Women with endometriosis are at higher risk for complications during pregnancy, including a higher risk of premature birth, miscarriage, placenta previa, smaller newborns, and cesarean delivery, according to a recent analysis.
The study, “Endometriosis and obstetrics complications: a systematic review and meta-analysis,” was published in the journal Fertility and Sterility.
Estimates suggest that approximately 10 percent of women in the general population are affected by endometriosis. Pregnancy was traditionally considered to have a positive effect on endometriosis and its symptoms, but how it impacted pregnancy outcomes remained relatively unexplored, authors explained.
“Endometriosis is known to alter a woman’s physiology in a way that could interfere with a number of stages of pregnancy,” Vincenzo Berghella, MD, professor of gynecology and director of maternal fetal medicine in the Department of Obstetrics and Gynecology at the Sidney Kimmel Medical College at Thomas Jefferson University, said in a press release.
“From causing inflammation at the endometrium, to resisting the action of progesterone during implantation and throughout the pregnancy, there are a number of ways that endometriosis may affect the normal course of pregnancy,” he said.
“Prior studies looking at this issue have reported conflicting results,” added Berghella, who is also the study’s lead author. “Studies like ours help clarify the findings by pooling the data from many studies to give the field a more conclusive answer to a debated research question. The collective data is stronger than any single study alone and often helps shape opinion in the field.”
In the meta-analysis, authors included 24 published studies with a total of 1,924,114 women: 52,111 (2.7%) were diagnosed with endometriosis before pregnancy, and 1,872,003 (97.3%) did not have a diagnosis of endometriosis (the control group).
Compared with the control group, women diagnosed with endometriosis showed a statistically significant higher risk for preterm birth and miscarriage. Additionally, endometriosis was also a risk factor for placenta previa (a complication of pregnancy that causes the placenta to tear away from the uterus), small-for-gestational-age newborns, and cesarean delivery.
No link was found between endometriosis and gestational hypertension or pre-eclampsia (a disorder of pregnancy characterized by high blood pressure and increased protein in the urine).
“It’s important that women with a history of endometriosis, and obstetricians caring for them, are aware of this association between prior endometriosis and higher risks of miscarriage, preterm birth, placenta previa, cesarean delivery, and a baby small for gestational age. These pregnancies deserve closer monitoring for these complications,” Berghella said.