Endometriosis results in worse pregnancy outcomes independent of fertility treatment

Independent of the infertility or the use of reproductive treatments, endometriosis was linked to worse pregnancy outcomes, says an article published in Fertility and Sterility.

10% of women in reproductive age have endometriosis, a chronic, multi-systemic illness linked to extrauterine development of endometrial-like glands and stromal tissue. The risk of preterm birth and cesarean section among endometriosis-affected women did not vary according to the method of conception, according to a new meta-analysis. However, patients who had an unaided conception had a higher risk of hypertensive disorders of pregnancy and preterm birth, whereas women who had an IVF or ICSI conception had a higher risk of placenta previa. The current study, carried out by Maria P. Velez and team sought to determine whether mediation from a known infertility diagnosis with or without fertility therapy accounted for some of the effect of endometriosis and the relationship between endometriosis and poor pregnancy.

This population-based retrospective cohort study made use of ICES Ontario's linked universal health datasets. Every single singleton pregnancy with a projected due date between October 2006 and February 2014. A surgical and/or medical diagnosis was used to determine the presence of endometriosis. Relative risks that account for mother age, economic quintiles, and a history of fibroids were used to quantify the relationship between endometriosis and pregnancy outcomes (aRR). When compared to unassisted conception, ovulation induction, intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection were the modes of conception used in the mediation analysis to estimate the direct effects of endometriosis diagnosis and indirect effects through mode of conception.

The key findings of this study were :

1. Endometriosis was previously diagnosed in 19,099 pregnancies, but not in 768,350 others.

2. The median (interquartile range) interval between the endometriosis diagnosis and the index pregnancy was 5.6 (4.3) years.

3. Placenta abruption, other placental diseases, cesarean delivery, stillbirth, and hypertensive disorders during pregnancy were all linked to an elevated incidence of endometriosis.

4. Except for stillbirth, where a diagnosis of infertility or fertility treatment indirectly contributed to the higher risk, mediation analysis reveals that endometriosis directly influences the majority of unfavorable pregnancy outcomes evaluated.

In conclusion, the results of this study indicate that some endometriosis patients may experience poor pregnancy outcomes without the benefit of fertility medication. Future research should look into the physiopathology of these correlations and possible treatments to lower the likelihood of unfavorable pregnancy outcomes in endometriosis-affected women. Even in individuals who are using natural conception, the history of endometriosis may be useful for forecasting pregnancy outcomes.

Reference:

Zahid, S., Hashem, A., Minhas, A. S., Bennett, W. L., Honigberg, M. C., Lewey, J., Davis, M. B., & Michos, E. D. (2022). Trends, Predictors, and Outcomes of Cardiovascular Complications at Delivery Associated With Gestational Diabetes: A National Inpatient Sample Analysis (2004–2019). In Journal of the American Heart Association. Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1161/jaha.122.026786