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Uterine leiomyomas develop in up to 50% of women older than 35 years. As maternal age rises, leiomyomas become more prevalent during pregnancy. This study was aimed to assess perinatal outcome in mothers with and without uterine leiomyoma during pregnancy.
A population-based cohort analysis including all singleton deliveries which occurred between the years 1991-2014 at a single regional tertiary medical center was conducted. Fetuses with congenital malformations and multiple pregnancies were excluded. Multivariable generalized estimating equation (GEE) analysis adjusted for recurrent maternal occurrence in the dataset and possible confounders was performed.
During the study period 242,232 singleton deliveries met the inclusion criteria; 0.5% of which were in mothers diagnosed with uterine leiomyoma (exposed group, n=1,226). As compared to the non-leiomyoma (comparison) group, the exposed group was characterized by more advanced mean maternal age (34.22±5.5 vs. 28.13±5.8 years, p=0.003), higher rates of fertility treatments (7.1% vs. 1.0% by in vitro fertilization; 3.9% vs. 0.7% by ovulation induction, p<0.001), and a history of recurrent pregnancy loss (9.0% vs. 5.0%, p<0.001). Significantly higher rates of hypertensive disorders, diabetes mellitus (gestational and pre-gestational), fetal growth restriction, and preterm labor (both < 37 and <34 weeks) was observed in the leiomyoma group (Table 1). In addition, the exposed group demonstrated higher rates of cesarean delivery, placental abruption, and small for gestational age newborns (defined as <5th percentile adjusted for gestational age). Nonetheless, perinatal mortality rates were comparable between the groups (0.9% vs. 0.5%, p=0.106). In the GEE multivariable analyses, controlling for maternal age, mode of delivery, hypertensive disorder and diabetes mellitus, fetal growth restriction, low birthweight (<2500gr), and small for gestational age newborns, were all found to be independently associated with uterine leiomyoma during pregnancy (Table 2).
Maternal uterine leiomyoma appears to be independently associated with adverse pregnancy outcome, mainly related to fetal growth, thus emphasizing the importance of appropriate perinatal and intrapartum surveillance in these high-risk pregnancies.