Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.
Department of Obstetrics and Gynecology, Gødstrup Regional Hospital, Herning, Denmark.
Acta Obstet Gynecol Scand. 2023 Aug;102(8):986-999. doi: 10.1111/aogs.14594. Epub 2023 Jul 20.
Exposures in utero are suggested to play a role in the etiology of endometriosis and adenomyosis, although the current evidence is inconclusive. Knowledge about potential prenatal programming and early life exposures that may affect this risk is of high importance, to focus potential preventive strategies for the diseases already during pregnancy. The aim of this study was to review systematically the literature of the association between measures of fetal growth and preterm birth and endometriosis and adenomyosis in adult life.
A systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines and by search on PubMed and EMBASE was carried out. We included published case-control and cohort studies. We excluded studies without a reference group, eg case series, case reports as well as commentaries, letters and editorials. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Meta-analyses using a random-effect inverse variance weighted model were performed. PROSPERO registration number is CRD42021249322.
A total of 11 studies were included. In general, the quality scores of the studies were moderate. We found that the risk of endometriosis was 26% higher in women born with a birthweight <2.5 kg (pooled odds ratio [pOR] 1.26, 95% confidence interval [CI] 1.05-1.52) and 32% higher in women born preterm (pOR 1.32, 95% CI 1.01-1.72) than in the reference groups. The studies on adenomyosis pointed towards no association, but a meta-analysis was unfeasible due to the small number of studies.
This systematic review and meta-analysis found that low birthweight and being born preterm were associated with endometriosis in adult life, but the results must be interpreted cautiously. No solid conclusion could be made regarding adenomyosis due to a limited number of published studies, but the studies included found no association. The results support the hypothesis of a potential early programming effect of endometriosis. However, the body of evidence is sparse and this hypothesis needs to be investigated further.
尽管目前的证据尚无定论，但宫内暴露被认为与子宫内膜异位症和子宫腺肌病的病因有关。了解可能影响这种风险的潜在产前编程和生命早期暴露的知识非常重要，以便在怀孕期间就开始关注针对这些疾病的潜在预防策略。本研究旨在系统回顾与胎儿生长和早产以及成年后患子宫内膜异位症和子宫腺肌病相关的文献。
根据系统评价和荟萃分析（PRISMA）指南以及在 PubMed 和 EMBASE 上进行了系统检索。我们纳入了已发表的病例对照和队列研究。我们排除了没有参考组的研究，例如病例系列、病例报告以及评论、信件和社论。使用纽卡斯尔-渥太华量表评估研究的质量。使用随机效应逆方差加权模型进行荟萃分析。PROSPERO 注册号为 CRD42021249322。
共纳入 11 项研究。总体而言，研究的质量评分中等。我们发现，出生体重<2.5kg 的女性患子宫内膜异位症的风险增加 26%（合并优势比[OR]1.26，95%置信区间[CI]1.05-1.52），早产的女性患子宫内膜异位症的风险增加 32%（OR 1.32，95%CI 1.01-1.72）。关于子宫腺肌病的研究指出两者之间没有关联，但由于研究数量较少，无法进行荟萃分析。
本系统评价和荟萃分析发现，低出生体重和早产与成年后患子宫内膜异位症有关，但结果必须谨慎解释。由于已发表的研究数量有限，关于子宫腺肌病没有得出明确的结论，但纳入的研究未发现两者之间存在关联。这些结果支持子宫内膜异位症潜在早期编程效应的假说。然而，证据基础薄弱，这一假说需要进一步研究。
