Maternal endometriosis: An independent risk factor for long-term infectious morbidity of the offspring

Endometriosis, a debilitating disease characterized by chronic inflammation, might be associated with adverse pregnancy outcomes. However, the long-term health implications for offspring born to mothers with endometriosis remain inadequately explored. The maternal immune response in pregnancy is crucial for fetal development and growth, and the pro-inflammatory state of endometriosis may alter fetal immunologic programming. We aimed to assess an association between fetal exposure to maternal endometriosis and long-term risk of infectious morbidity for the offspring. We conducted a retrospective population-based cohort study, comparing offspring of mothers with and without endometriosis. We followed the offspring longitudinally, tracking the time to their first diagnosis with an infectious disease made in a community-based clinic or hospitalization. A hazards plot was used to compare the cumulative incidence of offspring infectious morbidity between the study groups. A Cox regression model was constructed to evaluate an association between maternal endometriosis and offspring infectious morbidity, adjusting for possible confounders. A total of 232,476 singleton deliveries were included; 224 deliveries of mothers with endometriosis were compared to those without endometriosis. The cumulative incidence of infectious morbidity in offspring born to mothers with endometriosis was higher, using a hazards plot (p = 0.005). Likewise, a Cox regression model, adjusted for gestational age, fertility treatments, cesarean delivery, maternal diabetes, obesity, smoking and mother age at birth found that fetal exposure to maternal endometriosis was an independent risk factor for long-term infectious morbidity of the offspring (adjusted HR 1.17, 95 %CI 1.01-1.36, p = 0.049). In gestational age-stratified analyses, the association between maternal endometriosis and offspring infectious morbidity was driven primarily by term-born offspring. Fetal exposure to maternal endometriosis is an independent risk factor for long-term infectious morbidity of the offspring.