Endometriosis and Pregnancy–Dr. Ken Moghadam

Have you heard of the The Nurse’s Health Study (NHS)?  It began in 1976 to look at the effects of birth control pills in a portion of the United States population that was easier to follow and research.  The original study requirements not only included current birth control pill use but also only allowed for enrollment of married nurses!  The world has changed a lot over the last 40 years, and the current version (NHS III) includes specialized nursing fields and even male nurses.  Many European countries have a national health care system that facilitates research over many decades.  Among American women, the NHS has evolved into a great database to look at health problems that start in younger patients but may have other, long-term consequences.

A recent article from NHS II data (Obstetrics and Gynecology, September 2019 issue) looks at the effects of endometriosis on subsequent pregnancy. Endometriosis is a condition in which the cells of the uterine lining (endometrium) become displaced internally, most likely from backwards menstrual flow through the Fallopian tubes, creating an inflammatory condition that can lead to painful periods, painful intercourse and scar tissue formation.  Here are some key points:

• 8875 (4.5%) of the women whose pregnancies were studied had laparoscopically (surgically) confirmed endometriosis
• spontaneous miscarriage (19.3%) and tubal pregnancy (1.8%) were higher in women with endometriosis than in those without endometriosis (12.3% and 0.8%, respectively)
• preterm birth (12%), gestational diabetes (4.3%), and high blood pressure disorders in pregnancy (9.5%) were also higher with endometriosis patients
• the above findings were all likely contributors to the increased low birth weight risk (5.6%) seen in women with endometriosis relative to their peers (3.6%)
• the effects above were present independent of age; the degree or grade of disease was not available or commented on by the authors

We give a lot of deserved attention to endometriosis for its impact upon menstrual pain, chronic pelvic pain and infertility, as well as  its impact on quality of life in general.  Many of the theories regarding the obstetric problems listed above focus upon the effects of inflammation.  This study suggests that there is also a role for the experienced gynecologic or reproductive surgeon treating endometriosis to counsel their patients regarding pregnancy complications.  Talk to your physician and make sure that they outline everything from the expectations during surgery to their personal complication rate (particularly unrecognized complications) to the expected outcome once endometriosis has been diagnosed and treated.