CoChat
Sign Up
Cited by 206Endometriosis Research and TreatmentEctopic Pregnancy Diagnosis and ManagementPregnancy and preeclampsia studies

Endometriosis and adverse maternal, fetal and neonatal outcomes, a systematic review and meta-analysis

Open access
Lalani, S, Choudhry, A J, Firth, B, Bacal, V, Walker, Mark, Wen, S W, Singh, S, Amath, A +2 more·2018·Human Reproduction
DOI 10.1093/humrep/dey269PMC PMC6145420
Open this paper in CoChat — free accountOpen PDF

Abstract

STUDY QUESTION: How is endometriosis associated with adverse maternal, fetal and neonatal outcomes of pregnancy? SUMMARY ANSWER: Women with endometriosis are at elevated risk for serious and important adverse maternal (pre-eclampsia, gestational diabetes, placenta praevia and Cesarean section) and fetal or neonatal outcomes (preterm birth, PPROM, small for gestational age, stillbirth and neonatal death). WHAT IS KNOWN ALREADY: A number of studies have shown an association between endometriosis and certain adverse maternal and fetal outcomes, but the results have been conflicting with potential for confounding by the use of assisted reproductive technology. STUDY DESIGN, SIZE, DURATION: A systematic review and meta-analysis of observational studies (1 January 1990-31 December 2017) that evaluated the effect of endometriosis on maternal, fetal and neonatal outcomes was conducted. PARTICIPANTS/MATERIALS, SETTING, METHODS: Studies were considered for inclusion if they were prospective or retrospective cohort or case-control studies; included women greater than 20 weeks gestational age with endometriosis; included a control group of gravid women without endometriosis; and, reported at least one of the outcomes of interest. Each study was reviewed for inclusion, data were extracted and risk of bias was assessed by two independent reviewers. MAIN RESULTS AND THE ROLE OF CHANCE: The search strategy identified 33 studies (sample size, n = 3 280 488) for inclusion. Compared with women without endometriosis, women with endometriosis had higher odds of pre-eclampsia (odds ratio [OR] = 1.18 [1.01-1.39]), gestational hypertension and/or pre-eclampsia (OR = 1.21 [1.05-1.39]), gestational diabetes (OR = 1.26 [1.03-1.55]), gestational cholestasis (OR = 4.87 [1.85-12.83]), placenta praevia (OR = 3.31 [2.37, 4.63]), antepartum hemorrhage (OR = 1.69 [1.38-2.07]), antepartum hospital admissions (OR = 3.18 [2.60-3.87]), malpresentation (OR = 1.71 [1.34, 2.18]), labor dystocia (OR = 1.45 [1.04-2.01]) and cesarean section (OR = 1.86 [1.51-2.29]). Fetuses and neonates of women with endometriosis were also more likely to have preterm premature rupture of membranes (OR = 2.33 [1.39-3.90]), preterm birth (OR = 1.70 [1.40-2.06]), small for gestational age <10th% (OR = 1.28 [1.11-1.49]), NICU admission (OR = 1.39 [1.08-1.78]), stillbirth (OR = 1.29 [1.10, 1.52]) and neonatal death (MOR = 1.78 [1.46-2.16]). Among the subgroup of women who conceived spontaneously, endometriosis was found to be associated with placenta praevia, cesarean section, preterm birth and low birth weight. Among the subgroup of women who conceived with the use of assisted reproductive technology, endometriosis was found to be associated with placenta praevia and preterm birth. LIMITATIONS, REASONS FOR CAUTION: As with any systematic review, the review is limited by the quality of the included studies. The diagnosis for endometriosis and the selection of comparison groups were not uniform across studies. However, the effect of potential misclassification would be bias towards the null hypothesis. WIDER IMPLICATIONS OF THE FINDINGS: The association between endometriosis with the important and serious pregnancy outcomes observed in our meta-analysis, in particular stillbirth and neonatal death, is concerning and warrants further studies to elucidate the mechanisms for the observed findings. STUDY FUNDING/COMPETING INTEREST(S): Dr Shifana Lalani is supported by a Physicians' Services Incorporated Foundation Research Grant, and Dr Innie Chen is supported by a University of Ottawa Clinical Research Chair in Reproductive Population Health and Health Services. Dr Singh declares conflicts of interests with Bayer, Abvie, Allergan and Cooper Surgical. All other authors have no conflicts of interests to declare. REGISTRATION NUMBER: PROSPERO CRD42015013911.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1093/humrep/dey269

Cites

50 of 50 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Endometriosis-associated complications in pregnancy are rare.

    “Clinicians should be aware of endometriosis-associated complications in pregnancy, although these are rare.”

    From ESHRE guideline: endometriosis (2022) · cites this paper as Lalani et al., 2018

    The Discussion section on stillbirth and neonatal death says these outcomes affect fewer than 1% of all pregnancies. That supports rarity for those specific outcomes, but not the broader claim that endometriosis-associated pregnancy complications generally are rare; the Results section reports increased odds for several other complications without establishing their overall rarity. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Hysterectomy, treatment with GnRH agonists, PID, PCOS and adverse pregnancy outcomes are linked to higher CVD risk.

    “Hysterectomy, treatment with gonadotropin-releasing hormone (GnRH) agonists, PID, PCOS and adverse pregnancy outcomes are linked to higher CVD risk.”

    From Risk of cardiovascular outcomes among women with endometriosis in the United Kingdom: a retrospective matched cohort study (2021) · cites this paper as [18]

    The Results (All included women) and Discussion (Maternal outcomes) examine associations between endometriosis and adverse pregnancy outcomes, not whether those outcomes increase cardiovascular disease risk. Searches for CVD risk, hysterectomy, GnRH agonists, PID and PCOS found no passage in our copy supporting the attributed claim. Page numbers were not provided. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB Meta-analysis of observational studies in epidemiology—a proposal for reporting. J Am Med Assoc 2000; 283: 2008– 2012. 10789670

Cited by

Sorted by citations

Related

Authors
Lalani, S., Choudhry, A. J., Firth, B., Bacal, V, Walker, M., Wen, S. W., Singh, S., Amath, A., Hodge, M., & Chen, I.
Affiliations
  • University of Ottawa (CA)
  • Ottawa Hospital Research Institute (CA)
Corresponding author
Chen, I
ORCID
Venue
Human Reproduction
Publisher
Oxford University Press (OUP)
Published
2018-09-17
Volume
33
Issue
10
Pages
1854-1865
ISSN
  • 0268-1161 (ISSN-L)
  • 1460-2350
DOI
10.1093/humrep/dey269
PMC
PMC6145420
OpenAlex
W2891883011
Cited by
206
References
50
Citations by year
2026: 21 · 2025: 16 · 2024: 31 · 2023: 27 · 2022: 38 · 2021: 37 · 2020: 23 · 2019: 13
FWCI
2.76
Type
journal article
Language
en
Open access
Licence
Locations
  • Human Reproduction (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
  • University of Ottawa
  • Physicians' Services Incorporated Foundation
  • Allergan
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
  • Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
Keywords
endometriosis, pregnancy outcomes, preeclampsia, gestational diabetes mellitus, placenta previa, cesarean section, preterm birth, preterm premature rupture of membranes, small for gestational age, stillbirth, neonatal death, assisted reproduction, maternal morbidity, fetal outcomes, neonatal outcomes, antepartum hemorrhage
MeSH terms
Cesarean Section, Endometriosis, Female, Postpartum Hemorrhage, Humans, Infant, Newborn, Placenta Previa, Pre-Eclampsia, Pregnancy, Prospective Studies, Retrospective Studies, Case-Control Studies, Diabetes, Gestational, Premature Birth, Stillbirth, Perinatal Death

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review