Endometriosis is associated with pregnancy loss: a nationwide historical cohort study

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

Objective: To study whether endometriosis is associated with pregnancy loss and recurrent pregnancy loss (RPL). Design: Nationwide historical cohort study with a nested case-control analysis. Setting: National health registers. Patient(s): A total of 29,563 women born between 1957 and 1997 were identified in the national health registers, diagnosed with endometriosis between 1977 and 2017, and age-matched 1:10 with 295,630 women without endometriosis. The number of pregnancy losses was assessed, and data were analyzed with conditional logistic regression. Intervention(s): Endometriosis (International Classification of Diseases, 8th Revision, 62530-62539, and International Classification of Diseases, 10th Revision, DN80.0-9). Main Outcome Measure(s): The primary outcomes of interest were the numbers of pregnancy losses categorized as 0, 1, 2, and ≥ 3 losses, unadjusted and adjusted for gravidity, and RPL. The secondary outcome measures were the predefined types of pregnancy losses. Pregnancy loss was defined as the spontaneous demise of a pregnancy until 22 weeks of gestation. Primary RPL was defined as 3 or more consecutive pregnancy losses with no prior live birth or stillbirth, and secondary RPL was defined as 1 or more births followed by 3 or more consecutive losses. Result(s): A total of 18.9%, 3.9%, and 2.1% of ever-pregnant women with endometriosis had 1, 2, and ≥ 3 pregnancy losses compared with 17.3%, 3.5%, and 1.5% of the women without endometriosis, corresponding to the odds ratios of 1.13 (95% confidence interval, 1.09–1.17), 1.18 (1.10–1.26), and 1.44 (1.31–1.59), respectively. When adjusted also for gravidity, the corresponding results were 1.37 (95% confidence interval, 1.32–1.42), 1.75 (1.62–1.89), and 2.57 (2.31–2.85), respectively. The following predefined subgroups of RPL were positively associated with endometriosis: primary; secondary; secondary after giving birth to a boy; after a complicated delivery; and ≥ 3 pregnancy losses before the age of 30 years. Six endometriosis subgroup analyses found an association between endometriosis and pregnancy loss. These analyses were women diagnosed in the 4 decades between 1977 and 2017, women with adenomyosis, and women with adenomyosis only. Conclusion(s): This nationwide cohort study found endometriosis to be associated with pregnancy loss and RPL, and the association strengthened with an increasing number of losses.

OriginalsprogEngelsk
TidsskriftFertility and Sterility
Vol/bind119
Udgave nummer5
Sider (fra-til)826-835
ISSN0015-0282
DOI
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
A.D.B. reports research scholarship from the Research Fund of Hvidovre Hospital for the submitted work. P.E. has nothing to disclose. D.W. reports funding from the Novo Nordisk Foundation outside the submitted work. M.-L.M.F.B. has nothing to disclose. M.N. has nothing to disclose. D.H. has nothing to disclose. Ø.L. reports research scholarship from the Research Fund of Hvidovre Hospital for the submitted work, funding from the Institutional Grant for Epidemiological Research, and honoraria from the Danish National Health Board outside the submitted work. H.S.N. reports funding from Freya Biosciences ApS , Ferring Pharmaceuticals , BioInnovation Institute , Ministry of Education , Novo Nordic Foundation , Augustinus Fonden , Oda og Hans Svenningsens Fond , Demant Fonden , and Ole Kirks Fond and honoraria from Ferring Pharmaceuticals, Merck A/S, AstraZeneca, Cook Medical, and Ibsa Nordic outside the submitted work.

Funding Information:
A.D.B. reports research scholarship from the Research Fund of Hvidovre Hospital for the submitted work. P.E. has nothing to disclose. D.W. reports funding from the Novo Nordisk Foundation outside the submitted work. M.-L.M.F.B. has nothing to disclose. M.N. has nothing to disclose. D.H. has nothing to disclose. Ø.L. reports research scholarship from the Research Fund of Hvidovre Hospital for the submitted work, funding from the Institutional Grant for Epidemiological Research, and honoraria from the Danish National Health Board outside the submitted work. H.S.N. reports funding from Freya Biosciences ApS, Ferring Pharmaceuticals, BioInnovation Institute, Ministry of Education, Novo Nordic Foundation, Augustinus Fonden, Oda og Hans Svenningsens Fond, Demant Fonden, and Ole Kirks Fond and honoraria from Ferring Pharmaceuticals, Merck A/S, AstraZeneca, Cook Medical, and Ibsa Nordic outside the submitted work.

Publisher Copyright:
© 2023 American Society for Reproductive Medicine

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