Adenomyosis and Obstetrical Outcome: a Narrative Mini-Review of the Latest Evidence

Purpose of Review To critically evaluate the most recent evidence on obstetric outcomes in women with adenomyosis. Recent Findings There is growing evidence suggesting an increased risk of obstetrical complications in women with adenomyosis. Summary An electronic search was conducted among the databases of PubMed, Google Scholar, and Cochrane review from January 2016 to March 2021. Nine observational studies fulfilled the inclusion criteria. Limitations of eligible studies include the presence of a majority of pregnancies achieved by ART, despite ART pregnancies being reported to be associated per se with a higher risk of adverse obstetric outcome; lack of information regarding the presence or absence of endometriosis; nonhomogeneous diagnostic criteria for adenomyosis; lack of the description of the severity of adenomyosis; and different timing of the diagnosis either before or during pregnancy. All studies reported that adenomyosis is associated with preterm delivery. Moreover, available data suggest that adenomyosis is associated with lower pregnancy rates after assisted reproductive techniques (ART) and higher rates of small-for-gestational-age (SGA)/low–birth weight (LBW) infants, cesarean delivery, and hypertensive disorder of pregnancy (HDP). Further studies on naturally conceived pregnancies, accurately designed in order to consider potential confounding factors, are needed in order to estimate the actual role of adenomyosis on fertility and obstetric and neonatal outcomes. Until more accurate data are available, it seems wise to foresee, when managing pregnant women with adenomyosis, the possible need for additional obstetric and intra-partum care. Similar content being viewed by others

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance Harada T, Khine YM, Kaponis A, Nikellis T, Decavalas G, Taniguchi F. The Impact of Adenomyosis on Women’s Fertility. Obstet Gynecol Surv. 2016;71:557–68. https://doi.org/10.1097/OGX.0000000000000346. •• Nirgianakis K, Kalaitzopoulos DR, Schwartz ASK, Spaanderman M, Kramer BW, Mueller MD, et al. Pregnancy and neonatal outcomes of patients with adenomyosis: a systematic review and meta-analysis. Reprod Biomed Online. 2021;42:185–206. https://doi.org/10.1016/j.rbmo.2020.09.023. Epub 2020 Oct 4. Findings from this study suggest that adenomyosis is associated with a significantly lower clinical pregnancy rate and higher miscarriage rate after ART, especially when a short GnRH agonist or antagonist protocol is administered for ovarian stimulation. Van den Bosch T, Dueholm M, Leone FP, Valentin L, Rasmussen CK, Votino A, et al. 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In this matched, case-control study, they found that patients who had adenomyosis were more likely associated with spontaneous second trimester miscarriage, preeclampsia, placental malposition, and preterm delivery, and to delivery of a SGA infant. Scala C, Leone Roberti Maggiore U, Racca A, Barra F, Vellone VG, Venturini PL, et al. Influence of adenomyosis on pregnancy and perinatal outcomes in women with endometriosis. Ultrasound Obstet Gynecol. 2018;52:666–671. https://doi.org/10.1002/uog.18989. Sharma S, Bathwal S, Agarwal N, Chattopadhyay R, Saha I, Chakravarty B. Does presence of adenomyosis affect reproductive outcome in IVF cycles? A retrospective analysis of 973 patients. Reprod Biomed Online. 2019;38:13–21. https://doi.org/10.1016/j.rbmo.2018.09.014. Epub 2018 Oct 26. Shin YJ, Kwak DW, Chung JH, Kim MY, Lee SW, Han YJ. The risk of preterm births among pregnant women with adenomyosis. J Ultrasound Med. 2018;37:1937–43. https://doi.org/10.1002/jum.14540. Epub 2018 Jan 24. 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BJOG. 2018;125:12–5. https://doi.org/10.1111/1471-0528.14789. Epub 2017 Jul 26. Author information Authors and Affiliations Contributions NB and PV were responsible for conception and design of the study and for critical revision of the article for intellectual content. Acquisition of data was performed by AD, FF, and ML. Analysis and interpretation of data was accomplished by NB and PV. All the authors approved the final version of the manuscript. Corresponding author Ethics declarations Conflict of Interest Nicola Berlanda, Agnese Donati, Francesco Fedele, Massimo Lepri, and Paolo Vercellini declare that they have no conflict of interest. Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This article is part of the Topical Collection on Uterine Fibroids and Endometrial Lesions Rights and permissions About this article Cite this article Berlanda, N., Donati, A., Fedele, F. et al. Adenomyosis and Obstetrical Outcome: a Narrative Mini-Review of the Latest Evidence. Curr Obstet Gynecol Rep 13, 289–300 (2024). https://doi.org/10.1007/s13669-021-00316-1 Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s13669-021-00316-1