Maternal and fetal outcomes in women with endometriosis : A review and meta-analysis

The adverse maternal, fetal and neonatal outcomes are noticeably higher in pregnant women with endometriosis.

Key Points

 Importance:

• Endometriosis is a disease that changes the environmental conditions of the uterus and if a pregnancy achieved, it creates adverse maternal and fetal outcomes.

Highlights:

• Adverse maternal, fetal and neonatal outcomes are higher in pregnant women with endometriosis.

  What's done here:

• 33 abstracts selected from the literature, which consisted women >20 weeks gestational age with or without endometriosis, and which also have reported at least one of adverse maternal or fetal outcomes of interest, were included.
• Meta-analysis of maternal and fetal outcomes have been made and the results shared for further approaches.

Key results:

• Adverse maternal outcomes such as pre-eclampsia, gestational hypertension, gestational diabetes, gestational cholestasis, placental abruption, antepartum hemorrhagia, cesarean section, and postpartum hemorrhage are increased in the pregnant women with endometriosis.
• Adverse fetal and neonatal outcomes such as preterm birth, PPROM, intrauterine growth restriction, neonatal compromise, stillbirth, and neonatal death are also increased in pregnant women with endometriosis.
• The most important and severe adverse outcomes, namely stillbirths and the neonatal deaths are evaluated separately and were noticeably higher in the endometriosis group.

Limitations:

• The results are limited by the quality of the results of these thirty-three abstracts. 
• The diagnosis of endometriosis and the groups are not uniform across the studies. 

Lay Summary

Lalani et al from Dept. of Obstet. and Gynecol. , University of Ottowa, Canada, recently published this systemic review and meta-analysis of observational studies in the Journal of Human Reproduction, aimed to present the difference in the maternal and fetal outcomes during pregnancies with or without endometriosis.

Endometriosis is a disease to alter the ovulation, oocyst production, peritoneal fluid inflammatory cells content and endometrial tissue that could affect the peri-implantation period of conceiving and normal embryonic development. Even the pregnancy could be achieved in endometriotic patients, adverse maternal and fetal outcomes are expected.   

Two independent reviewers selected 33 studies from the literature to compare the pregnancy complications, maternal and fetal outcomes of endometriotic patients to those without endometriosis. Authors performed a meta-analysis to provide an estimate of the effect of each outcome. In all studies, there was a control group of healthy women pregnancies at the same age, same properties and over 20 weeks of gestation like the endometriotic patients' group.

Among endometriotic pregnants, the meta-analysis of pre-eclampsia, gestational hypertension and/or pre-eclampsia, gestational diabetes, gestational cholestasis, placenta previa, antepartum hemorrhage, cesarian section, malpresentation were higher compared to the control group.

Adverse fetal and neonatal outcomes like preterm premature rupture of membranes, preterm birth, small for gestational age, stillbirth and neonatal deaths in the group of endometriotic pregnants were also higher significantly. 

The authors separately studied the women with endometriosis who conceived spontaneously or with assisted reproductive techniques. The results of adverse maternal and fetal outcomes in groups show complexity in the literature, some studies found a positive correlation in the endometriotic group while others not. They concluded that this might be the need for ART in endometriotic patients.

In conclusion, the adverse fetal outcome as stillbirth and neonatal deaths are important and serious for endometriotic pregnancies and should be considered for further pregnancies.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/30239732