Background
Endometriosis and uterine fibroids are common gynecologic conditions associated with
a greater risk for infertility. Previous research has suggested that these conditions
are associated with adverse pregnancy outcomes, potentially because of increased utilization
of fertility treatments.
Objective
Our objective was to investigate whether women with a history of endometriosis or
fibroids had a greater risk for adverse pregnancy outcomes and whether this risk varied
by infertility history and fertility treatment utilization.
Study Design
Deliveries (2013–2017) recorded in Massachusetts’ vital records were linked to assisted
reproductive technology data, hospital stays, and all-payer claims database. We identified
endometriosis and fibroids diagnoses via the all-payer claims database before index
delivery. Adjusted relative risks for pregnancy complications were modeled using generalized
estimating equations with a log link and Poisson distribution. The influence of subfertility
or infertility and assisted reproductive technology was also investigated.
Results
Among 91,825 deliveries, 1560 women had endometriosis and 4212 had fibroids. Approximately
30% of women with endometriosis and 26% of women with fibroids experienced subfertility
or infertility without utilizing assisted reproductive technology, and 34% of women
with endometriosis and 21% of women with fibroids utilized assisted reproductive technology
for the index delivery. Women with a history of endometriosis or fibroids were at
a greater risk for pregnancy-induced hypertension, preeclampsia, or eclampsia (endometriosis
relative risk, 1.17; fibroids relative risk, 1.08), placental abnormalities (endometriosis
relative risk, 1.65; fibroids relative risk, 1.38), and cesarean delivery (endometriosis
relative risk, 1.22; fibroids relative risk, 1.17) than women with no history of those
conditions. Neonates born to women with a history of endometriosis or fibroids were
also at a greater risk for preterm birth (endometriosis relative risk, 1.24; fibroids
relative risk, 1.17). Associations between fibroids and low birthweight varied by
fertility status or assisted reproductive technology (P homogeneity=.01) and were stronger among noninfertile women.
Conclusion
Endometriosis or fibroids increased the risk for adverse pregnancy outcomes, possibly
warranting differential screening or treatment.
Key words
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Article Info
Publication History
Published online: January 29, 2022
Accepted:
December 29,
2021
Received in revised form:
December 21,
2021
Received:
August 24,
2021
Footnotes
S.A.M. reports receiving a consulting fee for service as an advisory board member for the Endometriosis Disease Burden and Endometriosis International Steering Committee working groups of AbbVie Inc. The remaining authors report no conflict of interest.
This study was funded by the National Institutes of Health , United States under grant number HD67270.
Cite this article as: Farland LV, Stern JE, Liu CL, et al. Pregnancy outcomes among women with endometriosis and fibroids: registry linkage study in Massachusetts. Am J Obstet Gynecol 2022;226:829.e1-14.
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