Endometriosis and obstetrics complications: a systematic review and meta-analysis

Objective To evaluate the effect of endometriosis on pregnancy outcomes. Design Systematic review and meta-analysis. Setting Not applicable. Patient(s) Women with or without endometriosis. Intervention(s) Electronic databases searched from their inception until February 2017 with no limit for language and with all cohort studies reporting the incidence of obstetric complications in women with a diagnosis of endometriosis compared with a control group (women without a diagnosis of endometriosis) included. Mean Outcome Measure(s) Primary outcome of incidence of preterm birth at <37 weeks with meta-analysis performed using the random effects model of DerSimonian and Laird to produce an odds ratio (OR) with 95% confidence interval (CI). Result(s) Twenty-four studies were analyzed comprising 1,924,114 women. In most of them, the diagnosis of endometriosis was made histologically after surgery. Women with endometriosis had a statistically significantly higher risk of preterm birth (OR 1.63; 95% CI, 1.32–2.01), miscarriage (OR 1.75; 95% CI, 1.29–2.37), placenta previa (OR 3.03; 95% CI, 1.50–6.13), small for gestational age (OR 1.27; 95% CI, 1.03–1.57), and cesarean delivery (OR 1.57; 95% CI, 1.39–1.78) compared with the healthy controls. No differences were found in the incidence of gestational hypertension and preeclampsia. Conclusion(s) Women with endometriosis have a statistically significantly higher risk of preterm birth, miscarriage, placenta previa, small for gestational age infants, and cesarean delivery.