Endometriosis and adverse maternal, fetal and neonatal outcomes, a systematic review and meta-analysis.
Endometriosis and adverse maternal, fetal and neonatal outcomes, a systematic review and meta-analysis.
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DOI：
10.1093/humrep/dey269
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发表时间：
2018-10-01
期刊：
影响因子：
--
通讯作者：
Chen I
中科院分区：
文献类型：
--
作者：
Lalani S;Choudhry AJ;Firth B;Bacal V;Walker M;Wen SW;Singh S;Amath A;Hodge M;Chen I
子宫内膜异位症如何与妊娠的不良母体、胎儿和新生儿结局相关？患有子宫内膜异位症的女性发生严重和重要不良母体（先兆子痫、妊娠期糖尿病、前置胎盘和剖宫产）和胎儿或新生儿结局（早产、PPROM、小于胎龄儿、死产和新生儿死亡）的风险升高。许多研究表明子宫内膜异位症与某些不良的母体和胎儿结局之间存在关联，但结果与使用辅助生殖技术的潜在混淆相冲突。对评价子宫内膜异位症对母体、胎儿和新生儿结局影响的观察性研究（1990年1月1日至2017年12月31日）进行了系统综述和荟萃分析。如果研究是前瞻性或回顾性队列研究或病例对照研究，则考虑纳入研究;包括孕龄大于20周的子宫内膜异位症妇女;包括无子宫内膜异位症的妊娠妇女的对照组;并且报告了至少一种感兴趣的结局。每项研究均由两名独立评审员进行纳入审查、数据提取和偏倚风险评估。检索策略确定了33项研究（样本量，n = 3 280 488）纳入。与没有子宫内膜异位症的妇女相比，子宫内膜异位症妇女先兆子痫的几率更高（比值比[OR]= 1.18 [1.01 - 1.39]）、妊娠期高血压和/或先兆子痫（OR = 1.21 [1.05 - 1.39]），妊娠期糖尿病（OR = 1.26 [1.03 - 1.55]），妊娠期胆汁淤积症（OR = 4.87 [1.85 - 12.83]），前置胎盘（OR = 3.31 [2.37，4.63]），产前出血（OR = 1.69 [1.38 - 2.07]），产前住院产时难产（OR = 1.45 [1.04 - 2.01]）和剖宫产（OR = 1.86 [1.51 - 2.29]）。子宫内膜异位症妇女的胎儿和新生儿也更容易发生早产胎膜早破（OR = 2.33 [1.39 - 3.90]），早产（OR = 1.70 [1.40 - 2.06]），小于胎龄儿<10th %（OR = 1.28 [1.11 - 1.49]）、入住NICU（OR = 1.39 [1.08 - 1.78]）、死产（OR = 1.29 [1.10，1.52]）和新生儿死亡（莫尔= 1.78 [1.46 - 2.16]）。在自发受孕的妇女亚组中，子宫内膜异位症与前置胎盘、剖宫产、早产和低出生体重有关。在使用辅助生殖技术受孕的妇女亚组中，发现子宫内膜异位症与前置胎盘和早产有关。与任何系统性综述一样，该综述受到纳入研究质量的限制。子宫内膜异位症的诊断和对照组的选择在研究中并不一致。然而，潜在错误分类的影响将偏向零假设。在我们的荟萃分析中观察到子宫内膜异位症与重要和严重的妊娠结局之间的相关性，特别是死胎和新生儿死亡，值得关注，并需要进一步研究以阐明观察结果的机制。Shifana Lalani博士得到医生服务公司基金会研究赠款的支持，Innie Chen博士得到渥太华大学生殖人口健康和健康服务临床研究主席的支持。Singh博士声明与拜耳、Abvie、Allergan和库珀外科有利益冲突。所有其他作者都没有利益冲突。PROSPERO CRD 42015013911。
How is endometriosis associated with adverse maternal, fetal and neonatal outcomes of pregnancy? 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). 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. 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. 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. 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. 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. 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. 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. PROSPERO CRD42015013911.
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DOI：
10.5402/2012/451915
发表时间：
2012-01-01
期刊：
ISRN obstetrics and gynecology
影响因子：
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作者：
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影响因子：
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DOI：
10.1111/1471-0528.12366
发表时间：
2013-10-01
影响因子：
5.8
作者：
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通讯作者：
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影响因子：
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通讯作者：
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