Association between adenomyosis and maternal and neonatal outcomes: a systematic review and meta-analysis

Adenomyosis has garnered increasing attention for its association with adverse pregnancy outcomes in recent years. However, findings across studies remain inconsistent. This meta-analysis of cohort studies evaluated the impact of adenomyosis on maternal and perinatal outcomes.

A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted to identify relevant studies published from their inception to September 25, 2025. Eligible studies included those comparing pregnancy and obstetric outcomes between women with adenomyosis and those without. To quantify the association between adenomyosis and unfavorable outcomes, meta-analyses were conducted using R 4.3.2 and STATA 12.0, yielding risk ratios (RRs) and 95% confidence intervals (CIs). Heterogeneity across studies was evaluated using Cochran's Q test, I² statistics, and 95% prediction intervals (PIs).

This meta-analysis synthesized data from 25 cohort studies, encompassing 24,113 women diagnosed with adenomyosis and 8,890,014 controls. The pooled analysis revealed that compared with controls, patients with adenomyosis exhibited significantly lower clinical pregnancy rate (RR [95% CI] = 0.753 [0.625-0.907], 95% PI: 0.433-1.311) and live birth rate (RR [95% CI] = 0.613 [0.469-0.801], 95% PI: 0.254-1.479), alongside markedly higher risks of miscarriage and preterm birth (all p < 0.05). The analysis also identified an increased risk of adverse outcomes, including small for gestational age, placenta previa, cesarean section, low birth weight (LBW), pre-eclampsia, postpartum hemorrhage, hypertensive disorders of pregnancy, and preterm premature rupture of membranes among patients with adenomyosis (all p < 0.05). Subgroup analyses indicated that women undergoing assisted reproductive technology continued to experience diminished clinical pregnancy and live birth rates, as well as increased risks of miscarriage, placenta previa, LBW, and pre-eclampsia. Moreover, the findings suggested that Asian populations may be more susceptible to pregnancy complications and adverse obstetric outcomes compared to Caucasian populations.

Adenomyosis is associated with various adverse pregnancy and neonatal outcomes. Pregnancies affected by this condition should be classified as high-risk, necessitating careful medical supervision and prompt, tailored interventions to mitigate potential complications throughout gestation.