Establishment and validation of a nomogram model for predicting adverse pregnancy outcomes of pregnant women with adenomyosis

Purpose To establish a reliable nomogram model to predict the risk of major adverse pregnancy outcomes in pregnant women with adenomyosis, and to provide a reference tool for the hierarchical management and the prenatal examination of pregnant women.

We collected the clinical data of pregnant women with adenomyosis who were treated in the First Affiliated Hospital of Chongqing Medical University, the Women and Children’s Hospital of Chongqing Medical University, and Yubei District People’s Hospital of Chongqing from January 2014 to June 2020. They were divided into the training cohort and the validation cohort, respectively. In the training cohort, we screened out risk factors associated with major adverse pregnancy outcomes and established a model, which was subsequently validated.

In the training cohort, we found that previous parity, natural conception or not, type of adenomyosis, with or without endometriosis, history of infertility or adverse pregnancy outcomes, and history of uterine body surgery were associated with major adverse pregnancy outcomes of pregnant women with adenomyosis, and based on these factors, a nomogram model was constructed. The calibration curves of the model were well fitted in both the training and validation cohorts. The receiver-operating characteristic curve (ROC curve) showed that the area under the curve (AUC) was 0.873 and 0.851 in the training and validation cohorts, respectively. The optimal risk threshold of the model was 0.22, and this threshold can be applied to risk stratification of pregnant women.

The nomogram model established in this study can reliably predict the risk of major APO in pregnant women with AD. Similar content being viewed by others Data availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Moawad G, Kheil MH, Ayoubi JM, Klebanoff JS, Rahman S, Sharara FI (2022) Adenomyosis and infertility. J Assist Reprod Genet 39:1027–1031 Szubert M, Koziróg E, Olszak O, Krygier-Kurz K, Kazmierczak J, Wilczynski J (2021) Adenomyosis and infertility-review of medical and surgical approaches. Int J Environ Res Public Health 18(3):1285 Kim MS, Jang JH, Park S, Ahn EH, Jung SH (2021) Effect of adenomyosis on adverse obstetrical outcomes in twin pregnancies achieved with assisted reproductive technology. J Obstet Gynaecol 41:1225–1229 Rodriguez-Wallberg KA, Ekberg S, Johansson AL, Iliadou AN (2018) A population-based register study of infant and late child mortality in singletons born after assisted reproductive techniques (ART) vs natural conceptions. Fertil Steril 110(4):e12 Qin J, Liu X, Sheng X, Wang H, Gao S (2016) Assisted reproductive technology and the risk of pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies: a meta-analysis of cohort studies. Fertil Steril 105:73-85.e1-6 Shinohara S, Okuda Y, Hirata S, Suzuki K (2020) Adenomyosis as a potential risk factor for adverse pregnancy outcomes: a multicenter case-control study. Tohoku J Exp Med 251:231–239 Vigano P, Corti L, Berlanda N (2015) Beyond infertility: obstetrical and postpartum complications associated with endometriosis and adenomyosis. Fertil Steril 104:802–812 Yang J, Wang Y, Wang XY, Zhao YY, Wang J, Zhao YY (2017) Adverse pregnancy outcomes of patients with history of first-trimester recurrent spontaneous abortion. Biomed Res Int 2017:4359424 Frick AP (2021) Advanced maternal age and adverse pregnancy outcomes. Best Pract Res Clin Obstet Gynaecol 70:92–100 Kho KA, Chen JS, Halvorson LM (2021) Diagnosis, evaluation, and treatment of adenomyosis. JAMA 326:177–178 Van den Bosch T, Dueholm M, Leone FP, Valentin L, Rasmussen CK, Votino A et al (2015) Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the morphological uterus sonographic assessment (MUSA) group. Ultrasound Obstet Gynecol 46:284–298 Celli V, Dolciami M, Ninkova R, Ercolani G, Rizzo S, Porpora MG et al (2022) MRI and adenomyosis: what can radiologists evaluate? Int J Environ Res Public Health 19(10):5840 Schrager S, Yogendran L, Marquez CM, Sadowski EA (2022) Adenomyosis: diagnosis and management. Am Fam Physician 105:33–38 Chapron C, Vannuccini S, Santulli P, Abrao MS, Carmona F, Fraser IS et al (2020) Diagnosing adenomyosis: an integrated clinical and imaging approach. Hum Reprod Update 26:392–411 Chapron C, Marcellin L, Borghese B, Santulli P (2019) Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol 15:666–682 McLucas B (2008) Diagnosis, imaging and anatomical classification of uterine fibroids. Best Pract Res Clin Obstet Gynaecol 22:627–642 Lees CC, Stampalija T, Baschat A, da Silva CF, Ferrazzi E, Figueras F et al (2020) ISUOG Practice Guidelines: diagnosis and management of small-for-gestational-age fetus and fetal growth restriction. Ultrasound Obstet Gynecol 56:298–312 McCowan LM, Figueras F, Anderson NH (2018) Evidence-based national guidelines for the management of suspected fetal growth restriction: comparison, consensus, and controversy. Am J Obstet Gynecol 218:S855–S868 Jiang P, Huang J, Deng Y, Hu J, Huang Z, Jia M et al (2020) Predicting recurrence in endometrial cancer based on a combination of classical parameters and immunohistochemical markers. Cancer Manag Res 12:7395–7403 Bendifallah S, Canlorbe G, Laas E, Huguet F, Coutant C, Hudry D et al (2015) A predictive model using histopathologic characteristics of early-stage type 1 endometrial cancer to identify patients at high risk for lymph node metastasis. Ann Surg Oncol 22:4224–4232 Schisterman EF, Perkins NJ, Liu A, Bondell H (2005) Optimal cut-point and its corresponding Youden Index to discriminate individuals using pooled blood samples. Epidemiology 16:73–81 Zullo F, Spagnolo E, Saccone G, Acunzo M, Xodo S, Ceccaroni M et al (2017) Endometriosis and obstetrics complications: a systematic review and meta-analysis. Fertil Steril 108:667–72.e5 Brosens I, Pijnenborg R, Benagiano G (2013) Defective myometrial spiral artery remodelling as a cause of major obstetrical syndromes in endometriosis and adenomyosis. Placenta 34:100–105 Harada T, Khine YM, Kaponis A, Nikellis T, Decavalas G, Taniguchi F (2016) The impact of adenomyosis on women’s fertility. Obstet Gynecol Surv 71:557–568 Vlahos NF, Theodoridis TD, Partsinevelos GA (2017) Myomas and adenomyosis: impact on reproductive outcome. Biomed Res Int 2017:5926470 Huang Y, Zhao X, Chen Y, Wang J, Zheng W, Cao L (2020) Miscarriage on endometriosis and adenomyosis in women by assisted reproductive technology or with spontaneous conception: a systematic review and meta-analysis. Biomed Res Int 2020:4381346 Hashimoto A, Iriyama T, Sayama S, Nakayama T, Komatsu A, Miyauchi A et al (2018) Adenomyosis and adverse perinatal outcomes: increased risk of second trimester miscarriage, preeclampsia, and placental malposition. J Maternal-Fetal Neonatal Med 31:364–369 Soave I, Wenger JM, Pluchino N, Marci R (2018) Treatment options and reproductive outcome for adenomyosis-associated infertility. Curr Med Res Opin 34:839–849 Munoz JL, Kimura AM, Xenakis E, Jenkins DH, Braverman MA, Ramsey PS et al (2021) 2021 Whole blood transfusion reduces overall component transfusion in cases of placenta accreta spectrum: a pilot program. J Maternal-Fetal Neonatal Med 10(1080/14767058):1915275 Liu XY, Zhang Y, Wei Y, Li R (2020) Zhao YY [Perinatal outcome of pregnant women with adenomyosis]. Zhonghua Fu Chan Ke Za Zhi 55:743–748 Shi J, Dai Y, Zhang J, Li X, Jia S, Leng J (2021) Pregnancy outcomes in women with infertility and coexisting endometriosis and adenomyosis after laparoscopic surgery: a long-term retrospective follow-up study. BMC Preg Childbirth 21:383 Tamura H, Kishi H, Kitade M, Asai-Sato M, Tanaka A, Murakami T et al (2017) Complications and outcomes of pregnant women with adenomyosis in Japan. Reproduct Med Biol 16:330–336 Funding There is no funding to report. Author information Authors and Affiliations Contributions YC: data collection. CG: data collection. YW: data collection, manuscript writing, and manuscript revision. YH: data analysis and manuscript writing. PJ: data collection or management. WK: data analysis and manuscript writing. LX: data collection. YY: data collection. YC: data collection. CG: data collection. ZH: project development. Corresponding author Ethics declarations Conflict of interest The authors have no relevant financial or non-financial interests to disclose. Ethics approval and consent to participate Ethics Committee of Chongqing Medical University approved this study (Ethics Approval No. 2021–547). Consent to participate All patients provided their informed consent before starting the treatment and gave consent to have their data published. As it was a retrospective clinical study, all the patients were contacted by telephone to obtain verbal informed consent and it was approved by the ethics committee. All data about the patients were anonymized or maintained with confidentiality. Consent to publish The authors affirm that human research participants provided informed consent for publication of the images in Tables 1, 2 and 3 and Figs. 1, 2, 3 and 4. 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 Wang, Y., Hu, Y., Jiang, P. et al. Establishment and validation of a nomogram model for predicting adverse pregnancy outcomes of pregnant women with adenomyosis. Arch Gynecol Obstet 309, 2575–2584 (2024). https://doi.org/10.1007/s00404-023-07136-z Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-023-07136-z