Adverse Pregnancy Outcomes in Endometriosis - Myths and Realities

There is increasing interest in the long-term health and comorbid conditions associated with endometriosis for both women and neonates. The purpose of this review was to synthesize and discuss the current state of the literature investigating endometriosis and risk of adverse pregnancy outcomes.

Methodologic considerations for studying endometriosis and adverse pregnancy outcomes include complexities regarding the comparison population, endometriosis definition, sample size, residual confounding, and interactions. The current research on endometriosis and adverse pregnancy outcomes should be interpreted cautiously. To date, evidence suggests that endometriosis may be associated with higher risk of ectopic pregnancy, placenta previa, preterm birth, and cesarean section. While an association with miscarriage and stillbirth has been consistently observed, the relative risk was small.

Pregnant women with endometriosis may be at higher risk for certain adverse pregnancy outcomes and may therefore benefit from additional monitoring. However, additional research is needed to confirm these associations and should focus on ensuring studies have internal and external validity, as well as, investigate the potential for differences in endometriosis phenotypes. Moreover, future research should focus on understanding potential mechanisms of association and better understanding how early interventions, through increased monitoring or screening during pregnancy, may improve outcomes.