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Endometriosis increases the rate of spontaneous early miscarriage in women who have adenomyosis lesions

  • Author Footnotes
    1 Joint first authors.
    Mathilde Bourdon
    Footnotes
    1 Joint first authors.
    Affiliations
    Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France

    Assistance Publique – Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre. (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Paris, France

    Département 3I ‘Infection, Immunité et Inflammation’, Institut Cochin, INSERM U1016, Paris, France
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  • Author Footnotes
    1 Joint first authors.
    Benjamine Pham
    Footnotes
    1 Joint first authors.
    Affiliations
    Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France
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  • Louis Marcellin
    Affiliations
    Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France

    Assistance Publique – Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre. (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Paris, France

    Département 3I ‘Infection, Immunité et Inflammation’, Institut Cochin, INSERM U1016, Paris, France
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  • Corinne Bordonne
    Affiliations
    Assistance Publique – Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre. (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Paris, France

    Assistance Publique – Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Hotel Dieu, Département Radiology, Paris, France

    Centre de Radiologie Bachaumont, IMPC, Paris, France
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  • Anne Elodie Millischer
    Affiliations
    Centre de Radiologie Bachaumont, IMPC, Paris, France
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  • Chloé Maignien
    Affiliations
    Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France

    Assistance Publique – Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre. (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Paris, France
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  • Author Footnotes
    # Joint last authors.
    Pietro Santulli
    Correspondence
    Corresponding author.
    Footnotes
    # Joint last authors.
    Affiliations
    Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France

    Assistance Publique – Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre. (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Paris, France

    Département 3I ‘Infection, Immunité et Inflammation’, Institut Cochin, INSERM U1016, Paris, France
    Search for articles by this author
  • Author Footnotes
    # Joint last authors.
    Charles Chapron
    Footnotes
    # Joint last authors.
    Affiliations
    Université de Paris, Faculté de Santé, Faculté de Médecine Paris Centre, Paris, France

    Assistance Publique – Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre. (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Paris, France

    Département 3I ‘Infection, Immunité et Inflammation’, Institut Cochin, INSERM U1016, Paris, France
    Search for articles by this author
  • Author Footnotes
    1 Joint first authors.
    # Joint last authors.
Published:October 18, 2021DOI:https://doi.org/10.1016/j.rbmo.2021.10.003

      Abstract

      Research question

      In women with radiologically diagnosed adenomyosis, is the presence of endometriosis associated with a higher rate of miscarriage?

      Design

      An observational cohort study of women who received medical care for benign gynaecological conditions between May 2005 and May 2018. Women who had adenomyosis lesions visualized by uterine magnetic resonance imaging (MRI) were included. Women who had never been pregnant were excluded. Women with adenomyosis identified by MRI but who did not have endometriosis lesions (control group) were compared with women with adenomyosis and endometriosis lesions (study group). Primary outcome was rate of a previous history of early miscarriage.

      Results

      A total of 214 pregnancies in the study group and 53 pregnancies in the control group were analysed. The rate of a previous miscarriage was significantly higher among women with adenomyosis and endometriosis lesions compared with women in the control group (61/214 [28.5%] versus 6/53 [11.3%], respectively, P = 0.009). A multivariable generalized estimating equation logistic regression model, adjusted for adenomyosis and endometriosis phenotypes, found that the association between endometriosis and adenomyosis significantly increased the risk of miscarriage (OR 3.2, 95% CI 1.1 to 9.65). The risk was significantly higher with deep infiltrating endometriosis (OR 4.37, 95% CI 1.32 to 14.53).

      Conclusions

      Women affected by endometriosis had a significantly higher rate of previous spontaneous miscarriage than women without endometriosis with adenomyosis lesions identified by MRI. Mechanistic studies are needed to establish the complex link between the presence of endometriosis and adenomyosis and the rate of spontaneous miscarriage.

      KEYWORDS

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      Biography

      Dr Pietro Santulli graduated from the University of Paris and became Professor in 2018. He oversees the fertility unit at Cochin University Hospital, Paris. His main research activities are basic and clinical research on endometriosis and adenomyosis and assisted reproductive technology.
      Key message
      Endometriosis increases the rate of spontaneous early miscarriage in women with radiologically diagnosed adenomyosis. To provide appropriate clinical care, women affected by adenomyosis should be evaluated for adenomyosis phenotype and the presence of endometriosis lesions. Studies are needed to investigate the mechanistic link between endometriosis, adenomyosis and spontaneous miscarriage.