Vendittelli Françoise, Barasinski Chloé, Rivière Olivier, Bourdel Nicolas, Fritel Xavier
Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, Clermont-Ferrand, France; AUDIPOG (Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique et Gynécologie), RTH Laennec Medical University, Lyon, France.
Université Clermont Auvergne, Clermont Auvergne INP, CHU Clermont-Ferrand, CNRS, Institut Pascal, Clermont-Ferrand, France.
Fertil Steril. 2025 Jan;123(1):137-147. doi: 10.1016/j.fertnstert.2024.07.037. Epub 2024 Jul 31.
To investigate first, the association between endometriosis and preterm birth; second, the associations between endometriosis and preeclampsia, placenta previa, postpartum hemorrhage, stillbirth, and small-for-gestational-age infants (assessed by birthweight); and third, the risk of these adverse pregnancy outcomes with and without the use of medically assisted reproduction.
Multicenter retrospective cohort study.
Deliveries by 368,935 women (377,338 infants) from 1999 through 2016.
Endometriosis, defined as a single disease entity (endometriosis and/or ademyosis) MAIN OUTCOMES MEASURES: The main outcome was the preterm birth rate (both <37 and <33 weeks). The secondary outcomes were rates of preeclampsia, placenta previa, postpartum hemorrhage, stillbirth, and small-for-gestational-age neonates.
Women in the endometriosis group had more frequent histories of infertility before the included pregnancy (34.7 vs. 5.0%), more hospitalizations during the pregnancy (27.4 vs. 19.8%), and more planned cesarean sections (14.0 vs. 8.7); they more often were nulliparous (51.7 vs. 43.4%). The prevalence of preterm birth at <37 weeks was 11.1% in the endometriosis group and 7.7% in the unexposed group, and for <33 weeks, it was 3.1% and 2.2%, respectively. The adjusted relative risk for confounding factors was higher in the endometriosis than the unexposed group for preterm delivery <37 weeks (1.40, 95% confidence interval, 1.18-1.67) or <33 weeks (1.53, 95% confidence interval, 1.08-2.16). For the secondary outcomes, the adjusted risk ratios for preeclampsia, placenta previa, postpartum hemorrhage, and small-for-gestational-age status of <10th and <5th percentiles were higher in the endometriosis group. The adjusted risk ratios for stillbirth and small-for-gestational-age status of <3rd percentile did not differ between the two groups, and those after stratification by medically assisted reproduction for preterm birth at <37 and <33 weeks did not differ statistically significantly between them, for the secondary outcomes, only the risk of placenta previa was higher in the medically assisted reproduction and non-medically assisted reproduction subgroups.
Pregnant women with endometriosis had higher risks of preterm birth and other poor pregnancy outcomes than women without endometriosis.
第一，研究子宫内膜异位症与早产之间的关联；第二，研究子宫内膜异位症与子痫前期、前置胎盘、产后出血、死产以及小于胎龄儿（根据出生体重评估）之间的关联；第三，研究使用和未使用医学辅助生殖技术情况下这些不良妊娠结局的风险。
多中心回顾性队列研究。
1999年至2016年期间368,935名女性（377,338名婴儿）的分娩情况。
子宫内膜异位症，定义为单一疾病实体（子宫内膜异位症和/或子宫腺肌病）
主要结局是早产率（孕周均<37周和<33周）。次要结局是子痫前期、前置胎盘、产后出血、死产以及小于胎龄新生儿的发生率。
子宫内膜异位症组的女性在纳入本次妊娠之前有不孕史的频率更高（34.7%对5.0%），孕期住院次数更多（27.4%对19.8%），计划剖宫产更多（14.0%对8.7%）；她们初产妇的比例更高（51.7%对43.4%）。子宫内膜异位症组孕周<37周的早产患病率为11.1%，未暴露组为7.7%，孕周<33周时，分别为3.1%和2.2%。对于孕周<37周（1.40，95%置信区间，1.18 - 1.67）或<33周（1.53，95%置信区间，1.08 - 2.16）的早产，子宫内膜异位症组经混杂因素调整后的相对风险高于未暴露组。对于次要结局，子宫内膜异位症组子痫前期、前置胎盘、产后出血以及第10百分位数和第5百分位数以下小于胎龄状态的调整风险比更高。两组之间死产以及第3百分位数以下小于胎龄状态的调整风险比没有差异，并且在按医学辅助生殖技术分层后，孕周<37周和<33周早产的两组之间在统计学上没有显著差异，对于次要结局，仅在医学辅助生殖技术组和非医学辅助生殖技术亚组中前置胎盘的风险更高。
患有子宫内膜异位症的孕妇比没有子宫内膜异位症的孕妇有更高的早产和其他不良妊娠结局风险。
