Impact of endometriosis on obstetric outcome after natural conception: a multicenter Italian study
Nicola Berlanda, Walter Alio, Stefano Angioni, Valentino Bergamini, Cecilia Bonin, Patrizia Boracchi, Massimo Candiani, Gabriele Centini, Maurizio Nicola D’Alterio, Simona Del Forno, Agnese Donati, Dhouha Dridi, Domenico Incandela, Lucia Lazzeri, Antonio Maiorana, Alberto Mattei, Jessica Ottolina, Annalisa Orenti, Alessio Perandini, Federica Perelli, Ilaria Piacenti, Ida Pino, Maria Grazia Porpora, Sara Scaramuzzino, Renato Seracchioli, Eugenio Solima, Edgardo Somigliana, Roberta Venturella, Paolo Vercellini, Paola Viganò, M. Vignali, Fulvio Zullo, Errico Zupi, Endometriosis Treatment Italian Club (ETIC)
Abstract
PURPOSE: To evaluate obstetric outcome in women with endometriosis who conceive naturally and receive standard obstetric care in Italy. METHODS: Cases were consecutive women with endometriosis managed in eleven Italian referral centers. Controls were women in whom endometriosis was excluded. All women filled in a questionnaire addressing previous natural pregnancies. Marginal logistic regression models were fitted to evaluate the impact of endometriosis on obstetric outcome. A post hoc analysis was performed within the endometriosis group comparing women with severe adenomyosis versus women with absent or mild adenomyosis. RESULTS: Three hundred and fifty-five pregnancies in endometriosis group and 741 pregnancies in control group were included. Women with endometriosis had a higher risk of preterm delivery < 34 weeks (6.4% vs 2.8%, OR 2.42, 95% CI 1.22-4.82), preterm delivery < 37 weeks (17.8% vs 9.7%, OR 1.98, 95% CI 1.23-3.19), and neonatal admission to Intensive Care Unit (14.1% vs 7.0%, OR 2.04, 95% CI 1.23-3.36). At post hoc analysis, women with endometriosis and severe adenomyosis had an increased risk of placenta previa (23.1% vs 1.8%, OR 16.68, 95% CI 3.49-79.71), cesarean delivery (84.6% vs 38.9%, OR 8.03, 95% CI 1.69-38.25) and preterm delivery < 34 weeks (23.1% vs 5.7%, OR 5.52, 95% CI 1.38-22.09). CONCLUSION: Women with endometriosis who conceive naturally have increased risk of preterm delivery and neonatal admission to intensive care unit. When severe adenomyosis is coexistent with endometriosis, women may be at increased risk of placenta previa and cesarean delivery. TRIAL REGISTRATION: Clinical trial registration number: NCT03354793.