Association between Endometriosis and Risk of Preeclampsia in Women Who Conceived Spontaneously: A Systematic Review and Meta-analysis

Objective: To evaluate the association between endometriosis and the risk of preeclampsia and other maternal outcomes in spontaneously conceived women.Data Sources: PubMed, MEDLINE, Embase, Scopus, Cochrane Library, Web of Science, and Google Scholar were sys-temically searched for studies published from inception to November 2021 (CRD42020198741). Observational studies pub-lished in English or French that investigated the risk of preeclampsia in women with endometriosis who conceived spontaneously were included. Methods of Study Selection: A total of 610 articles were reviewed once duplicates were removed. Inclusion criteria included spontaneous conception and surgical and/or imaging ascertainment of an endometriosis diagnosis. Exclusion crite-ria included conception using assisted reproductive technologies, multiple pregnancies, chronic hypertension, and unclear diagnoses of endometriosis.Tabulation, Integration, and Results: Data of selected studies were extracted, and analysis was performed on Review Manager, version 5.4. Quality assessment of included studies for potential risk of bias was evaluated using the Newcastle -Ottawa Scale for cohort studies. Three cohort studies of spontaneous pregnancies were included. Endometriosis was associ-ated with an increased risk of preeclampsia (risk ratio [RR] = 1.47, 95% CI 1.13-1.89, p = .003; I2 = 0%; n = 3 studies). A sensitivity analysis excluding a study with adenomyosis cases yielded similar risk (RR = 1.44; 95% CI, 1.11-1.87; p = .006; I2 = 0%; n = 2 studies). Having endometriosis did not significantly increase risk of cesarean delivery (RR = 1.38; 95% CI, 0.99-1.92; p = .06; I2 = 80%; n = 2 studies) or postpartum hemorrhage (RR = 1.16; 95% CI, 0.46-2.91; p = .76; I2 = 50%; n = 2 studies).Conclusion: We detected an increased risk of preeclampsia in women with endometriosis who conceived spontaneously. Endometriosis did not seem to increase the risk of cesarean delivery and postpartum hemorrhage, but the number of studies was limited, and the heterogeneity was high. Journal of Minimally Invasive Gynecology (2023) 30, 91-99.(c) 2022 AAGL. All rights reserved.