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Adverse Pregnancy Outcomes in Endometriosis – Myths and Realities

  • Endometriosis (P. Stratton, Section Editor)
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Abstract

Purpose of Review

There is increasing interest in the long-term health and comorbid conditions associated with endometriosis for both women and neonates. The purpose of this review was to synthesize and discuss the current state of the literature investigating endometriosis and risk of adverse pregnancy outcomes.

Recent Findings

Methodologic considerations for studying endometriosis and adverse pregnancy outcomes include complexities regarding the comparison population, endometriosis definition, sample size, residual confounding, and interactions. The current research on endometriosis and adverse pregnancy outcomes should be interpreted cautiously. To date, evidence suggests that endometriosis may be associated with higher risk of ectopic pregnancy, placenta previa, preterm birth, and cesarean section. While an association with miscarriage and stillbirth has been consistently observed, the relative risk was small.

Summary

Pregnant women with endometriosis may be at higher risk for certain adverse pregnancy outcomes and may therefore benefit from additional monitoring. However, additional research is needed to confirm these associations and should focus on ensuring studies have internal and external validity, as well as, investigate the potential for differences in endometriosis phenotypes. Moreover, future research should focus on understanding potential mechanisms of association and better understanding how early interventions, through increased monitoring or screening during pregnancy, may improve outcomes.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA

    Leslie V. Farland & Samantha Davidson

  2. Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Naoko Sasamoto

  3. MRC Centre for Reproductive Health, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK

    Andrew W. Horne

  4. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Stacey A. Missmer

  5. Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, USA

    Stacey A. Missmer

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  1. Leslie V. Farland
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  4. Andrew W. Horne
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Correspondence to Leslie V. Farland.

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Conflict of Interest

Samantha Davidson and Naoko Sasamoto each declare that they have no conflict of interest. Leslie V. Farland reports personal fees from Merck & Co. outside the submitted work. Andrew W. Horne reports grants from Chief Scientist Office, grants from NIHR EME, grants from MRC, grants from Wellbeing of Women, grants from Ferring, and other from Roche Diagnostics during the conduct of the study; and Honoraria for consultancy for Ferring, Roche Diagnostics, Nordic Pharma and Abbvie outside the submitted work. Stacey A. Missmer reports personal fees from Abbvie outside the submitted work.

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All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines.

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Farland, L.V., Davidson, S., Sasamoto, N. et al. Adverse Pregnancy Outcomes in Endometriosis – Myths and Realities. Curr Obstet Gynecol Rep 9, 27–35 (2020). https://doi.org/10.1007/s13669-020-00281-1

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