Abstract
ObjectiveTo investigate the association between preceding endometriosis and gestational hypertension-preeclampsia (GH-PE).MethodsIn this nationwide population-based longitudinal study, data from 1998–2012 Taiwan National Health Insurance Research Database were used. We used ICD9-CM codes 617.X and 642.X respectively for the diagnoses of endometriosis and GH-PE, which were further confirmed by examining medical records of surgeries, blood pressure and urine protein to ensure the accuracy of the diagnoses. The study excluded women diagnosed with endometriosis at < 15 or > 45 years of age, chronic hypertension, and GH-PE prior to endometriosis. Each pregnant woman with a prior diagnosis of endometriosis was matched to 4 pregnant women without endometriosis by age. Logistic regression analysis was used to calculate odds ratios (ORs) for the risk of GH-PE with adjustment for age, occupation, urbanization, economic status and comorbidities.ResultsAmong 6,300 women with a prior endometriosis diagnosis who were retrieved from a population of 1,000,000 residents, 2,578 (40.92%) had subsequent pregnancies that were eligible for further analysis and were compared with 10,312 pregnant women without previous endometriosis. GH-PE occurred more in women with prior endometriosis as compared to those without endometriosis (3.88% vs. 1.63%, p<0.0001). Further analysis revealed prior endometriosis was associated with GH-PE (adjusted OR = 2.27; 95% CI:1.76–2.93). For danazol-treated and non-danazol-treated subgroups, the incidences of GH-PE were 3.13% (15/480) and 4.05% (85/2,098), respectively. Although the risk for subsequent GH-PE was lower (adjusted OR = 1.49; 95% CI:0.86–2.56) after receiving danazol treatment than average (adjusted OR = 2.27; 95% CI:1.76–2.93) for women with preceding endometriosis, the reduction of risk was not statistically remarkable for danazol-treated (adjusted OR = 1.49) vs. non-danazol-treated (adjusted OR = 2.48) subgroups (p heterogeneity = 0.12).ConclusionsPreceding endometriosis is an independent and significant risk factor for the occurrence of GH-PE.
Highlights
Endometriosis, a common cause of pelvic pain and subfertility, is characterized by endometrial-like tissue outside the endometrium, primarily on the uterine myometrium, ovaries, rectovaginal septum and pelvic peritoneum [1]
In the NHI Research Database (NHIRD), International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes are used for disease diagnosis, and National Health Insurance (NHI) codes are used for procedures or treatments
According to our experiences in using LHID for population-based studies [23], the main reasons for censored data were deaths and withdrawal of nationals from the NHI. This dataset has been confirmed to have no significant difference in age, sex, or healthcare costs compared with the whole population, which is composed of all beneficiaries in the NHI program
Summary
Endometriosis, a common cause of pelvic pain and subfertility, is characterized by endometrial-like tissue outside the endometrium, primarily on the uterine myometrium, ovaries, rectovaginal septum and pelvic peritoneum [1]. The prevalence of endometriosis is estimated to be approximately 6%-10% of reproductive-aged women [1, 2] the etiology and pathogenesis of endometriosis remain uncertain, the ectopic endometrial cells and tissues, which are dependent on estrogen for growth, can implant on peritoneal surfaces and elicit a chronic inflammatory response and subsequent adhesions, fibrosis, scarring, neuronal infiltration, and anatomical distortion [1,2,3]. Some biophysical and biochemical methods including maternal uterine artery Doppler [7, 9, 13, 19], fetal aorta intima-media thickness (aIMT) [9], and biochemical markers [12,13,14, 18] have been developed for detecting PE among low-risk populations. Much remains unknown regarding the mechanisms and markers of GH-PE
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