Maternal and Neonatal Outcomes in Pregnancies with Adenomyosis

Objectives Adenomyosis is a common gynecologic disease involving the uterus, with its effect on pregnancy being poorly understood. This study aimed to evaluate the associations between adenomyosis and obstetrical and newborn outcomes.

Using the Healthcare Cost and Utilization Project-National Inpatient Sample from the United States, we conducted a retrospective cohort study of all birth-related admissions from 2016 to 2019. Pregnancies with adenomyosis were identified using the ICD-10 code N80.03, with the remaining pregnancies being the reference group. Then, ICD-10 codes were used to identify obstetrical and neonatal outcomes and multivariable logistic regression models, adjusted for baseline maternal demographics, were used to determine the impact of adenomyosis on these outcomes. Also, in light of the potential detection bias inherent in births by cesarean delivery, adjustment for mode of delivery was included in all regression analyses.

Among the 2,943,532 women who delivered between 2016 and 2019, 1,084 had adenomyosis, for an overall prevalence of 36 cases/100,000 births, which was stable throughout the study period. Adenomyosis in pregnancy was associated with increased frequency of placenta abruptio (adjusted OR 1.7, 95% CI 1.2-2.4), preterm delivery (1.4, 1.2-1.6), preterm premature rupture of membranes (1.3, 1.1-1.6), postpartum hemorrhage (2.7, 2.1-3.3), post-partum transfusion (2.2, 1.6-3.0), disseminated intravascular coagulation (9.3, 4.2-20.9), sepsis (2.7, 1.6-4.5), congenital anomalies (2.0, 1.3-2.8), and intrauterine fetal demise (2.0, 1.0-3.8). Also, these pregnancies had an elevated risk of delivering by cesarean (15.7, 12.7-19.3).

Adenomyosis in pregnancy is associated with adverse obstetric and fetal outcomes. As such, pregnancies in patients with adenomyosis should be considered high-risk and should be delivered in centers capable of managing the potential poor events associated with these pregnancies. Significance Pregnancies complicated by adenomyosis are associated with an increased risk of poor outcomes, including pre-eclampsia, preterm birth, postpartum hemorrhage, and cesarean section deliveries, although there are discordances in results between some studies. AbstractSection What this Study Adds?Adenomyosis in pregnancy is associated with a greater likelihood of individuals experiencing sepsis and disseminated intravascular coagulation. These adverse outcomes may be attributed to the chronic inflammatory state and the hypercoagulability characteristic of adenomyosis. Similar content being viewed by others Data Availability All data is freely available to the public from the Healthcare Cost and Utilization Project-National Inpatient Sample. Code Availability Not applicable.

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Author information Authors and Affiliations Contributions SH contributed to the design of the study; interpreted the data results; drafted the initial manuscript; and reviewed and revised the subsequent drafts of the manuscript. NCS carried out the data analyses and revised the manuscript. ARS contributed to the data analytic design; interpreted the data; and reviewed and revised the manuscript. HAA conceptualized the study; designed the study; supervised and designed the data analyses; and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. Corresponding author Ethics declarations Ethical Approval According to the Tri-Council Policy of 2021, institutional ethics approval was not required for this study as it was solely based on data from a publicly available database. Consent to Participate Not applicable. Consent for Publications Not applicable. Competing Interests The authors report no competing interests. Additional information Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Hguig, S., Czuzoj-Shulman, N., Spence, A.R. et al. Maternal and Neonatal Outcomes in Pregnancies with Adenomyosis. Matern Child Health J 29, 1284–1292 (2025). https://doi.org/10.1007/s10995-025-04138-y Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s10995-025-04138-y