forman,Dorte Rytter,Regitze Pinnerup,Niels Uldbjerg

doi:10.3390/jcm10040667

Kjerstine Breintoft, Linn Håkonsen Arendt + Show 5 more

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https://doi.org/10.3390/jcm10040667

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Abstract

Background: This systematic review and meta-analysis summarizes the evidence for the association between endometriosis and adverse pregnancy outcome, including gestational hypertension, pre-eclampsia, low birth weight, and small for gestational age, preterm birth, placenta previa, placental abruption, cesarean section, stillbirth, postpartum hemorrhage, spontaneous hemoperitoneum in pregnancy, and spontaneous bowel perforation in pregnancy. Methods: We performed the literature review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), by searches in PubMed and EMBASE, until 1 November 2020 (PROSPERO ID CRD42020213999). We included peer-reviewed observational cohort studies and case-control studies and scored them according to the Newcastle–Ottawa Scale, to assess the risk of bias and confounding. Results: 39 studies were included. Women with endometriosis had an increased risk of gestational hypertension, pre-eclampsia, preterm birth, placenta previa, placental abruption, cesarean section, and stillbirth, compared to women without endometriosis. These results remained unchanged in sub-analyses, including studies on spontaneous pregnancies only. Spontaneous hemoperitoneum in pregnancy and bowel perforation seemed to be associated with endometriosis; however, the studies were few and did not meet the inclusion criteria. Conclusions: The literature shows that endometriosis is associated with an increased risk of gestational hypertension, pre-eclampsia, preterm birth, placenta previa, placental abruption, cesarean section, and stillbirth.

Highlights

Endometriosis affects about 10% of women of reproductive age [1]
We reviewed studies on endometriosis related to spontaneous hemoperitoneum in pregnancy (SHiP) and spontaneous bowel perforation in pregnancy
A total of 39 cohort studies and no case-control studies were included in the systematic review

Summary

Introduction

Endometriosis affects about 10% of women of reproductive age [1]. It is a chronic gynecological disease whereby estrogen-dependent endometrial fragments are located on organs other than the uterus, with the development of inflammation, adhesions, and pain [1], with the ovaries and the posterior cul-de-sac (pouch of Douglas) most often affected [2].Several pathogenic mechanisms are possible, but the most supported is retrograde bleeding through the fallopian tubes, due to dysperistaltic uterine contractions [3]. Endometriosis affects about 10% of women of reproductive age [1]. It is a chronic gynecological disease whereby estrogen-dependent endometrial fragments are located on organs other than the uterus, with the development of inflammation, adhesions, and pain [1], with the ovaries and the posterior cul-de-sac (pouch of Douglas) most often affected [2]. Peritoneal levels of inflammatory mediators, such as cytokines, chemokines, and prostaglandins, increase, leading to a state of chronic inflammation in women with endometriosis [4]. Many pathogenic consequences of endometriosis have been suggested to play a role in the decreased fertility seen in these women, e.g., structural changes in the junctional zone, chronic inflammation, mechanical defects, and ovarian dysfunction [5,6]. Abnormal remodeling of the spiral arteries in the junctional zone may cause defective deep placentation, increasing the risk of adverse pregnancy outcome [5]

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