A recent study published in Fertility and Sterility highlights a significant association between endometriosis and a higher risk of preterm birth and other adverse pregnancy outcomes. While the link between endometriosis and infertility has been well established, the impact on pregnancy outcomes has remained contentious.
The study, conducted using data from 103 French maternity units spanning 1999 to 2016, analyzed information from the AUDIPOG sentinel network. This network gathers data from midwives and obstetricians across both public and private maternity units in France.
Researchers examined 368,935 pregnancies and 377,338 neonates, with 2,108 participants having endometriosis. Key findings included a higher prevalence of preterm births among women with endometriosis: 11.1% delivered before 37 weeks of gestation compared to 7.7% without endometriosis (adjusted relative risk [aRR], 1.40), and 3.1% delivered before 33 weeks versus 2.2% (aRR, 1.53).
Additionally, women with endometriosis faced higher risks of preeclampsia (aRR, 1.64), placenta previa (aRR, 4.29), postpartum hemorrhage (aRR, 1.30), and having a small for gestational age infant (aRR, 1.21 for <10th percentile and aRR, 1.23 for <5th percentile). The study found that the risks for preterm birth and secondary outcomes did not significantly differ when stratified by the use of medically assisted reproduction, though placenta previa risk was higher in those who used such methods.
The study’s limitations include a lower prevalence of endometriosis in the database compared to estimated rates, the inability to confirm coexisting adenomyosis, and a lack of specific diagnostic confirmation for conditions like preeclampsia.
The authors recommend further research to explore optimal diagnostic and treatment options for endometriosis, emphasizing the need for large, prospective cohort studies to better understand the risks of adverse maternal and neonatal outcomes associated with endometriosis.
