Reproductive prognosis in endometriosis. A national cohort study

TY - JOUR

T1 - Reproductive prognosis in endometriosis.

T2 - A national cohort study

AU - Hjordt Hansen, Maj V

AU - Dalsgaard, Torur

AU - Hartwell, Dorthe

AU - Skovlund, Charlotte W

AU - Lidegaard, Ojvind

N1 - © 2014 Nordic Federation of Societies of Obstetrics and Gynecology.

PY - 2014/5

Y1 - 2014/5

N2 - Objective To assess the reproductive long-term prognosis of women with and without endometriosis, to explore changes over time, and to quantify the contribution of artificial reproductive techniques. Design Cohort study. Setting Denmark 1977-2009. Sample Data retrieved from four national registries. Among 15-49-year-old women during the period 1977-82, 24 667 were diagnosed with endometriosis and 98 668 (1:4) women without endometriosis were age-matched. Methods To assess long-term reproductive prognosis, all pregnancy outcomes were identified among the women with and without endometriosis until the end of 2009. To explore changes over time, the endometriosis cohorts were followed for 15 years from the years 1980, 1986, 1992 and 1998, with the corresponding control cohorts. All pregnancy outcomes were categorized into naturally or artificially conceived pregnancies. Main outcome measures Births, miscarriages, induced abortions, ectopic pregnancies and hydatidiform moles. Results Compared with women without endometriosis, women with endometriosis had a lowered relative risk for childbirth of 0.93 (95% confidence interval 0.92-0.95), for miscarriages the relative risk was 1.2 (95% confidence interval 1.2-1.3), ectopic pregnancies were almost twice as many (relative risk 1.9, 95% confidence interval 1.8-2.1), while frequencies of induced abortions were equivalent. The chances for childbirth increased over time from 0.82 to 0.92 (p < 0.001) with successive cohorts, but this was restricted to pregnancies from assisted reproduction. Conclusion Women with endometriosis have slightly fewer children, but this lessened over time due to artificially conceived pregnancies. The risk for miscarriages and ectopic pregnancies was increased compared with women without the disease.

AB - Objective To assess the reproductive long-term prognosis of women with and without endometriosis, to explore changes over time, and to quantify the contribution of artificial reproductive techniques. Design Cohort study. Setting Denmark 1977-2009. Sample Data retrieved from four national registries. Among 15-49-year-old women during the period 1977-82, 24 667 were diagnosed with endometriosis and 98 668 (1:4) women without endometriosis were age-matched. Methods To assess long-term reproductive prognosis, all pregnancy outcomes were identified among the women with and without endometriosis until the end of 2009. To explore changes over time, the endometriosis cohorts were followed for 15 years from the years 1980, 1986, 1992 and 1998, with the corresponding control cohorts. All pregnancy outcomes were categorized into naturally or artificially conceived pregnancies. Main outcome measures Births, miscarriages, induced abortions, ectopic pregnancies and hydatidiform moles. Results Compared with women without endometriosis, women with endometriosis had a lowered relative risk for childbirth of 0.93 (95% confidence interval 0.92-0.95), for miscarriages the relative risk was 1.2 (95% confidence interval 1.2-1.3), ectopic pregnancies were almost twice as many (relative risk 1.9, 95% confidence interval 1.8-2.1), while frequencies of induced abortions were equivalent. The chances for childbirth increased over time from 0.82 to 0.92 (p < 0.001) with successive cohorts, but this was restricted to pregnancies from assisted reproduction. Conclusion Women with endometriosis have slightly fewer children, but this lessened over time due to artificially conceived pregnancies. The risk for miscarriages and ectopic pregnancies was increased compared with women without the disease.

KW - Abortion, Induced

KW - Abortion, Spontaneous

KW - Adolescent

KW - Adult

KW - Case-Control Studies

KW - Denmark

KW - Endometriosis

KW - Female

KW - Humans

KW - Hydatidiform Mole

KW - Live Birth

KW - Middle Aged

KW - Pregnancy

KW - Pregnancy, Ectopic

KW - Prognosis

KW - Reproductive Techniques, Assisted

KW - Time Factors

KW - Uterine Diseases

KW - Young Adult

U2 - 10.1111/aogs.12373

DO - 10.1111/aogs.12373

M3 - Journal article

C2 - 24617701

SN - 0001-6349

VL - 93

SP - 483

EP - 489

JO - Acta Obstetrica et Gynecologica

JF - Acta Obstetrica et Gynecologica

IS - 5

ER -