Department of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Japan.
Department of Public Health, Tottori University Faculty of Medicine, Yonago, Japan.
PLoS One. 2019 Aug 2;14(8):e0220256. doi: 10.1371/journal.pone.0220256. eCollection 2019.
Because of the increased number of diagnosed cases of endometriosis or adenomyosis resulting in infertility, many women require assisted reproductive technology (ART) to become pregnant. However, incidences of obstetric complications are increased for women who conceive using ART. There has been no prospective cohort study examining the influence of endometriosis and adenomyosis on obstetric outcomes after adjusting for the confounding influence of ART therapy.
This study evaluated the impact of endometriosis and adenomyosis on the incidence of adverse pregnancy outcomes.
Data were obtained from a prospective cohort study, known as the Japan Environment and Children's Study (JECS), of the incidence of obstetric complications for women with endometriosis and adenomyosis. The data of 103,099 pregnancies that resulted in live birth or stillbirth or that were terminated through abortion between February 2011 and July 2014 in Japan were included.
Women with endometriosis or adenomyosis were at increased risk for complications during pregnancy compared to those without a medical history of endometriosis (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.23 to 1.41) or adenomyosis (OR, 1.72; 95% CI, 1.37 to 2.16). Our analysis showed that the adjusted ORs for obstetric complications of pregnant women who conceived naturally or after infertility treatment that did not involve ART therapy were 1.26 (CI, 1.17 to 1.35) for pregnant women with a history of endometriosis and 1.52 (CI, 1.19 to 1.94) for those with a history of adenomyosis.
The presence of endometriosis and adenomyosis significantly increased the prevalence of obstetric complications after adjusting for the influence of ART outcomes.
由于子宫内膜异位症或子宫腺肌病导致不孕的诊断病例增多，许多妇女需要辅助生殖技术（ART）来怀孕。然而，使用 ART 受孕的妇女发生产科并发症的几率增加。没有前瞻性队列研究在调整 ART 治疗的混杂影响后，检查子宫内膜异位症和子宫腺肌病对产科结局的影响。
本研究评估了子宫内膜异位症和子宫腺肌病对不良妊娠结局发生率的影响。
本研究的数据来自一项前瞻性队列研究，即日本环境与儿童研究（JECS），研究子宫内膜异位症和子宫腺肌病患者的产科并发症发生率。该研究纳入了 2011 年 2 月至 2014 年 7 月期间在日本因活产或死产或人工流产而终止的 103099 例妊娠的数据。
与没有子宫内膜异位症病史的女性（比值比[OR]，1.32；95%置信区间[CI]，1.23 至 1.41）或子宫腺肌病病史的女性（OR，1.72；95%CI，1.37 至 2.16）相比，患有子宫内膜异位症或子宫腺肌病的女性在妊娠期间发生并发症的风险增加。我们的分析表明，对于自然受孕或未涉及 ART 治疗的不孕治疗后受孕的孕妇，患有子宫内膜异位症病史的孕妇的产科并发症调整后 OR 为 1.26（CI，1.17 至 1.35），患有子宫腺肌病病史的孕妇为 1.52（CI，1.19 至 1.94）。
在调整 ART 结果的影响后，子宫内膜异位症和子宫腺肌病的存在显著增加了产科并发症的发生率。
