Lalani S, et al. - Experts examined the relationship between endometriosis and adverse maternal, fetal, and neonatal outcomes in pregnancy. Findings from this systematic review and meta-analysis of observational studies (January 1, 1990 to December 31, 2017) showed an elevated risk for serious and important adverse maternal (pre-eclampsia, gestational diabetes, placenta previa, and cesarean section) and fetal or neonatal outcomes (preterm birth, preterm premature rupture of the membranes [PPROM], small for gestational age, stillbirth and neonatal death) in women with endometriosis. However, results were found to be conflicting with potential confounding by the use of assisted reproductive technology.

Methods

• Researchers considered the studies for inclusion if they were prospective or retrospective cohort or case-control studies; included women > 20 weeks gestational age with endometriosis; included a control group of gravid women without endometriosis; and reported ≥ 1 of the outcomes of interest.
• They reviewed each study for inclusion, extracted the data, and assessed the risk of bias by two independent reviewers.

Results

• A total of 33 studies (sample size, n=3,280,488) were included in the analysis.
• Findings suggested that women with endometriosis had higher odds of pre-eclampsia, gestational hypertension and/or pre-eclampsia, gestational diabetes, gestational cholestasis, placenta previa, antepartum hemorrhage, antepartum hospital admissions, malpresentation, labor dystocia, and cesarean section vs women without endometriosis.
• Researchers noted a greater likeliness of the fetuses and neonates of women with endometriosis to have PPROM, preterm birth, small for gestational age < 10th percentile, neonatal intensive care unit admission, stillbirth, and neonatal death.
• Endometriosis was found to be associated with placenta previa, cesarean section, preterm birth, and low birth weight in the subgroup of women who conceived spontaneously.
• Endometriosis was found to be associated with placenta previa and preterm birth among the subgroup of women who conceived with the use of assisted reproductive technology.