Pregnancy outcomes after assisted reproductive technology among women with endometriosis in Ukraine: results a multicenter study

Aidyn G Salmanov; Volodymyr V Artyomenko; Victor O Rud; Olena A Dyndar; Oleksandra Z Dymarska; Svitlana M Korniyenko; Orusia A Kovalyshyn; Anastasia S Padchenko; Vitalii S Strakhovetskyi

doi:10.36740/wlek202407101

Pregnancy outcomes after assisted reproductive technology among women with endometriosis in Ukraine: results a multicenter study

Salmanov AG, Artyomenko VV, Rud VO, Dyndar OA, Dymarska OZ, Korniyenko SM, Kovalyshyn OA, Padchenko AS, Strakhovetskyi VS

Wiadomosci lekarskie (Warsaw, Poland : 1960), 2024

DOI 10.36740/wlek202407101 PMID 39241126

RRM Academy Synopsis

Endometriosis linked to higher preterm birth risk after ART in Ukraine

Endometriosis was linked to preterm birth after ART (adjusted odds ratio 1.33) in a retrospective cohort of 11,271 singleton births in Ukraine. Before adjustment, about 7 out of 100 births to women with endometriosis were preterm, against about 5 out of 100 to women without. Women with endometriosis also had higher risks of bleeding, placental problems, pre-eclampsia and Caesarean section.

Study at a glance, retrospective cohort: Endometriosis linked to higher preterm birth risk after ART — Study at a glance, retrospective cohort of 11,271 singleton births: Endometriosis linked to higher preterm birth risk after ART. Source: Salmanov AG et al., 2024, PMID 39241126.

Key Findings

Preterm birth, adjusted odds ratio 1.33 (95% CI 1.23–1.44), among 94 women with endometriosis who delivered 102 infants, within 11,271 singleton births.
Preterm birth by type: odds ratio 1.61 (95% CI 1.41–1.83) for induced (Caesarean section) preterm birth and 1.22 (95% CI 1.11–1.34) for spontaneous preterm birth.
Antepartal bleeding or placental complications, adjusted odds ratio 1.76 (95% CI 1.56–1.99). Pre-eclampsia, adjusted odds ratio 1.13 (95% CI 1.02–1.26).
Caesarean section occurred in 21.57% of births with endometriosis and 13.48% without, adjusted odds ratio 1.47 (95% CI 1.40–1.54).
Small-for-gestational-age birth, adjusted odds ratio 1.04 (95% CI 0.92–1.17), and stillbirth, adjusted odds ratio 1.02 (95% CI 0.74–1.40), showed no association with endometriosis.

Interpretation

This retrospective cohort reports associations between endometriosis and pregnancy outcomes in women who conceived with ART in Ukraine. The endometriosis group had 102 births, and 7 were preterm. Some women were classed as having endometriosis from clinical suspicion or ultrasound, without laparoscopy. The authors could not assess disease stage or type. The paper marks its ART comparison as data not shown and gives no results split by ART use. The authors advise increased antenatal surveillance for pregnant women with endometriosis.

RRM Context

Every one of the 94 women had the diagnosis recorded before delivery. ART achieves pregnancy without treating the endometriosis, while restorative reproductive medicine finds the cause first and then treats it. Excision is the surgical standard.

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

Abstract

Aim

To evaluate the association between adverse pregnancy outcome, assisted reproductive technology (ART) and a previous diagnosis of endometriosis in Ukraine.

Materials and Methods

We conducted a multicentre retrospective cohort study was based on infertility surveillance data among women reproductive age from January 1st, 2017 to December 31st, 2021 in Ukraine. The patients from 10 Ukrainian regions who achieved singleton pregnancy by ART were included in this study. Linked hospital, pregnancy/birth and mortality data were used. Logistic regression analysis was performed to calculate odds ratios (OR) and 95 % confidence interval (CI) for the rates of adverse pregnancy outcomes.

Results

During study period within the cohort of 11,271 singleton births, 94 women with endometriosis diagnosed before birth delivered 102 infants. Compared with women without endometriosis, women with endometriosis had higher risks of preterm birth [adjusted odds ratio 1.33, 95% confidence interval (CI), 1.23-1.44]. Women with endometriosis had higher risks of antepartal bleeding/placental complications, pre-eclampsia and Caesarean section. There was no association between endometriosis and risk of SGA-birth or stillbirth.

Conclusions

Endometriosis and ART use are both independently associated with increased risk of preterm birth, antepartum haemorrhage, placenta praevia and planned birth. These findings are clinically relevant to obstetricians for distinguishing high- and low-risk pregnancies. Pregnant women with endometriosis require increased antenatal surveillance.

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.

22 min read

Topics

Assisted Reproduction › Safety and Risks › Neonatal and Birth Outcomes · Birth and Delivery › Birth Outcomes › Maternal Morbidity · Endometriosis › Fertility and Outcomes › Conception After Excision

Aidyn G Salmanov, Volodymyr V Artyomenko, Victor O Rud, Olena A Dyndar, Oleksandra Z Dymarska, Svitlana M Korniyenko, Orusia A Kovalyshyn, Anastasia S Padchenko, Vitalii S Strakhovetskyi

A Salmanov, V Artyomenko, V Rud, O Dyndar, O Dymarska, S Korniyenko, O Kovalyshyn, A Padchenko, V Strakhovetskyi

PMID 39241126 39241126 DOI 10.36740/wlek202407101 10.36740/wlek202407101 Salmanov et al. 2024, Salmanov 2024

Pregnancy outcomes after assisted reproductive technology among women with endometriosis in Ukraine: results a multicenter study

Endometriosis linked to higher preterm birth risk after ART in Ukraine

Key Findings

Interpretation

RRM Context

Abstract

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Topics

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