Systematic review and meta-analysis of adverse pregnancy outcomes after uterine adenomyosis

Background Studies on the impact of adenomyosis and its pregnancy complications have yielded conflicting results. Objective To determine the likelihood of adverse pregnancy outcomes among women with adenomyosis relative to women without adenomyosis. Search strategy PubMed, Embase, Scopus, and Web of Science were searched for studies published up to June 15, 2018. Selection criteria Observational studies with medically confirmed pregnancy outcomes as endpoints. Data collection and analysis Two researchers independently screened and selected relevant studies. Dichotomous data for all adverse pregnancy outcomes were expressed as an odds ratio (OR) with 95% confidence interval (CI), and combined in a meta-analysis by using a random-effects model. Main results Six studies (322 cases and 9420 controls) were eligible for inclusion in the meta-analysis. Women with adenomyosis had an increased likelihood of preterm birth (OR, 3.05; 95% CI, 2.08-4.47; P<0.001), small for gestational age (OR, 3.22; 95% CI, 1.71-6.08; P<0.001), and pre-eclampsia (OR, 4.35; 95% CI, 1.07-17.72; P=0.042). Conclusion Adenomyosis seems to have a detrimental impact on pregnancy outcomes, resulting in a higher likelihood of preterm birth, small for gestational age, and pre-eclampsia.