Endometriosis and higher risk for obstetrical complications: Monitoring immune parameters throughout the pregnancy is the key to minimize obstetrical complications!

Posted By Braverman IVF & Reproductive Immunology || 27-September-2018

A study recently published in the journal Human Reproduction reviewed the risk of occurrence for pregnancy complications, in a meta-analysis based on 33 scientific studies. Over 48 000 pregnant women at 20-weeks or more, with endometriosis have been included in the analysis (ENDO-group). 2.8 million of healthy pregnant women being 20-weeks pregnant or more constitute the control group with no endometriosis (ENDO-free group).

Endometriosis and pregnancy complications: the risks are real and high!
The results of the study showed a strong association of endometriosis with pregnancy complications as seen by:

  • higher rate of pre-eclampsia: +18%
  • higher rate of hypertension: +21%
  • higher rate of gestational diabetes: +26%
  • higher rate of c-section that almost doubles: +86%
  • the rate of placenta praevia tripled: +231%
  • higher rate of ante-partum hemorrhage: +69%
  • higher rate of gestational cholestasis (buildup of bile acid in the liver that spill in the bloodstream and causes itching): +387% (risk is almost multiplied by a factor 5!)

    The neonatal outcomes have also been assessed and an increased risk has been reported for:

  • preterm premature rupture of membranes (PPROM): +133%
  • Preterm birth: +70%
  • Small for gestational age: +28%
  • Stillbirth: +29%
  • Neonatal death: +78%

    These findings don’t come as a surprise as many large-scale, retrospective studies including for some, over 13 000 women diagnosed with endometriosis (1) reported higher rate of preterm-birth (2-3), pre-eclampsia (1-2), obstetrical bleeding (1,4), c-section (4-6) and placenta previa (7) in the ENDO group as compared to the ENDO-free patients.

    Interestingly, this study did a second analysis comparing patients who conceived spontaneously versus those who used assisted reproduction. Findings showed that patients conceiving naturally have higher risk for placenta praevia (+583%) than those using IVF (+233%), higher rate of preterm birth (+70% versus +27%) and higher rate of c-section (+76% versus +24%).

    These results may be taken with a grain of salt as the differences seen can be due to different population size among other parameters as those listed below.

    The review is limited by the quality and heterogeneity of the studies included. The diagnosis for endometriosis differs from one study to the other, while some endometriosis cases are surgically proven, other studies used the International Classification of Diseases (ICD) codes to identify endometriotic patients. Further, there is a lack of stage specific analysis while endometriosis is a spectrum where the different stages in the progression of the disease may differentially affect pregnancy. In a similar way, the degree of patient infertility is not reported.

    It is very possible that the patients who got spontaneously pregnant had early onset of endometriosis while the patients using assisted reproduction have a more advanced stage of endometriosis. Lastly, are the endometriotic patients treated prior to pregnancy and if so how? This remains unclear.

    You may know that the very nature of endometriosis, an inflammatory disease (8), could play a key role in triggering preterm birth and other obstetrical complications. In addition, endometriosis has also been described as a condition inducing a defective placentation (9).

    Inflammation and poor placentation could be responsible of the many obstetrical and neonatal complications reported in this review including still birth. For more information, read our blogs on the topic, “Endometriosis increases your risk for pregnancy complications”, “Critical need of early screening, close monitoring and adequate care in pregnant patients affected by Endometriosis”, and “Ending preventable stillbirths by 2030: Recent Lancet article fails to account for immune related issues”.

    So, what can we do to help you? Early detection, close monitoring of immune parameters and adequate therapeutic interventions during pregnancy

    The increasing rate of pregnancy complications calls for a better detection and monitoring of immune parameters, in women with endometriosis during pregnancy. Both women with spontaneous conception and assisted reproduction are at elevated risk for adverse pregnancy outcomes.

    At Braverman Reproductive Immunology, suspicious cases of endometriosis (based on genetic and immune screening) are confirmed by surgical laparoscopy with the excision of endometriotic lesions and the destruction of the peritoneum.

    Many patients can get spontaneously pregnant after surgery. In addition, a frequent monitoring is performed through a thorough workup to detect any immunological alterations, potentially dangerous to the maintenance of a pregnancy and to the fetal health. When found, our timely therapeutic interventions attempt to restore a more tolerant immunologic environment by reducing and controlling the inflammation during pregnancy. This possibly reduces the occurrence of obstetrical complications.
    Questions? Call 516.584.8710 
    We would be happy to help you take control of your fertility journey and answer any questions you may have.


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