Endometriosis, assisted reproduction technology, and risk of adverse pregnancy outcome
Endometriosis, assisted reproduction technology, and risk of adverse pregnancy outcome
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DOI：
10.1093/humrep/dep186
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发表时间：
2009-09-01
影响因子：
6.1
通讯作者：
Falconer, Henrik
中科院分区：
文献类型：
--
作者：
Stephansson, Olof;Kieler, Helle;Falconer, Henrik
子宫内膜异位症是一种常见的妇科疾病，以局部和全身炎症为特征，可导致不孕，从而增加辅助生殖技术（ART）的使用。我们的目的是评估有子宫内膜异位症病史的妇女与无子宫内膜异位症病史的妇女相比，早产、小于胎龄儿（SGA）、死产、剖腹产、先兆子痫和产前出血的风险。在一项包括1 442 675例单胎分娩的瑞典全国性研究中，我们评估了不良妊娠结局、ART和子宫内膜异位症的既往诊断。通过将1992年至2006年的医疗出生登记数据与1964年至2006年的患者登记数据联系起来获得信息。在8922名诊断为子宫内膜异位症的妇女中，有13090名单胎分娩。与无子宫内膜异位症的妇女相比，子宫内膜异位症妇女有更高的早产风险[校正比值比1.33，95%置信区间（CI），1.23-1.44]。在子宫内膜异位症的妇女中，11.9%的妇女在ART后怀孕，而没有子宫内膜异位症的妇女只有1.4%。接受ART治疗的妇女与子宫内膜异位症相关的早产风险为1.24（95%CI，0.99-1.57），未接受ART治疗的妇女为1.37（95%CI，1.25-1.50）。子宫内膜异位症妇女发生产前出血/胎盘并发症、先兆子痫和剖腹产的风险更高。子宫内膜异位症与SGA-分娩或死产风险之间没有关联。子宫内膜异位症似乎是早产的危险因素，与ART无关。子宫内膜异位症患者更可能通过剖腹产分娩，并遭受产前出血/胎盘并发症和先兆子痫。
Endometriosis, a common gynaecological disease, is characterized by local and systemic inflammation, which may cause infertility and consequently, increased utilization of assisted reproduction technology (ART). We aimed to estimate the risk for preterm birth, small-for-gestational-age (SGA) birth, stillbirth, Caesarean section, pre-eclampsia and antepartal haemorrhage among women with a previous diagnosis of endometriosis compared with women with no previous diagnosis of endometriosis.In a nationwide Swedish study including 1 442 675 singleton births we assessed the association between adverse pregnancy outcome, ART and a previous diagnosis of endometriosis. Information was obtained by linkage of data between 1992 and 2006 in the Medical Birth Register with the Patient Register between 1964 and 2006.There were 13 090 singleton births among 8922 women diagnosed with endometriosis. Compared with women without endometriosis, women with endometriosis had higher risks of preterm birth [adjusted odds ratio 1.33, 95% confidence interval (CI), 1.23-1.44]. Among women with endometriosis 11.9% conceived after ART compared with 1.4% of women without endometriosis. The risk of preterm birth associated with endometriosis among women with ART was 1.24 (95% CI, 0.99-1.57), and among women without ART 1.37 (95% CI, 1.25-1.50). Women with endometriosis had higher risks of antepartal bleeding/placental complications, pre-eclampsia and Caesarean section. There was no association between endometriosis and risk of SGA-birth or stillbirth.Endometriosis appears to be a risk factor for preterm birth, irrespective of ART. Women with endometriosis may be more likely to be delivered by Caesarean section and to suffer from antepartal haemorrhage/placental complications and pre-eclampsia.