Miscarriage on Endometriosis and Adenomyosis in Women by Assisted Reproductive Technology or with Spontaneous Conception: A Systematic Review and Meta-Analysis.
Level 3 - non-randomized controlled study
Systematic review of observational/non-randomized cohort studies
PubMed 33490243 · doi:10.1155/2020/4381346
What was done
A systematic review and meta-analysis of PubMed, Embase, and Cochrane Library databases (inception to February 29, 2020) evaluated miscarriage risk (<28 weeks) and secondary perinatal outcomes in pregnant women with endometriosis or adenomyosis who conceived spontaneously or via assisted reproductive technology (ART). Data from 39 studies comprising 697,984 women were synthesized.
What was found
Endometriosis increased miscarriage risk in spontaneous conception compared to women without endometriosis (OR: 1.81, 95% CI: 1.44-2.28, I2 = 96%), but not in ART compared to tubal infertility controls (OR: 1.03, 95% CI: 0.92-1.14, I2 = 0%). Adenomyosis increased miscarriage risk in ART compared to controls without adenomyosis (OR: 2.81, 95% CI: 1.44-5.47, I2 = 64%). Endometriosis was also linked to higher odds of antepartum hemorrhage, postpartum hemorrhage, preterm birth, stillbirth, and placenta praevia, with no significant differences for ectopic pregnancy, placental abruption, pre-eclampsia, gestational diabetes, low birthweight, or intrauterine growth restriction.
Why it matters
The findings differentiate miscarriage risk profiles by conception route, highlighting elevated loss risks for spontaneous pregnancies in endometriosis and ART pregnancies in adenomyosis.
Limits
The included literature consists of observational studies with substantial statistical heterogeneity (I2 up to 96%). Inconsistent comparator groups were used across subsets, and data for spontaneous conception in adenomyosis were not reported in the abstract.
Cited by
- supports Endometriosis and associated pelvic inflammation increase the risk of ectopic pregnancy and miscarriage.