Adenomyosis as a Potential Risk Factor for Adverse Pregnancy Outcomes: A Multicenter Case-Control Study

Satoshi Shinohara, Yasuhiko Okuda, Shuji Hirata, Kohta Suzuki
The Tohoku journal of experimental medicine · 2020 · vol. 251(3) , pp. 231–239 · doi:10.1620/tjem.251.231 · PMID:32684535 · W3042857419
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⚙ AI-generated summary by claude@2026-06, 2026-06-10 ⓘ

This case-control study found that adenomyosis, particularly diffuse adenomyosis, is associated with increased risks of preterm delivery, hypertensive disorders, cesarean delivery, and postpartum hemorrhage.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 · read from full text ⓘ

This multicenter retrospective 1:4 case-control study evaluated whether adenomyosis is associated with adverse singleton pregnancy outcomes by comparing 61 women diagnosed with adenomyosis to 244 propensity score–matched controls without adenomyosis, including analyses by adenomyosis type (diffuse vs focal). Women with adenomyosis had higher incidences of preterm delivery, hypertensive disorders of pregnancy, cesarean delivery, and postpartum hemorrhage than controls, and the diffuse adenomyosis subgroup showed significantly higher rates of these complications (including preterm labor, severe hypertensive disorders of pregnancy, preterm premature rupture of membranes, cesarean delivery, and postpartum hemorrhage), whereas focal adenomyosis was not significantly different from controls. A key limitation is that the study is retrospective, so potential residual confounding remains despite propensity matching. This paper is centrally about endometriosis-related pathology in the form of adenomyosis—specifically whether adenomyosis type is linked to adverse pregnancy outcomes.

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Abstract

As the number of women who postpone their first pregnancy until their late 30s or early 40s is increasing, adenomyosis is more frequently encountered by obstetricians. Some studies have reported on the relationship between adenomyosis and pregnancy complications. We aimed to investigate the effect of adenomyosis on pregnancy complications and outcomes and associations between adenomyosis type and pregnancy outcomes. This multicenter retrospective 1:4 case-control study included 61 women with singleton pregnancies diagnosed with adenomyosis. The control group included women with singleton pregnancies without adenomyosis; these women were matched to those with adenomyosis using propensity scores. The incidence of obstetric complications, delivery, and neonatal outcomes were compared. The adenomyosis group (n = 61) had significantly higher incidence of preterm delivery (21.3% vs. 9.4%), hypertensive disorders of pregnancy (13.1% vs. 5.3%), cesarean delivery (46.0% vs. 20.9%), and postpartum hemorrhage (57.3% vs. 36.8%) than the control group (n = 244). Subgroup analysis by the adenomyosis type revealed that the diffuse adenomyosis group (n = 41) was significantly more likely to experience preterm labor (29.3% vs. 7.3%), hypertensive disorders of pregnancy (17.0% vs. 5.5%), severe hypertensive disorders of pregnancy (12.2% vs. 1.8%), preterm premature rupture of membranes (12.2% vs. 2.4%), cesarean delivery (61.3% vs. 18.9%), and postpartum hemorrhage (70.7% vs. 44.5%) than the control group (n = 164). The focal adenomyosis (n = 20) group was not statistically different from the control group (n = 80) with respect to obstetric complications. Women with diffuse adenomyosis require more careful perinatal management than previously thought.
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Keywords

adenomyosis, hypertensive disorders of pregnancy, postpartum hemorrhage, pregnancy outcome, preterm labor 2020 Volume 251 Issue 3 Pages 231-239 Details

Abstract

As the number of women who postpone their first pregnancy until their late 30s or early 40s is increasing, adenomyosis is more frequently encountered by obstetricians. Some studies have reported on the relationship between adenomyosis and pregnancy complications. We aimed to investigate the effect of adenomyosis on pregnancy complications and outcomes and associations between adenomyosis type and pregnancy outcomes. This multicenter retrospective 1:4 case-control study included 61 women with singleton pregnancies diagnosed with adenomyosis. The control group included women with singleton pregnancies without adenomyosis; these women were matched to those with adenomyosis using propensity scores. The incidence of obstetric complications, delivery, and neonatal outcomes were compared. The adenomyosis group (n = 61) had significantly higher incidence of preterm delivery (21.3% vs. 9.4%), hypertensive disorders of pregnancy (13.1% vs. 5.3%), cesarean delivery (46.0% vs. 20.9%), and postpartum hemorrhage (57.3% vs. 36.8%) than the control group (n = 244). Subgroup analysis by the adenomyosis type revealed that the diffuse adenomyosis group (n = 41) was significantly more likely to experience preterm labor (29.3% vs. 7.3%), hypertensive disorders of pregnancy (17.0% vs. 5.5%), severe hypertensive disorders of pregnancy (12.2% vs. 1.8%), preterm premature rupture of membranes (12.2% vs. 2.4%), cesarean delivery (61.3% vs. 18.9%), and postpartum hemorrhage (70.7% vs. 44.5%) than the control group (n = 164). The focal adenomyosis (n = 20) group was not statistically different from the control group (n = 80) with respect to obstetric complications. Women with diffuse adenomyosis require more careful perinatal management than previously thought. © 2020 Tohoku University Medical Press This article is licensed under a Creative Commons [Attribution-NonCommercial-NoDerivatives 4.0 International] license. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC-BY-NC-ND 4.0). Anyone may download, reuse, copy, reprint, or distribute the article without modifications or adaptations for non-profit purposes if they cite the original authors and source properly. https://creativecommons.org/licenses/by-nc-nd/4.0/ Favorites & Alerts Recently viewed articles - About this Journal The Tohoku Journal of Experimental Medicine (TJEM) was founded in 1920 by professors of Tohoku Imperial University, Medical School. The TJEM has been published continuously, except for the year of 1946 just after the World War II. The TJEM is open to original articles in all branches of medical sciences. The TJEM also covers the fields of disaster-prevention science, including earthquake archeology. - Submitted manuscripts will be screened for plagiarism with Similarity Check (https://www.crossref.org/services/similarity-check/). Announcements from publisher - Subscriptions Inland subscriptions should be sent to Tohoku University Medical Press, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, JAPAN. Subscriptions from abroad should be addressed to MARUZEN CO., LTD., EXPORT DEPARTMENT, Postal address: P.O.Box 75, Shinagawa, Tokyo 140-8799, JAPAN. e-mail: [email protected]

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Condition tags

adenomyosis

MeSH descriptors

Adenomyosis Pregnancy Complications Pregnancy Outcome Adenomyosis Adult Case-Control Studies Cesarean Section Cesarean Section Female Humans Hypertension, Pregnancy-Induced Hypertension, Pregnancy-Induced Incidence Infant, Newborn Japan Japan Obstetric Labor Complications Obstetric Labor Complications Obstetric Labor, Premature Obstetric Labor, Premature

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