Maternal and Neonatal Outcomes in Pregnancies With Adenomyosis [ID: 1375447

Abstract

INTRODUCTION: Adenomyosis is a common gynecologic disease involving the uterus with effect on pregnancy being poorly understood. This study aimed to evaluate the associations between adenomyosis and obstetrical and newborn outcomes. METHODS: Using the Healthcare Cost and Utilization Project–National Inpatient Sample from the United States, we conducted a retrospective cohort study of all birth-related admissions from 2016 to 2019. Pregnancies with adenomyosis were identified using the ICD-10 code N80.0, with the remaining pregnancies being the reference group. Multivariate logistic regression models, adjusting for baseline maternal demographics, were used to determine the effect of adenomyosis on pregnancy outcomes. In light of the diagnosis bias inherent in births by cesarean delivery, adjustment for mode of delivery was performed on all outcome analyses. RESULTS: Among the 2,943,532 women who delivered between 2016 and 2019, 1,084 had adenomyosis, for an overall prevalence of 36 cases per 100,000 births, which was stable throughout the study period. Adenomyosis in pregnancy was associated with increased frequency of placenta abruptio (odds ratio 1.67, 95% CI 1.17–2.39), preterm delivery (1.36, 1.16–1.59), preterm premature rupture of membranes (1.31, 1.07–1.61), postpartum hemorrhage (2.65, 2.14–3.27), postpartum transfusion (2.20, 1.62–2.99), disseminated intravascular coagulation (9.31, 4.15–20.92), sepsis (2.67, 1.60–4.45), congenital anomalies (1.95, 1.34–2.84), and intrauterine fetal demise (1.98, 1.02–3.84). CONCLUSION: Adenomyosis in pregnancy is associated with adverse obstetric and fetal outcomes. Pregnancies in patients with adenomyosis should be considered at higher risk and may benefit from delivering in centers capable of managing postpartum hemorrhage.