Short-term obstetrical and neonatal complications in women with endometriosis

Endometriosis is a chronic gynecological condition that affects women in their reproductive age and could potentially lead to reproductive difficulties. Despite extensive research into the impact of endometriosis on fertility and reproductive health, its association with obstetric complications and short-term neonatal outcomes is still an area of limited understanding with conflicting evidence in published studies. We conducted this study to explore a potential effect of endometriosis on obstetric and neonatal outcomes.

A retrospective population-based cohort study was conducted comparing obstetric and perinatal complications in women with and without endometriosis. We evaluated all singleton deliveries that occurred between 1991 and 2021 at a tertiary medical center. Fetuses with chromosomal abnormalities or congenital malformations were excluded. Generalized estimation equation (GEE) models were used to control for maternal recurrence in the cohort and for confounding variables.

During the study period, 232,476 deliveries met our inclusion criteria, 0.1% (n = 224) of whom had documented endometriosis. In the univariate analysis, women with endometriosis were significantly older, had higher rates of infertility and diabetes mellitus, and were more likely to undergo cesarean delivery. They also had higher rates of preterm birth and low birthweight infants, whereas perinatal mortality rates were comparable between the groups. In the GEE models, after controlling for maternal age, gravidity, and fertility treatments, the association for most of the aforementioned variables was no longer statistically significant. However, women with endometriosis were found to have a significant independent higher risk for cesarean delivery (adjusted OR 2.14 (1.62-2.83, p < 0.001).

Among the obstetrical and perinatal complications investigated in this study, endometriosis was found to be an independent risk factor for cesarean delivery, while all other pregnancy outcomes were comparable to women without endometriosis.