Pregnancy outcomes in women with different endometriosis lesion types: A review of current evidence

IF 1.6 4区医学 Q3 OBSTETRICS & GYNECOLOGY

Journal of Obstetrics and Gynaecology Research Pub Date : 2025-05-19 DOI:10.1111/jog.16321

Hrishikesh Munshi, Nayna Barada, Sandhya Anand, Rahul K. Gajbhiye

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引用次数: 0

Abstract

Background

Endometriosis, affecting ~10% of women of reproductive age, is associated with infertility and adverse pregnancy outcomes. The condition is classified into superficial peritoneal endometriosis (SUP), ovarian endometriomas (OMA), and deep infiltrating endometriosis (DIE), with varying impacts on pregnancy. This review examines the relationship between lesion subtypes and adverse maternal–fetal outcomes.

Methods

A comprehensive literature search was conducted using PubMed, Scopus, Google Scholar, and Web of Science. Studies published between 2014 and 2025 that investigated pregnancy outcomes in women with endometriosis were included. Articles were screened based on predefined inclusion criteria, with 10 studies meeting the final selection. Outcomes analyzed included placenta previa, preterm birth, stillbirth, pre-eclampsia, intrauterine growth restriction (IUGR), and miscarriage.

Results

Women with endometriosis exhibited a significantly higher risk of placenta previa, particularly those with Stages III–IV disease (p < 0.05) and deep infiltrating lesions (p < 0.05). The risk was further elevated in pregnancies conceived via assisted reproductive technologies (ART) (p = 0.01). The likelihood of preterm birth was higher in patients with bladder DIE (p = 0.02) and rectal DIE (p = 0.01), but not in those with ovarian endometriomas. Meta-analysis data indicated a moderate association between endometriosis and pre-eclampsia (p < 0.05), particularly in patients with deep lesions (p = 0.03). Stillbirth risk showed inconsistent findings, with some studies reporting an increased risk (p < 0.05) while others found no significant association. IUGR and small-for-gestational-age (SGA) infants were more common in women with DIE (p = 0.03) and advanced-stage disease (p = 0.05). Miscarriage risk was elevated in patients with superficial endometriosis (p < 0.05) compared with those with DIE or OMA.

Conclusion

Endometriosis, particularly ovarian and deep infiltrating, significantly increases the risk of placenta previa, preterm birth, IUGR, and miscarriage. ART conception further amplifies these risks. While conflicting evidence exists for stillbirth and pre-eclampsia, lesion-specific trends suggest a need for individualized obstetric management. Larger studies are required to clarify these associations and optimize pregnancy care for affected women.

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不同子宫内膜异位症病变类型妇女的妊娠结局：当前证据综述

子宫内膜异位症影响约10%的育龄妇女，与不孕和不良妊娠结局有关。该病分为浅表性腹膜子宫内膜异位症（SUP）、卵巢子宫内膜异位症（OMA）和深浸润性子宫内膜异位症（DIE），对妊娠的影响各不相同。本文综述了病变亚型与不良母胎结局之间的关系。方法采用PubMed、Scopus、谷歌Scholar、Web of Science等数据库进行综合文献检索。2014年至2025年间发表的研究调查了子宫内膜异位症女性的妊娠结局。根据预先确定的纳入标准对文章进行筛选，有10项研究符合最终选择。结果分析包括前置胎盘、早产、死产、先兆子痫、宫内生长受限（IUGR）和流产。结果子宫内膜异位症患者发生前置胎盘的风险明显增加，尤其是III-IV期（p < 0.05）和深度浸润性病变（p < 0.05）。通过辅助生殖技术（ART）妊娠的风险进一步升高（p = 0.01）。膀胱死亡（p = 0.02）和直肠死亡（p = 0.01）患者早产的可能性更高，而卵巢子宫内膜异位瘤患者则不然。荟萃分析数据显示子宫内膜异位症与先兆子痫之间存在中度关联（p < 0.05），特别是在深部病变患者中（p = 0.03）。死产风险显示出不一致的结果，一些研究报告风险增加（p < 0.05），而另一些研究没有发现显著关联。IUGR和小胎龄儿（SGA）在死亡（p = 0.03）和疾病晚期（p = 0.05）的妇女中更为常见。浅表性子宫内膜异位症患者与DIE或OMA患者相比，流产风险升高（p < 0.05）。结论子宫内膜异位症，尤其是卵巢及深部浸润性子宫内膜异位症可显著增加前置胎盘、早产、IUGR和流产的风险。ART受孕进一步放大了这些风险。虽然存在与死产和子痫前期相矛盾的证据，但病变特异性趋势表明需要个性化的产科管理。需要更大规模的研究来澄清这些关联，并优化受影响妇女的妊娠护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Obstetrics and Gynaecology Research 医学-妇产科学

CiteScore

3.10

自引率

0.00%

发文量

376

审稿时长

3-6 weeks

期刊介绍： The Journal of Obstetrics and Gynaecology Research is the official Journal of the Asia and Oceania Federation of Obstetrics and Gynecology and of the Japan Society of Obstetrics and Gynecology, and aims to provide a medium for the publication of articles in the fields of obstetrics and gynecology. The Journal publishes original research articles, case reports, review articles and letters to the editor. The Journal will give publication priority to original research articles over case reports. Accepted papers become the exclusive licence of the Journal. Manuscripts are peer reviewed by at least two referees and/or Associate Editors expert in the field of the submitted paper.