Adenomyosis and Obstetrical Outcome: a Narrative Mini-Review of the Latest Evidence

To critically evaluate the most recent evidence on obstetric outcomes in women with adenomyosis.

There is growing evidence suggesting an increased risk of obstetrical complications in women with adenomyosis.

An electronic search was conducted among the databases of PubMed, Google Scholar, and Cochrane review from January 2016 to March 2021. Nine observational studies fulfilled the inclusion criteria. Limitations of eligible studies include the presence of a majority of pregnancies achieved by ART, despite ART pregnancies being reported to be associated per se with a higher risk of adverse obstetric outcome; lack of information regarding the presence or absence of endometriosis; nonhomogeneous diagnostic criteria for adenomyosis; lack of the description of the severity of adenomyosis; and different timing of the diagnosis either before or during pregnancy. All studies reported that adenomyosis is associated with preterm delivery. Moreover, available data suggest that adenomyosis is associated with lower pregnancy rates after assisted reproductive techniques (ART) and higher rates of small-for-gestational-age (SGA)/low–birth weight (LBW) infants, cesarean delivery, and hypertensive disorder of pregnancy (HDP). Further studies on naturally conceived pregnancies, accurately designed in order to consider potential confounding factors, are needed in order to estimate the actual role of adenomyosis on fertility and obstetric and neonatal outcomes. Until more accurate data are available, it seems wise to foresee, when managing pregnant women with adenomyosis, the possible need for additional obstetric and intra-partum care.