Women with endometriosis have a greater risk of preeclampsia, placenta previa, and preterm birth, which cannot be explained by the use of medically assisted reproduction. These findings may inform future obstetric care among this population. |
Introduction
Methods
Study design
Data sources and study population
Exposure assessment
Outcomes
Covariates
Statistical analysis
Missing data
Sensitivity analysis
Results
Cohort characteristics
Characteristics | Total | Endometriosis | No endometriosis |
---|---|---|---|
N = 912,747 | (n = 19,476) | (n = 893,271) | |
Maternal age, years | |||
15–24 | 225,204 (24.7) | 4855 (24.9) | 220,349 (24.7) |
25–29 | 292,416 (32.0) | 6037 (31.0) | 286,379 (32.1) |
30–34 | 260,947 (28.6) | 5334 (27.4) | 255,613 (28.6) |
35–39 | 113,489 (12.4) | 2731 (14.0) | 110,758 (12.4) |
40–49 | 20,691 (2.3) | 519 (2.7) | 20,172 (2.3) |
SES in quintiles | |||
< 20th percentile | 181,980 (19.9) | 3860 (19.8) | 178,120 (19.9) |
20–39th percentile | 182,472 (20.0) | 4015 (20.6) | 178,457 (20.0) |
40–59th percentile | 182,685 (20.0) | 3765 (19.3) | 178,920 (20.0) |
60–79th percentile | 182,731 (20.0) | 3964 (20.4) | 178,767 (20.0) |
≥ 80th percentile | 182,879 (20.0) | 3872 (19.9) | 179,007 (20.0) |
Time period of birth | |||
1980–1984 | 102,077 (11.2) | 1494 (7.7) | 100,583 (11.3) |
1985–1989 | 115,682 (12.7) | 2843 (14.6) | 112,839 (12.6) |
1990–1994 | 121,186 (13.3) | 3791 (19.5) | 117,395 (13.1) |
1995–1999 | 121,670 (13.3) | 3639 (18.7) | 118,031 (13.2) |
2000–2004 | 119,334 (13.1) | 2,982 (15.3) | 116,352 (13.0) |
2005–2009 | 141,603 (15.5) | 2681 (13.8) | 138,922 (15.6) |
2010–2015 | 191,195 (20.9) | 2046 (10.5) | 189,149 (21.2) |
Parity | |||
First birth | 368,504 (40.4) | 7516 (38.6) | 360,988 (40.4) |
2nd birth | 309,240 (33.9) | 6557 (33.7) | 302,683 (33.9) |
3rd birth | 148,061 (16.2) | 3375 (17.3) | 144,686 (16.2) |
≥ 4 birth | 86,869 (9.5) | 2028 (10.4) | 84,841 (9.5) |
Missing | 73 (0.0) | 0 (0.0) | 73 (0.0) |
MAR | |||
No | 890,327 (97.5) | 16,198 (83.2) | 874,129 (97.9) |
Yes | 22,420 (2.5) | 3278 (16.8) | 19,142 (2.1) |
Smoking during pregnancy | |||
No | 427,544 (46.8) | 7782 (40.0) | 419,762 (47.0) |
Yes | 80,709 (8.8) | 1539 (7.9) | 79,170 (8.9) |
Missing | 404,494 (44.3) | 10,155 (52.1) | 394,339 (44.1) |
Ethnicity (race) | |||
Caucasian | 759,584 (83.2) | 17,734 (91.1) | 741,850 (83.0) |
Non-Caucasian | 153,163 (16.8) | 1742 (8.9) | 151,421 (17.0) |
Outcomes | No endometriosis n = 893,271 (%) | Endometriosis n = 19,476 (%) | Unadjusted RR (95% CI) | Adjusted RR (95% CI) using doubly robust estimation |
---|---|---|---|---|
Preeclampsia | 54,098 (6.1) | 1468 (7.5) | 1.24 (1.18, 1.31) | 1.18 (1.11, 1.26) |
Early | 4749 (0.6) | 157 (0.8) | 1.52 (1.30, 1.78) | 1.50 (1.12, 2.02) |
Late | 32,240 (3.6) | 823 (4.3) | 1.17 (1.09, 1.25) | 1.06 (0.92, 1.21) |
Placenta previa | 8901 (1.0) | 364 (1.9) | 1.88 (1.69, 2.08) | 1.59 (1.42, 1.79) |
Preterm birth | 62,706 (7.0) | 1989 (10.2) | 1.45 (1.39, 1.52) | 1.45 (1.37, 1.54) |
Spontaneous | 36,034 (4.0) | 978 (5.0) | 1.27 (1.16, 1.38) | 1.40 (1.27, 1.56) |
Indicated | 26,671 (3.0) | 1011 (5.2) | 1.62 (1.48, 1.78) | 1.74 (1.58, 1.93) |
Outcome | MAR (n = 22,420) | Non-MAR (n = 890,327) | P-value | |||||||
---|---|---|---|---|---|---|---|---|---|---|
Number | PE (%) | Crude RR (95% CI) | Adjusted RR (95% CI) | Number | PE (%) | Crude RR (95% CI) | Adjusted RR (95% CI) | |||
PE | Endometriosis | < 0.001 | ||||||||
Yes | 3278 | 214 (6.5) | 0.99 (0.86, 1.14) | 0.86 (0.69, 1.07) | 16,198 | 1254 (7.7) | 1.28 (1.21, 1.35) | 1.22 (1.10, 1.35) | ||
No | 19,142 | 1256 (6.6) | 874,129 | 52, 842 (6.0) | ||||||
PP | Number | PP (%) | Crude RR (95% CI) | Adjusted RR (95% CI) | Number | PP (%) | Crude RR (95% CI) | Adjusted RR (95% CI) | < 0.001 | |
Endometriosis | ||||||||||
Yes | 3278 | 82 (2.5) | 1.20 (0.95, 1.52) | 1.11 (0.83, 1.46) | 16,198 | 282 (1.7) | 1.79 (1.59, 2.01) | 1.77 (1.50, 2.08) | ||
No | 19,142 | 400 (2.1) | 874,129 | 8501 (1.0) | ||||||
PTB | Number | PTB (%) | Crude RR (95% CI) | Adjusted RR (95% CI) | Number | PTB (%) | Crude RR (95% CI) | Adjusted RR (95% CI) | < 0.001 | |
Endometriosis | ||||||||||
Yes | 3278 | 416 (12.7) | 1.21 (1.09, 1.33) | 1.26 (1.09, 1.45) | 16,198 | 1573 (9.7) | 1.40 (1.33, 1.47) | 1.67 (1.55, 1.80) | ||
No | 19,142 | 2011 (10.5) | 874,129 | 60,695 (6.9) |