Endometriosis Not Linked With Preterm Birth, New Study Finds

Endometriosis Not Linked With Preterm Birth, New Study Finds

February 9, 2022 — Researchers evaluating the association of endometriosis with preterm birth found no such association in a study of over 1,300 women.

These new results, which have been published online in JAMA open networksuggest that a change in strategy to prevent preterm birth in women with this disease may not be required.

The research team, led by Louis Marcellin, MD, from the Department of Obstetrics and Gynecology at the University of Paris in France, also found that the phenotype of the disease, or whether the preterm labor was induced or spontaneous, did not affect the outcome.

These results differ from previous studies. There is little data on phenotypes and their association with preterm birth. But previous studies have shown that the risk of preterm birth is higher in women with deep endometriosis. In women with ovarian endometriosis.

“Little is known about the impact of endometriosis on obstetric outcomes. Unlike previous studies, we did not report differences in the risk of preterm birth between women with endometriosis (34 of 470). [7.2%]). And without endometriosis (53 out of 881 [6.0%]), even after adjusting for several factors,” says Marceline.

The authors of the study took into account the age of the mother, body mass index before pregnancy, country of birth, the number of births in a woman, the previous caesarean section and a history of preterm birth.

The researchers found no difference between preterm births based on maternal endometriosis phenotype. These phenotypes include isolated superficial peritoneal endometriosis, ovarian endometrioma, and deep endometriosis.


“Pregnancy follow-up outside of normal protocols or a change in management strategy may not be warranted in cases of endometriosis,” Marcellin said.

An expert not involved in the study said the new article highlights important new research avenues. But should not be taken as the final word on the link between endometriosis and preterm birth.

Of the 1351 participants in the study who gave birth to one child after 22 weeks of pregnancy, 470 were assigned to the endometriosis group, and 881 were assigned to the control group.

The authors conclude: “Pregnant women with endometriosis should not be considered as having an exceptionally high risk of preterm birth. However, further studies are needed to explore the possibility of other adverse perinatal outcomes or specific but rare complications.”

Daniela Carusi, MD, said the difficulty with the study design is that “preterm birth is not one problem or one disease.”

Many different problems can end in premature birth. Sometimes it is, for example, an infection, inflammation or bleeding in the uterus, or hypertension in the mother. All of which can lead to premature birth, she explained.

“This study inherently brings all of these things together,” said Carusi, chief of the Department of Surgical Obstetrics. And Placental Anomalies in the Department of Obstetrics and Gynecology at Brigham and Women’s Hospital in Boston. “It’s possible that endometriosis could have a big impact in one of these areas and not affect other areas, but the study design won’t be able to account for that.”

Editors: results challenge findings from previous studies

In an accompanying commentary, Liisu Saavalainen, MD, and Oskari Heikinheimo, MD. Both from the Department of Obstetrics and Gynecology, University of Helsinki, Finland, write that several previous studies have shown that women with endometriosis have a slightly higher risk of preterm birth.

These studies were mostly retrospective and differed in how they classified endometriosis and how they selected patients, they write. In addition, most of the women in these studies tended to be infertile.

The study by Marcellin and colleagues differs from previous similar studies. In that it was prospective and assessed the risk of preterm birth in women with and without endometriosis. Conducted in several maternity hospitals in France. Women with endometriosis were classified according to the severity of the disease.

Editors write:[T]The new results of Marcellin et al. challenge the results of most previous studies on this topic. These results are valuable and comforting. However, they may also prompt new research into the pregnancy risks associated with different types of endometriosis. It’s a good news”.

Carusi said the study was done well and included a particularly large size. Complementing the study, she said it was important to talk about this little-discussed complication of pregnancy.

The study was funded by research grants from the French Ministry of Health and sponsored by the Département de la Recherche Clinique et du Développement de l’Assistance Publique-Hôpitaux de Paris. Carusi reports no relevant financial relationship. Study co-author reports personal fees from Bioserinity and Ferring outside of submitted work. There were no other disclosures.

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