Endometriosis diagnosis, staging and typology and adverse pregnancy outcome  history

Karen C Schliep; Leslie V Farland; Anna Z Pollack; Germaine Buck Louis; Joseph B Stanford; Kristina Allen-Brady; Michael W Varner; Kebba Kah; C Matthew Peterson

doi:10.1111/ppe.12887

Endometriosis Fertility and Outcomes

Endometriosis diagnosis, staging and typology and adverse pregnancy outcome history

Schliep KC, Farland LV, Pollack AZ, Buck Louis G, Stanford JB, Allen-Brady K, Varner MW, Kah K, Peterson CM

Published November 2022 Paediatric and Perinatal Epidemiology, 36(6), 771-781

DOI 10.1111/ppe.12887 PMID 35570746 PMC PMC9588543

RRM Academy Synopsis

Endometriosis is linked to more miscarriages, notably in deep disease

Women with endometriosis reported more miscarriages than women without it, especially with deep disease. A cross-sectional study of 392 women who had been pregnant found this. Some came from surgery, some from the community. Among these women, the median number of pregnancies did not differ.

Key Findings

Endometriosis was found in 109 of 316 women (34%) in the operative cohort and in 9 of 76 women (12%) in the population cohort.
Live birth occurred in 61% of pregnancies in women with endometriosis and 69% in women without, in the operative cohort. The population cohort showed 68% and 77%.
Operative cohort, adjusted: live births aPR 0.94 (95% CI 0.85, 1.03), miscarriages aPR 1.48 (95% CI 1.23, 1.77). Pooled: live birth 0.89 (95% CI 0.81, 0.97), miscarriage 1.32 (95% CI 1.06, 1.66).
Deep endometriosis: 17 of 39 pregnancies (44%) ended in miscarriage, against 134 of 640 (21%) without endometriosis. The aPR was 2.98 (95% CI 1.12, 7.95).
In the operative cohort, the study saw no clear trend in live birth or miscarriage by endometriosis stage.

Interpretation

This cross-sectional study asked women about their past pregnancies, drawing on a surgical cohort and a community cohort. Miscarriage was most common with deep disease. Nearly half of those pregnancies ended in miscarriage. The authors note that recall by questionnaire adds some uncertainty. The findings support larger, prospective studies of endometriosis and pregnancy loss.

RRM Context

Restorative reproductive medicine treats endometriosis as a disease with a cause to find and treat. Deep lesions carried the largest miscarriage signal in this cohort. That fits a root-cause approach to evaluating pregnancy loss before treatment.

Our editorial summary of this paper, not the article's abstract.

Abstract

Background

Women with endometriosis may have an increased risk of adverse pregnancy outcomes. Research has focused on infertility clinic populations limiting generalisability. Few studies report differences by endometriosis severity.

Objectives

We investigated the relationships between endometriosis diagnosis, staging and typology and pregnancy outcomes among an operative and population-based sample of women.

Methods

Menstruating women ages 18-44 years enrolled in the ENDO Study (2007-2009), including the operative cohort: 316 gravid women undergoing laparoscopy/laparotomy at surgical centres in Utah and California; and the population cohort: 76 gravid women from the surgical centres' geographic catchment areas. Pregnancy outcomes were ascertained by questionnaire and included all pregnancies prior to study enrolment. Endometriosis was diagnosed via surgical visualisation in the operative cohort and pelvic magnetic resonance imaging in the population cohort. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) were estimated using generalised linear mixed models for pregnancy outcomes, adjusting for women's age at study enrolment and at pregnancy, surgical site, body mass index and lifestyle factors.

Results

Women in the operative cohort with visualised endometriosis (n = 109, 34%) had a lower prevalence of live births, aPR 0.94 (95% CI 0.85, 1.03) and a higher prevalence of miscarriages, aPR 1.48 (95% CI 1.23, 1.77) compared with women without endometriosis. The direction and magnitude of estimates were similar in the population cohort. Women with deep endometriosis were 2.98-fold more likely (95% CI 1.12, 7.95) to report a miscarriage compared with women without endometriosis after adjusting for women's age at study enrolment and at pregnancy, surgical site and body mass index. No differences were seen between endometriosis staging and pregnancy outcomes.

Conclusions

While there was no difference in number of pregnancies among women with and without endometriosis in a population-based sample, pregnancy loss was more common among women with endometriosis, notably among those with deep endometriosis.

Read the guide

Endometriosis Explained: Diagnosis, Excision Surgery, and the RRM Approach

Endometriosis is a chronic inflammatory disease that drives pain, organ dysfunction, and infertility. How RRM-trained clinicians diagnose and treat it through excision surgery, cycle charting, and longitudinal care.

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Topics

Endometriosis › Fertility and Outcomes › Conception After Excision · Pregnancy › Pregnancy Complications › Hypertensive Disorders · Birth and Delivery › Birth Outcomes › Maternal Morbidity

Karen C Schliep, Leslie V Farland, Anna Z Pollack, Germaine Buck Louis, Joseph B Stanford, Kristina Allen-Brady, Michael W Varner, Kebba Kah, C Matthew Peterson

K Schliep, L Farland, A Pollack, G Louis, Joe Stanford, Joey Stanford, J Stanford, K Allen-Brady, Mike Varner, M Varner, K Kah

PMID 35570746 35570746 DOI 10.1111/ppe.12887 10.1111/ppe.12887 Schliep et al. 2022, Schliep 2022