A recently published article in the journal Human Reproduction has found that women with endometriosis are at a higher risk for pregnancy complications. Having endometriosis can increase the risk for several complications that can affect the mother, the unborn fetus, and a newborn infant.1
About the study
While several studies in recent years have suggested that endometriosis is associated with pregnancy complications, other studies have found conflicting data. To assess the potential for complications among women with endometriosis, researchers evaluated studies from 1990-2017 and aggregated data from 33 studies. With this extensive data, the study authors were able to identify complications as well as compare women who had conceived naturally to women who had conceived using assisted reproductive techniques.1
Increased risk of complications
The study found that compared to women without endometriosis, women with endometriosis are more likely to experience complications such as:1
Pre-eclampsia (high blood pressure during pregnancy)
Gestational cholestasis (a liver disease)
Placenta previa (a condition where the placenta covers part or all of the cervix and may separate from the uterine wall as the cervix dilates during labor)
Bleeding after delivery
Hospital admissions after delivery
Low birth weight
In women who conceived naturally, also called spontaneous conception, endometriosis was associated with placenta previa, cesarean section, preterm birth, and low birth weight. Among the women who used assisted reproductive techniques, endometriosis was associated with placenta previa and preterm birth.1
While this list of complications is frightening, these findings are important. By identifying the increased risk for complications among women with endometriosis, this study establishes the need for additional research to further understand these risks and the underlying disease processes that cause them.
How endometriosis increases the risk of complications
The tissue that lines the uterus is known as endometrium. Endometriosis is a chronic condition in which endometrial-like tissue grows outside of the uterus, including on the fallopian tubes, ovaries, outer surface of the uterus, and other areas in the pelvis. While the exact disease mechanisms that are associated with pregnancy complications aren’t fully understood, researchers believe that endometriosis may increase the risks of these complications by one or more of the following:1
Damage to the uterine wall
Altered contractility (a change in the normal wave-like muscle movements of the uterus)
Increased resistance to progesterone, a hormone that is important for the health of the uterus
What you can do
If you are pregnant or planning to become pregnant, talk to your OB/GYN about all your health conditions, including endometriosis, and whether you need additional monitoring. If your pregnancy is considered high-risk, additional monitoring and more frequent prenatal visits may be recommended. Some women may also want to consult a maternal-fetal medicine doctor, a specialist who has training on high-risk pregnancies and caring for the mother and child.2
In addition to the physical challenges, high-risk pregnancies can be emotionally challenging. Identify and lean on your support system, including family, friends, others who are pregnant, and our online community here.
Lalani S, Choudhry AJ, Firth B, Bacal V, et al. Endometriosis and adverse maternal, fetal and neonatal outcomes, a systematic review and meta-analysis. Human Reproduction. 2018 Oct;33(10):1854–1865. doi: https://doi.org/10.1093/humrep/dey269
Understanding a high-risk pregnancy. American Pregnancy Association. Available at http://americanpregnancy.org/pregnancy-complications/high-risk-pregnancy/. Accessed 9/24/18.