Systematic review and meta-analysis of adverse pregnancy outcomes with different types of adenomyosis

Different types of adenomyosis have distinct impacts on various pregnancy outcomes. The influence of diffuse and focal adenomyosis on adverse pregnancy outcomes remains controversial.

To examine the effects of diffuse and focal adenomyosis on adverse pregnancy outcomes in women.

We conducted searches on PubMed, Embase, Web of Science, and the Cochrane Database for studies published between January 1950 and June 2024.

We included observational studies that identified medically confirmed adverse pregnancy outcomes (preterm birth, hypertensive disorders of pregnancy, and fetal growth restriction) as endpoints.

Two researchers independently screened and selected pertinent studies. The methodological quality of these selected studies was assessed using the Newcastle-Ottawa Quality Assessment Form for Case-control and Cohort studies. Data analysis was primarily performed using Stata software. Dichotomous data for all adverse pregnancy outcomes were reported as odds ratios (ORs) with 95% confidence intervals (CIs) and synthesized in a meta-analysis using a fixed-effects model.

Five studies (involving 390 women with diffuse adenomyosis and 233 women with focal adenomyosis) were included in the meta-analysis. The analysis indicated that diffuse adenomyosis was significantly associated with an increased risk of adverse pregnancy outcomes (OR 2.59, 95% CI 1.73-3.88; P < 0.001). Women with diffuse adenomyosis had higher odds of experiencing preterm birth(OR1.66, 95% CI1.03-2.67, P = 0.038) and hypertensive disorders of pregnancy (OR 2.23, 95% CI 1.32-3.77; P = 0.002).

Women with diffuse adenomyosis are more likely to experience preterm birth and hypertensive disorders of pregnancy compared with those with focal adenomyosis.