目的:调查:首先,子宫内膜异位症与早产之间的关系;第二,子宫内膜异位症和先兆子痫之间的关系,前置胎盘,产后出血,死产,和小于胎龄儿(按出生体重评估);第三,在使用和不使用医学辅助生殖的情况下,这些不良妊娠结局的风险。
方法:多中心回顾性队列研究。
方法:103个法国产妇单位。
方法:从1999年到2016年,368,935名妇女(377,338名婴儿)分娩。
方法:子宫内膜异位症,定义为单一疾病实体(子宫内膜异位症和/或淀粉样变性)。
方法:主要结局是早产率(<37周和<33周)。次要结果是先兆子痫的发生率,前置胎盘,产后出血,死产,和胎龄小的新生儿。
结果:子宫内膜异位症组的女性在纳入妊娠之前有更多的不孕史(34.7vs5.0%,P<10-4),怀孕期间住院更多(27.4vs.19.8%,P<10-4),和更多的计划剖宫产(14.0vs.8.7,P<10-4);他们更经常是未产的(51.7vs.43.4%,P<10-4)。子宫内膜异位症组早产<37周的患病率为11.1%,未暴露组为7.7%,和<33周分别为3.1%和2.2%。对于早产<37周(1.40,95CI1.18-1.67)或<33周(1.53,95CI1.08-2.16),子宫内膜异位症中混杂因素的校正相对风险高于未暴露组。对于次要结果,调整后的先兆子痫风险比,前置胎盘,产后出血,子宫内膜异位症组小于胎龄状态<第10百分位数和<第5百分位数更高。两组死产和小于胎龄状态<3百分位数的调整风险比没有差异,和那些通过医学辅助生殖对早产<37周和<33周进行分层后的患者在次要结局方面没有统计学上的显著差异,在医学辅助生殖和非医学辅助生殖亚组中,只有前置胎盘的风险较高.
结论:患有子宫内膜异位症的孕妇比没有子宫内膜异位症的孕妇有更高的早产和其他不良妊娠结局的风险。
OBJECTIVE: To investigate first, the association between endometriosis and preterm birth; second, the associations between endometriosis and preeclampsia, placenta previa, postpartum hemorrhage, stillbirth, and small-for-gestational-age infants (assessed by birthweight); and third, the risk of these adverse pregnancy outcomes with and without the use of medically assisted reproduction.
METHODS: Multicenter retrospective cohort study.
METHODS: A total of 103 French maternity units.
METHODS: Deliveries by 368,935 women (377,338 infants) from 1999 through 2016.
METHODS: Endometriosis, defined as a single disease entity (endometriosis and/or ademyosis) MAIN OUTCOMES MEASURES: The main outcome was the preterm birth rate (both <37 and <33 weeks). The secondary outcomes were rates of preeclampsia, placenta previa, postpartum hemorrhage, stillbirth, and small-for-gestational-age neonates.
RESULTS: Women in the endometriosis group had more frequent histories of infertility before the included pregnancy (34.7 vs. 5.0%), more hospitalizations during the pregnancy (27.4 vs. 19.8%), and more planned cesarean sections (14.0 vs. 8.7); they more often were nulliparous (51.7 vs. 43.4%). The prevalence of preterm birth at <37 weeks was 11.1% in the endometriosis group and 7.7% in the unexposed group, and for <33 weeks, it was 3.1% and 2.2%, respectively. The adjusted relative risk for confounding factors was higher in the endometriosis than the unexposed group for preterm delivery <37 weeks (1.40, 95% confidence interval, 1.18-1.67) or <33 weeks (1.53, 95% confidence interval, 1.08-2.16). For the secondary outcomes, the adjusted risk ratios for preeclampsia, placenta previa, postpartum hemorrhage, and small-for-gestational-age status of <10th and <5th percentiles were higher in the endometriosis group. The adjusted risk ratios for stillbirth and small-for-gestational-age status of <3rd percentile did not differ between the two groups, and those after stratification by medically assisted reproduction for preterm birth at <37 and <33 weeks did not differ statistically significantly between them, for the secondary outcomes, only the risk of placenta previa was higher in the medically assisted reproduction and non-medically assisted reproduction subgroups.
CONCLUSIONS: Pregnant women with endometriosis had higher risks of preterm birth and other poor pregnancy outcomes than women without endometriosis.