THE ASSOCIATION OF ADENOMYOSIS WITH UTEROPLACENTAL INSUFFICIENCY AND PREECLAMPSIA IN WOMEN UNDERGOING ICSI CYCLE

Abstract

To explore the association of adenomyosis with maternal and perinatal outcomes in women undergoing ICSI. Prospective cohort study over a 2-year period between 2018 and 2020. Women with ongoing pregnancy (>20 weeks) after ICSI were included. Exclusion criteria were oocyte donation cycles, high-order pregnancies and women with uterine fibroids, hydrosalpinx, or stage 3-4 endometriosis according to revised AFS criteria. Adenomyosis was diagnosed according to MUSA group consensus statement. The analysis groups were divided into women with and without adenomyosis. The primary outcomes were prevalence of preeclampsia and composite adverse perinatal outcomes (small-for-gestational age at birth, neonatal care unit admission, asphyxia, preeclampsia, preterm delivery). Secondary outcome was the difference of uterine artery Doppler pulsatility index between two groups. Group comparison of primary and secondary outcomes were performed using Bayesian inference methods (Metropolis Hastings MCMC) with vague priors due to limited sample size. The results were reported as mean difference between the groups, 95% credible intervals (CrI) and the probability of significant difference. Additional results were reported via frequentist statistical methods. There were 486 ongoing ICSI cycles during the study period and 101 (20.8%) ongoing pregnancies were eligible for inclusion. The adenomyosis prevalence was 18.8% (19/101). The prevalence of preeclampsia (21.1 vs. 13.4%) and composite adverse perinatal outcomes (63.1 vs. 42.7%) were higher in women with adenomyosis. Bayesian analysis showed the probability of preeclampsia (probability 84.1%, mean difference: 7.7%, 95% CrI: -11.7%-27.2%) and composite adverse perinatal outcomes (probability 99.5%, mean difference: 29.6% 95% CrI: 7.3%-51.8%) could be higher in women with adenomyosis compared to those without. First trimester mean uterine artery pulsatility index was higher in women with adenomyosis compared to those without (probability: 99.5%, mean difference: 0.32, 95% CrI: 0.07 to 0.57). Results of additional adverse pregnancy and neonatal outcomes are available in Table 1. Women with adenomyosis show signs of uteroplacental malperfusion during the first trimester and possibly have an increased risk of preeclampsia and composite adverse perinatal outcomes.Tabled 1Adverse OutcomeAdenomyosis (number, percentage)Control (number, percentage)Preeclampsia4 (21.1)4 (13.4)SGA at birth7 (36.8)9 (10.9)Preterm Delivery8 (42.3)15 (18.3)NICU admission7 (36.8)7 (8.5)Asphyxia2 (10.5)2 (2.4) Open table in a new tab