Unveiling Hidden Risks: Obstetrical Complications in Endometriosis Associated Infertility Post-Laparoscopic Surgery

Unveiling Hidden Risks: Obstetrical Complications in Endometriosis Associated Infertility Post-Laparoscopic Surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Unveiling Hidden Risks: Obstetrical Complications in Endometriosis Associated Infertility Post-Laparoscopic Surgery Shunhe Lin, Qingshan Chen, Chaobin Liu, Guan Lin, Penghui Huang, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4796942/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study aims to elucidate the spectrum of obstetrical complications in patients with endometriosis-associated infertility following complete laparoscopic excision of endometriosis lesions, and to assess the impact of endometriosis severity on these outcomes. Study design: This case-control study enrolled 151 women who underwent laparoscopic surgery for endometriosis-associated infertility at Fujian Maternity and Child Health Hospital between January 2014 and September 2020, and who subsequently gave birth to a singleton at the same hospital by September 2021. Participants were divided into a stage I–II endometriosis group (n = 88) and a stage III–IV endometriosis group (n = 63). A control group consisted of 302 women without endometriosis who delivered a singleton at the same hospital during the same period. Clinical data and complications during pregnancy, delivery, and the neonatal stages were collected from the hospital’s medical record system. Results After adjusting for confounding factors, women in the stage I–II endometriosis group had a significantly higher risk of gestational diabetes mellitus (GDM) ( P = 0.004) and cesarean section ( P = 0.027) compared to the control group. Women in the stage III–IV endometriosis group exhibited a higher risk of GDM ( P = 0.048) and premature rupture of membranes ( P = 0.039). No statistically significant differences were observed in other obstetrical complications between the endometriosis and control groups. Conclusions Women with a history of stage I–II endometriosis who have undergone laparoscopic conservative surgery face a higher risk of GDM and cesarean section during pregnancy. Those with a history of stage III–IV endometriosis are at an elevated risk of GDM and premature rupture of membranes. These findings underscore the need for heightened monitoring and management of pregnancies in women with prior endometriosis. Endometriosis Infertility Laparoscopy Conservative surgery Pregnancy outcomes INTRODUCTION Endometriosis is a multifaceted gynecological condition characterized by the ectopic presence of endometrial tissue, including glands and stroma, outside the uterine cavity, most commonly affecting the ovaries and peritoneum ( 1 ). Despite being a benign disorder, the incidence of endometriosis has been on the rise. Based on the location of the lesions, endometriosis is classified into peritoneal endometriosis, ovarian endometriosis, deep infiltrating endometriosis (DIE), and other less common forms ( 2 ). The predominant symptoms of endometriosis include chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility, with infertility affecting approximately 30–50% of women with endometriosis ( 3 ). As a hormone-dependent disease, endometriosis primarily affects women of reproductive age, with an estimated prevalence of 10% in this population and nearly 50% among infertile women ( 4 – 5 ). Addressing infertility while ensuring optimal reproductive outcomes remains a significant challenge in the management of endometriosis. The advent of laparoscopic conservative surgery, combined with assisted reproductive technology (ART), has markedly improved pregnancy rates, achieving up to 80% within two years post-surgery ( 6 ). In recent years, the impact of endometriosis on pregnancy outcomes has garnered increasing attention. Research on the impact of endometriosis on pregnancy outcomes is mixed, with some studies suggesting no significant effect while others indicate increased risks of complications such as preterm birth and cesarean section ( 7 – 9 ). Conversely, other studies suggest that endometriosis elevates the risk of obstetrical complications such as preterm birth, placenta previa, and cesarean section ( 10 – 14 ), particularly in women who conceive via ART. The variability in findings may be attributed to the heterogeneity of the disease, differing postoperative follow-up durations, varying definitions of pregnancy outcomes, and differences in inclusion and exclusion criteria, surgical techniques, conception methods, and sample sizes. Consequently, the definitive impact of endometriosis on pregnancy outcomes remains ambiguous. Notably, many studies have not accounted for the confounding effects of ART, nor have they detailed the specific surgical interventions undertaken. This oversight is critical, as obstetrical complications are known to increase with ART and can vary based on the surgical procedure employed ( 15 – 16 ). To the best of our knowledge, few studies have rigorously evaluated whether the complete laparoscopic excision of endometriotic lesions in women with endometriosis-associated infertility continues to confer a higher risk of obstetrical complications after adjusting for the confounding influence of ART. The objectives of this study were to evaluate the impact of laparoscopic excision of endometriotic lesions on subsequent pregnancy, delivery, and neonatal complications in patients with endometriosis-associated infertility, after adjusting for the confounding influence of ART therapies. Additionally, this study aimed to determine whether the severity of endometriosis influences the incidence and types of obstetrical complications. MATERIALS AND METHODS For this case-control study, the case group comprised all infertile patients who underwent laparoscopic excision of endometriotic lesions at Fujian Maternity and Child Health Hospital from January 2014 to September 2020. A total of 151 infertile women, each with histologically confirmed complete laparoscopic excision of endometriotic lesions, who subsequently conceived and delivered a singleton at the same hospital by September 2021, were included in the study. The case group was further stratified into 88 women with prior r-AFS stage I (1–5 points) or stage II (6–15 points) endometriosis, and 63 women with prior r-AFS stage III (16–40 points) or stage IV (> 40 points) endometriosis. The control group consisted of 302 women, randomly selected through a computer-generated system from all singleton births at the hospital between January 2018 and September 2021. Women with a documented history of endometriosis were excluded from the control group. This study also excluded women with pre-existing medical conditions, such as diabetes mellitus and hypertension, prior to pregnancy. All participants confirmed that they did not smoke. Women with multiple pregnancies were excluded due to their higher risk of obstetric complications. The study protocol was approved by the Research Ethics Committee of Fujian Maternal and Child Health Hospital (grant number 2021-KRD022). Informed consent was obtained from all participants, allowing the use of their medical records for research purposes. The appropriate norms and regulations were adhered to during the execution of all methods and procedures. The following variables that could potentially affect obstetric outcomes were collected: maternal age at childbirth, pre-pregnancy body mass index (BMI), history of cesarean section, parity, and mode of conception. Detailed data on specific surgical procedures, type and stage of endometriosis, as well as pregnancy, delivery, and neonatal complications were also gathered. All clinical data used in this study were extracted from the hospital’s electronic medical record system. SURGICAL TREATMENT All laparoscopic conservative surgeries were performed by a skilled surgical team with extensive experience in treating endometriosis. The procedures involved a comprehensive exploration of pathological changes in the uterus, fallopian tubes, ovaries, and pelvis. Following the exploratory phase, endometrioma excision, ectopic lesion removal, cauterization, pelvic adhesion separation, salpingoplasty, and salpingostomy were conducted as necessitated by the extent of endometriosis. During surgery, efforts were made to remove and electrocoagulate all visible endometriotic tissue while completely peeling off the endometrioma. Hemostasis was achieved using sutures, with particular attention paid to the ovarian anatomy to preserve ovarian function. The normal anatomical relationships among the ovaries, fallopian tubes, and uterus were then restored. Hysteroscopy was performed to assess the shape of the uterine cavity, the tubal openings, and any anatomical abnormalities or space-occupying lesions. In cases of endometrial hyperplasia or polyps, curettage or polypectomy was performed, while endometrial sampling was conducted for patients with a normal endometrium. For fertility purposes, bilateral tubal interstitial catheterization was performed to determine tubal patency. All patients were scored using the revised American Society for Reproductive Medicine (r-ASRM) classification and the Endometriosis Fertility Index (EFI). Postoperatively, the pelvis and abdominal cavity were repeatedly irrigated with normal saline until the effluent was clear. An anti-adhesion agent was used for patients with severe adhesions. Antibiotics were routinely administered to prevent postoperative infection. All excised tissue was subjected to pathological examination. Depending on the patient’s age, ovarian reserve, and r-ASRM stage, an intramuscular injection of a gonadotropin-releasing hormone agonist (GnRH-a) at a dose of 3.75 mg every 28 days was considered as adjunctive therapy, with the treatment course ranging from 3 to 6 months. OBSTETRIC OUTCOME DEFINITIONS Pregnancy Complications: Premature Rupture of Membranes (PROM) Defined as the spontaneous rupture of the membranes prior to labor. When occurring before 37 weeks of gestation, it is referred to as preterm premature rupture of membranes (pPROM). Gestational Diabetes Mellitus (GDM) Defined as normal glucose metabolism before pregnancy and a positive oral glucose tolerance test during pregnancy. Hypertensive Disorders in Pregnancy (HDP) Defined as hypertension developing after 20 weeks of gestation, with a systolic blood pressure ≥ 140 mm Hg and/or a diastolic blood pressure ≥ 90 mm Hg. This includes gestational hypertension (hypertension without proteinuria) and preeclampsia (hypertension with proteinuria ≥ 300 mg in a 24-hour urine collection or a random urine protein/creatinine ratio ≥ 0.3). Placenta Previa Defined as a placenta located lower than the presenting part of the fetus, attached to the lower segment of the uterus, reaching or covering the internal cervical os after 28 weeks of gestation. Placental Abruption Defined as partial or complete detachment of a normally positioned placenta from the uterine wall before delivery, occurring after 20 weeks of pregnancy. Polyhydramnios Defined as an excessive amount of amniotic fluid, with an amniotic fluid index (AFI) ≥ 24 cm or a single deepest pocket ≥ 8 cm during an ultrasound scan. Oligohydramnios Defined as a decreased amount of amniotic fluid, with an AFI ≤ 5 cm or a single deepest pocket ≤ 2 cm during an ultrasound scan. Gestational Age Determined in the first trimester using obstetric criteria based on the last menstrual period and/or an ultrasound scan. Delivery Complications: Preterm Birth Defined as delivery occurring between 28 weeks and less than 37 weeks of gestation. Precipitate Delivery Defined as a total labor duration of less than 3 hours. Postpartum Hemorrhage (PPH) Defined as an estimated blood loss of ≥ 500 ml within 24 hours of vaginal delivery or ≥ 1000 ml after cesarean section. Neonatal Complications: Small-for-Gestational Age (SGA) Defined as a birth weight below the 10th percentile for gestational age. Low Birth Weight (LBW) Defined as a birth weight less than 2.5 kg. Macrosomia Defined as a birth weight greater than 4 kg. Stillbirth Defined as fetal death occurring in utero after 20 weeks of gestation. Neonatal Intensive Care Unit (NICU) Admission Defined as the admission of a newborn to the NICU after birth. STATISTICAL ANALYSIS Statistical analyses were performed using SPSS version 25.0 (SPSS Inc., Chicago, IL, USA). Continuous variables with a normal distribution were presented as mean ± standard deviation (SD) and compared between groups using Student's t-test. Continuous variables with a non-normal distribution were expressed as median (interquartile range) [M (P25, P75)] and compared using the Mann–Whitney U test. Qualitative variables were expressed as frequencies and percentages (%), and comparisons between groups were made using the chi-square test, the modified chi-square test, or Fisher’s exact test. Variables included in multivariate logistic regression models were selected based on clinical relevance and baseline characteristics that showed significant differences between study groups. A P -value of < 0.05 was considered statistically significant. RESULTS The case group comprised 151 infertile women who underwent complete laparoscopic excision of endometriotic lesions and subsequently delivered a singleton at Fujian Maternity and Child Health Hospital. This group included 88 women with stage I–II endometriosis and 63 women with stage III–IV endometriosis. Among them, 84 patients (55.63%) were diagnosed with peritoneal endometriosis, 57 patients (37.75%) with ovarian endometriosis, and 10 patients (6.62%) with deep infiltrating endometriosis (DIE). The control group consisted of 302 women who delivered a singleton at the same hospital without a documented history of endometriosis. Baseline characteristics between the groups, including maternal age at childbirth, pre-pregnancy BMI, previous cesarean section, parity, mode of conception, and type of endometriosis, are shown in Table 1 . Table 1 Baseline characteristics between women with endometriosis and women without endometriosis. Characteristics Endometriosis (n = 151) Non-endometriosis (n = 302) P value Maternal age at childbirth (years) 32.58 ± 3.826 29.68 ± 4.452 < 0.001 * Pre-pregnancy BMI (kg/m 2 ) 20.87 ± 2.584 20.74 ± 2.582 0.602 Parity (n,%) < 0.001 * 0 119(78.81) 185(61.26) ≥ 1 32(21.19) 117(38.74) Previous cesarean section (n,%) 0.309 No 136(90.07) 262(86.75) Yes 15(9.93) 40(13.25) Mode of conception (n,%) < 0.001 * Natural 99(65.56) 299 (99.01) ART 52(34.44) 3 (0.99) Endometriosis stages (n,%) Ⅰ-Ⅱ 88 (58.28) - - Ⅲ-Ⅳ 63 (41.72) - - Endometriosis types (n,%) Peritoneal 84 (55.63) - - Ovarian 57 (37.75) - - DIE 10 (6.62) - - Note: BMI = Body mass index, ART = Assisted reproductive technology, DIE = deep infiltrating endometriosis. * P < 0.05. There were no statistically significant differences between the case group and the control group in terms of pre-pregnancy BMI and previous cesarean section ( P = 0.602 and P = 0.309, respectively). However, pregnancies following endometriosis surgery were characterized by a higher maternal age at childbirth (32.58 ± 3.26 years versus 29.68 ± 4.45 years, P < 0.001), lower parity (21.19% versus 38.74%, P < 0.001), and a higher rate of conception through ART therapy (34.44% versus 0.99%, P < 0.001). Table 2 presents a comparison of pregnancy, delivery, and neonatal complications between women with endometriosis and those without. After adjusting for potential confounding factors such as maternal age at childbirth, parity, and mode of conception using multivariate logistic regression models, women with a history of laparoscopic excision of endometriosis lesions were found to have a significantly higher risk of gestational diabetes mellitus (GDM) (adjusted OR: 2.428; 95% CI: 1.383–4.263; P = 0.002). However, no statistically significant differences were observed in the rates of premature rupture of membranes (PROM), preterm premature rupture of membranes (pPROM), hypertensive disorders of pregnancy (HDP), placenta previa, placental abruption, polyhydramnios, oligohydramnios, preterm birth, precipitate delivery, cesarean section, postpartum hemorrhage (PPH), small for gestational age (SGA), low birth weight (LBW), macrosomia, stillbirth, or neonatal intensive care unit (NICU) admission between the case and control groups, with all P-values adjusted to > 0.05. Table 2 Pregnancy, delivery and neonatal complications between women with endometriosis and women without endometriosis. Complications Endometriosis (n = 151) Non- endometriosis (N = 302) P value Adjusted OR(95%CI) a Adjusted P Value a Pregnancy PROM 44(29.14) 77(25.50) 0.409 1.317(0.784–2.213) 0.299 PPROM 1 (0.66) 7(2.32) 0.377 0.121(0.007–2.038) 0.146 GDM 45(29.80) 43(14.24) 0.999 0.584(0.073–4.667) 0.612 Polyhydramnios 1(0.66) 2(0.66) >0.999 2.067(0.166–25.687) 0.572 Oligohydramnios 6(3.97) 15(4.97) 0.635 0.652(0.190–2.242) 0.498 Delivery Preterm birth 6(3.97) 15(4.97) 0.635 0.648(0.190–2.205) 0.487 Precipitate delivery 8(5.30) 8(5.30) >0.999 2.172(0.787–5.993) 0.134 Cesarean section 85(56.29) 104(34.44) 0.999 0.994(0.267–3.696) 0.993 Macrosomia 7(4.64) 11(3.64) 0.610 1.185(0.388–3.623) 0.766 Stillbirth 0(0.00) 1(0.33) >0.999 - 0.996 NICU admission 31(20.53) 46(15.23) 0.157 1.603(0.876–2.933) 0.126 Note: PROM = Premature rupture of membrane; PPROM = Preterm premature rupture of membrane; GDM = Gestational diabetes mellitus; HDP = Hypertensive disorders of pregnancy; PPH = Postpartum hemorrhage; SGA = Small for gestational age; LBWB = Low birth weight baby; NICU admission = Neonatal intensive care unit admission; OR = odds ratio; CI = Confidence interval. Most of P values was above 0.05. a Adjusted for childbirth age, parity, and mode of conception by multivariate logistic regression models. * P <0.05. Table 3 presents the baseline characteristics of women with stage I–II endometriosis and those with stage III–IV endometriosis. No statistically significant differences were observed in baseline characteristics between the two groups (all P > 0.05), except for the type of endometriosis (P < 0.001). Peritoneal endometriosis was predominant in patients with stage I–II endometriosis, whereas ovarian endometriosis was more common in patients with stage III–IV endometriosis. Table 3 Baseline characteristics between women with stage Ⅰ–Ⅱ endometriosis and women with stage Ⅲ–Ⅳ endometriosis. Characteristics stage Ⅰ–Ⅱ endometriosis (n = 88) stage Ⅲ–Ⅳ endometriosis (n = 63) P value Maternal age at childbirth (years) 32.63 ± 4.032 32.52 ± 3.538 0.875 Pre-pregnancy BMI(kg/m 2 ) 20.67 ± 2.691 21.16 ± 2.420 0.254 Parity(n,%) 0.342 0 67(76.14) 52(82.54) ≥ 1 21(23.86) 11(17.46) Previous cesarean section(n,%) 0.072 No 76(86.36) 60(95.24) Yes 12(13.64) 3(4.76) Mode of conception(n,%) 0.199 Natural 54(61.36) 45(71.43) ART 34(38.64) 18(28.57) Endometriosis types(n,%) <0.001 * Peritoneal 79(89.77) 5(7.94) Ovarian 4(4.55) 53(84.13) DIE 5(5.68) 5(7.94) Note: BMI = Body mass index; ART = Assisted reproductive technology; DIE = deep infiltrating endometriosis. * P <0.05. Tables 4 and 5 present pregnancy, delivery, and neonatal complications when the case group was stratified into the stage I–II endometriosis group and the stage III–IV endometriosis group according to r-AFS stages. After adjusting for confounding factors such as maternal age at childbirth, parity, and mode of conception using multivariate logistic regression models, women with stage I–II endometriosis (compared to women without endometriosis) had a significantly higher risk of gestational diabetes mellitus (GDM) (adjusted OR: 2.647; 95% CI: 1.357–5.161; P = 0.004) and cesarean section (adjusted OR: 1.960; 95% CI: 1.080–3.555; P = 0.027). Women with stage III–IV endometriosis had a significantly higher risk of GDM (adjusted OR: 2.160; 95% CI: 1.007–4.634; P = 0.048) and premature rupture of membranes (adjusted OR: 2.053; 95% CI: 1.038–4.062; P = 0.039). Other pregnancy, delivery, and neonatal complications did not significantly differ between the stage I–II endometriosis group and the control group or between the stage III–IV endometriosis group and the control group (all adjusted P > 0.05). Table 4 Obstetrical complications between women with stage Ⅰ–Ⅱ endometriosis and women without endometriosis. Complications stage Ⅰ–Ⅱ endometriosis (n = 88) Non- endometriosis ( n = 302 ) P Value Adjusted OR(95%CI) a Adjusted P Value a Pregnancy PROM 22(25.00) 77(25.50) 0.925 0.918(0.469–1.797) 0.803 PPROM 0(0.00) 7(2.32) 0.325 - 0.997 GDM 28(31.82) 43(14.24) 0.999 0.414(0.010-16.706) 0.640 Placental abruption 2(2.27) 5(1.66) >0.999 1.059(0.131–8.591) 0.957 Polyhydramnios 0(0.00) 2(0.66) >0.999 - 0.997 Oligohydramnios 3(3.41) 15(4.97) 0.746 0.765(0.173–3.378) 0.724 Delivery Preterm birth 2(2.27) 15(4.97) 0.428 0.729(0.155–3.423) 0.689 Precipitate delivery 5(5.68) 8(5.30) >0.999 1.988(0.591–6.689) 0.267 Cesarean section 52(59.09) 104(34.44) <0.001 * 1.960(1.080–3.555) * 0.027 * PPH 6(6.82) 0(0.00) <0.001 * - 0.994 Neonatal SGA 1(1.14) 14(4.64) 0.235 0.316(0.039–2.570) 0.282 LBWB 2(2.27) 12(3.97) 0.668 1.113(0.227–5.450) 0.895 Macrosomia 4(4.55) 11(3.64) 0.942 0.881(0.202–3.839) 0.866 Stillbirth 0(0.00) 1(0.33) >0.999 - 0.997 NICU admission 14(15.91) 46(15.23) 0.877 1.733(0.825–3.640) 0.146 Note: PROM = Premature rupture of membrane; PPROM = Preterm premature rupture of membrane; GDM = Gestational diabetes mellitus; HDP = Hypertensive disorders of pregnancy; PPH = Postpartum hemorrhage; SGA = Small for gestational age; LBWB = Low birth weight baby; NICU admission = Neonatal intensive care unit admission; OR = odds ratio; CI = Confidence interval. Most of P values was above 0.05. a Adjusted for childbirth age, parity, and mode of conception by multivariate logistic regression models. * P <0.05. Table 5 Obstetrical complications between women with stage Ⅲ–Ⅳ endometriosis and women without endometriosis. Complications stage Ⅲ–Ⅳ endometriosis (n = 63) Non- endometriosis (n = 302) P Value Adjusted OR(95%CI) a Adjusted P Value a Pregnancy PROM 22(34.92) 77(25.50) 0.126 2.053(1.038–4.062) * 0.039 * PPROM 1(1.59) 7(2.32) >0.999 0.301(0.019–4.681) 0.391 GDM 17(26.98) 43(14.24) <0.013 * 2.160(1.007–4.634) * 0.048 * HDP 3(4.76) 6(1.99) 0.398 0.495(0.063–3.901) 0.504 Placenta previa 2(3.17) 3(0.99) 0.207 2.569(0.263–25.099) 0.417 Placental abruption 0(0.00) 5(1.66) 0.592 - 0.997 Polyhydramnios 1(1.59) 2(0.66) 0.435 6.137(0.479–78.615) 0.163 Oligohydramnios 3(4.76) 15(4.97) >0.999 0.649(0.127–3.316) 0.603 Delivery Preterm birth 4(6.35) 15(4.97) 0.891 0.722(0.156–3.353) 0.678 Precipitate delivery 3(4.76) 8(5.30) >0.999 2.412(0.592–9.822) 0.219 Cesarean section 33(52.38) 104(34.44) 0.007 * 1.173(0.607–2.266) 0.634 PPH 1(1.59) 0(0.00) 0.173 - 0.994 Neonatal SGA 2(3.17) 14(4.64) 0.859 0.300(0.036–2.469) 0.263 LBWB 4(6.35) 12(3.97) 0.617 0.985(0.177–5.480) 0.986 Macrosomia 3(4.76) 11(3.64) 0.952 1.801(0.449–7.218) 0.406 Stillbirth 0(0.00) 1(0.33) >0.999 - 0.998 NICU admission 17(26.98) 46(15.23) 0.025 * 1.466(0.666–3.225) 0.342 Note: PROM = Premature rupture of membrane; PPROM = Preterm premature rupture of membrane; GDM = Gestational diabetes mellitus; HDP = Hypertensive disorders of pregnancy; PPH = Postpartum hemorrhage; SGA = Small for gestational age; LBWB = Low birth weight baby; NICU admission = Neonatal intensive care unit admission; OR = odds ratio; CI = Confidence interval. Most of P values was above 0.05. a Adjusted for childbirth age, parity, and mode of conception by multivariate logistic regression models. * P 0.05), as shown in Table 6 . Table 6 Obstetrical complications between women with stage Ⅰ–Ⅱ endometriosis and women with stage Ⅲ–Ⅳ endometriosis. Complications stage Ⅰ–Ⅱ Endometriosis (n = 88) stage Ⅲ–Ⅳ endometriosis (n = 63) OR(95%CI) P Value Pregnancy PROM 22(25.00) 22(34.92) 1.397(0.852–2.290) 0.186 PPROM 0(0.00) 1(1.59) - 0.417 GDM 28(31.82) 17(26.98) 0.848(0.510–1.410) 0.522 HDP 4(4.55) 3(4.76) 1.048(0.243–4.518) >0.999 Placenta previa 1(1.14) 2(3.17) 2.79(0.259–30.142) 0.769 Placental abruption 2(2.27) 0(0.00) - 0.510 Polyhydramnios 0(0.00) 1(1.59) - 0.417 Oligohydramnios 3(3.41) 3(4.76) 1.397(0.291–6.696) >0.999 Delivery Preterm birth 2(2.27) 4(6.35) 2.794(0.528–14.785) 0.400 Precipitate delivery 5(5.68) 3(4.76) 0.838(0.208–3.379) >0.999 Cesarean section 52(59.09) 33(52.38) 0.886(0.662–1.188) 0.412 PPH 6(6.82) 1(1.59) 0.233(0.029–1.886) 0.265 Neonatal SGA 1(1.14) 2(3.17) 2.794(0.259–30.142) 0.769 LBWB 2(2.27) 4(6.35) 2.794(0.528–14.785) 0.400 Macrosomia 4(4.55) 3(4.76) 1.048(0.243–4.518) >0.999 Stillbirth 0(0.00) 0(0.00) - - NICU admission 14(15.91) 17(26.98) 1.696(0.904–3.182) 0.097 Note: PROM = Premature rupture of membrane; PPROM = Preterm premature rupture of membrane; GDM = Gestational diabetes mellitus; HDP = Hypertensive disorders of pregnancy; PPH = Postpartum hemorrhage; SGA = Small for gestational age; LBWB = Low birth weight baby; NICU admission = Neonatal intensive care unit admission; OR = odds ratio; CI = Confidence interval. All P values was above 0.05. DISCUSSION Our study identified a higher prevalence of gestational diabetes mellitus (GDM) and cesarean section in women with a surgical management history of stage I–II endometriosis, and a significantly higher prevalence of GDM and premature rupture of membranes (PROM) in women with a surgical management history of stage III–IV endometriosis, compared to women without endometriosis. These findings suggest that, even though endometriosis lesions were completely removed by laparoscopic surgery prior to pregnancy, women previously afflicted by endometriosis remain at risk for obstetrical complications, irrespective of whether they conceived through assisted reproductive technology (ART). Additionally, the types of obstetrical complications varied depending on the severity of endometriosis. Studies comprehensively evaluating pregnancy, delivery, and neonatal complications following complete laparoscopic excision of endometriosis lesions in patients with endometriosis-associated infertility are relatively rare, particularly those accounting for the confounding influence of ART therapy. Farella et al. ( 17 ) reported that women with a history of endometriosis surgery have a higher risk of small-for-gestational-age (SGA), preterm birth, and placenta previa, particularly among those who conceived through ART therapy and those with stage III–IV endometriosis or deep infiltrating endometriosis (DIE). Even after adjusting for the mode of conception, the higher incidences of SGA and preterm birth remained statistically significant. However, it is important to note that the surgical implications in patients with endometriosis in this study included factors beyond infertility, such as pain management. Infertility itself can increase the risk of adverse obstetric outcomes ( 18 ). Therefore, the observed obstetric complications in patients with or without endometriosis-associated infertility may not significantly differ following surgery. Our study indicates that women with stage III–IV endometriosis have a higher risk of complications related to premature rupture of membranes (PROM), even after the complete removal of endometriotic lesions. This increased risk may be due to the persistent inflammatory state in endometriosis patients, irrespective of disease severity, which leads to elevated levels of inflammatory cytokines and prostaglandins (PGs). These factors can activate matrix metalloproteinase 9 (MMP-9), which is associated with the disease's aggressiveness ( 19 , 20 ). Both physical and microbial inflammation can weaken the fetal membrane by increasing levels of PGs and MMP-9, resulting in collagen degradation within the fetal membrane ( 21 ). Preterm premature rupture of membranes (PPROM) is the most common cause of preterm birth. In our study, we found no significant difference in the incidence rates of PPROM or preterm birth between patients with and without endometriosis, which contrasts with the findings reported by Harada et al. ( 22 ). This discrepancy may be attributed to the effectiveness of laparoscopic surgery in removing endometriotic lesions and reducing harmful inflammatory factors, particularly in cases of stage I–II endometriosis where lesions can be more thoroughly excised. Endometriosis is a chronic, subclinical inflammatory disease characterized by altered immune-related cells, inflammatory cytokines, angiogenic factors, and growth factors in peritoneal fluid ( 23 ). It is also associated with oxidative stress ( 24 ). Insulin resistance is considered the main cause of GDM ( 25 ). Oxidative stress has been suggested to be associated with both infertility and insulin resistance( 26 ). Furthermore, changes in inflammatory factors have been observed in patients with GDM ( 27 , 28 ). These findings can explain the increased risk of GDM in women with a history of endometriosis. Consistent with previous studies ( 29 – 31 ), our research indicates a higher prevalence of cesarean sections among women with a history of stage I–II endometriosis. This increased prevalence may be attributed to both biological and psychological factors. Women with endometriosis-associated infertility often regard their pregnancies as particularly valuable, leading to higher rates of elective cesarean sections and obstetrical interventions. Additionally, some endometriosis patients experience pelvic pain, and cesarean sections can help alleviate this pain during delivery ( 29 ). Although our study found that the cesarean section rate in the stage III–IV endometriosis group was higher than that in the control group, this difference was not statistically significant (adjusted OR: 1.173; 95% CI: 0.607–2.266; P = 0.634). This may be due to the small sample size of our study. Consequently, further large-scale prospective studies are necessary to evaluate the impact of endometriosis on cesarean section rates. In patients with endometriosis, factors such as chronic inflammation, junction zone thickening, defective artery transformation, placental blood perfusion insufficiency, suboptimal endometrial receptivity, progesterone resistance, abnormal uterine peristalsis and contraction, microtrauma, and placenta implantation injury may all contribute to adverse outcomes such as premature delivery, placenta previa, preeclampsia, small-for-gestational-age (SGA), placental abruption, and postpartum hemorrhage (PPH) ( 32 – 35 ). However, our study did not observe an increased rate of these obstetric complications in patients with endometriosis-associated infertility. This absence of increased risk may be attributed to the small sample size of our study or the effectiveness of the surgical intervention. Therefore, large-scale prospective studies are needed to further evaluate the impact of endometriosis on these obstetric outcomes. The strengths of this study are as follows: First, the case group included all women with endometriosis who underwent infertility surgery at the Fujian Maternity and Child Health Hospital between January 2014 and September 2020, and subsequently gave birth to singletons at this facility by September 2021. Additionally, a randomization method was employed to select the control group, effectively minimizing selection bias. Second, all clinical data were extracted from the hospital’s electronic medical record system, reducing both information and recall bias. Furthermore, this study comprehensively included most obstetric complications documented in previous research. Third, all patients with endometriosis-associated infertility were pathologically diagnosed following surgery performed by an experienced surgical team. The detailed documentation of specific surgical procedures reduces the impact of misclassification, variations in surgical techniques, and the condition of infertility itself on the results. Fourth, our analysis adjusted for the influence of conception methods on obstetric complications, providing a more accurate assessment. Fifth, the study conducted a subgroup analysis based on different stages of endometriosis, allowing for a nuanced understanding of the relationship between disease severity and obstetric outcomes. However, this study has certain unavoidable limitations. The relatively small sample size and the retrospective design from a single medical facility may limit the generalizability of the findings. Additionally, the study did not account for different types of ART therapies, the various stages and extents of endometriosis pathology, or other potential confounding factors such as lifestyle and genetic predispositions. Future studies with larger, multi-center cohorts and prospective designs are necessary to validate these findings and explore the underlying mechanisms. In conclusion, this study demonstrates that women with a history of stage I–II endometriosis have a higher risk of GDM and cesarean section during pregnancy, while those with a history of stage III–IV endometriosis have a higher risk of GDM and PROM during pregnancy following laparoscopic surgical excision. Current research on this subject remains insufficient to fully elucidate the beneficial effects of endometriosis surgery on obstetric outcomes. Therefore, for infertile patients with a history of endometriosis surgery, heightened vigilance for potential obstetric complications and stringent prenatal monitoring are recommended to optimize pregnancy outcomes. ETHICS STATEMENT The study protocol was approved by the Research Ethics Committee of the Fujian Maternal and Child Health Hospital (No. 2021KRD022). All patients included in the study had signed informed consent forms, permitting their medical records to be used for medical research. Declarations ETHICS STATEMENT The study protocol was approved by the Research Ethics Committee of the Fujian Maternal and Child Health Hospital (No. 2021KRD022). All patients included in the study had signed informed consent forms, permitting their medical records to be used for medical research. AUTHOR CONTRIBUTIONS Shunhe Lin and Qingshan Chen conceived of this research. Qingshan Chen conducted data analysis and drafted the article. Shunhe Lin contributed to the draft and revise the article. Penghui Huang conducted data compilation and data analysis. Chaobin Liu collected medical histories and surgical procedures. Guan Lin and Wei Qi were responsible for follow-up and collecting pregnancy-related information. Yuyan Guo, Zhenna Wang and Xi Xie conducted the organization and implementation of the project and final approval of the version to be published as the corresponding author. All authors approved the manuscript and this submission. CONFLICT OF INTERESTS The authors have stated explicitly that they don’t have direct or indirect conflict in connection with publishing this article. FUNDINGS This work was sponsored by grants from the Fujian Provincial Natural Science Foundation ( No. 2021J01414 and No. 2021J01421 ) and Fujian provincial health technology project ( No. 2022GGB004 ) of China. Data availability The datasets used and/or analysed during the current study available from the corresponding author on reasonable request. References Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. LANCET. 2021; 397 (10276)：839-852. doi:10.1016/S0140-6736(21)00389-5. Ye Louie, Whitaker Lucy HR, Mawson Rebecca L, et al. Endometriosis.BMJ (Clinical research ed.). 2022;379：e068950.doi:10.1136/bmj-2021-068950. Zondervan Krina T, Becker Christian M, Missmer Stacey A. Endometriosis. NEW ENGLAND JOURNAL OF MEDICINE. 2020; 382 (13)：1244-1256. doi: 10.1056/NEJMra1810764. Shafrir AL, Farland LV, Shah DK., Harris HR, Kvaskoff M, Zondervan K, and Missmer SA. 2018. Risk for and consequences of endometriosis: A critical epidemiologic review. Best Practice & Research Clinical Obstetrics and Gynaecology 06, 001-015. de Ziegler D, Pirtea P, Carbonnel M, Poulain M, Cicinelli E, Bulletti C, Kostaras K, Kontopoulos G, and Keefe D. 2019. Assisted reproduction in endometriosis. Best Pract Res Clin Endocrinol Metab 33, 47–59. Ekine AA, Fülöp I, Tekse I, Rúcz Á, Jeges S, Koppán Á, and Koppán M. 2020. The Surgical Benefifit of Hysterolaparoscopy in Endometriosis-Related Infertility: A Single Centre Retrospective Study with a Minimum 2-Year Follow-Up. J. Clin. Med. 9, 507-518. Sharon Nataly Zilberman, Shiber Yair, Vaknin Zvi, et al. Endometriosis and pregnancy: a complication to be aware of. ARCHIVES OF GYNECOLOGY AND OBSTETRICS. 2023;307 (1)：71-72.doi:10.1007/s00404-022-06592-3 Farella Marilena, Chanavaz-Lacheray Isabella, Verspick Eric, et al. Pregnancy outcomes in women with history of surgery for endometriosis. FERTILITY AND STERILITY. 2020;113 (5)：996-1004.doi:10.1016/j. fertnstert.2019.12.037. Sorrentino Felice, DE Padova Maristella, Falagario Maddalena, et al. Endometriosis and adverse pregnancy outcome.Minerva Obstetrics and Gynecology. 2022;74 (1)：31-44.doi:10.23736/S2724-606X.20.04718-8. Shadjoo Khadijeh, Gorgin Atefeh, Maleki Narges, et al. Pregnancy-related complications in patients with endometriosis in different stages. Contraception and reproductive medicine. 2024; 9 (1)：23.doi:10.1186/s40834-024-00280-0. Breintoft Kjerstine, Pinnerup Regitze, Henriksen Tine Brink, et al. Endometriosis and Risk of Adverse Pregnancy Outcome: A Systematic Review and Meta-Analysis. Journal of clinical medicine. 2021;10 (4).doi:10.3390/jcm10040667. Sharon Nataly Zilberman, Shiber Yair, Vaknin Zvi, et al. Endometriosis and pregnancy: a complication to be aware of. ARCHIVES OF GYNECOLOGY AND OBSTETRICS. 2023; 307 (1)：71-72.doi:10.1007/s00404-022-06592-3. Farland Leslie V, Prescott Jennifer, Sasamoto Naoko, et al. Endometriosis and Risk of Adverse Pregnancy Outcomes. OBSTETRICS AND GYNECOLOGY.2019;134 (3)：527-536. doi:10.1097/AOG.0000000000003410 Yi Kyong Wook, Cho Geum Joon, Park KeonVin, et al. Endometriosis Is Associated with Adverse Pregnancy Outcomes: a National Population-Based Study.Reproductive Sciences. 2020;27 (5)：1175-1180.doi:10.1007/s43032-019-00109-1. Ribot Edouard, Berbis Julie, Hamouda Ilyes, et al. Pregnancy outcomes after in vitro fertilization for moderate and severe endometriosis. A case-control study. Journal of gynecology obstetrics and human reproduction. 2022;51 (2)：102274. doi:10.1016/j.jogoh.2021.102274. Ibiebele Ibinabo, Nippita Tanya, Baber Rodney, et al. Pregnancy outcomes in women with endometriosis and/or ART use: a population-based cohort study. HUMAN REPRODUCTION. 2022;37 (10)：2350-2358.doi:10.1093/humrep/deac186. Farella M, Chanavaz-Lacheray I, Verspick E, Merlot B, Klapczynski C, Hennetier C, Tuech JJ, and Roman H. 2020. Pregnancy outcomes in women with history of surgery for endometriosis. Fertil Steril. 113, 996-1004. Wang Jian-Qing, Zhang Jia-Miao, Qian Bin. Adverse pregnancy outcomes for women with endometriosis: a systematic review and meta-analysis. Ginekologia Polska. 2021.doi:10.5603/GP.a2021.0081. Madjid Tita Husnitawati, Ardiansyah Dennis Fachmi, Permadi Wiryawan, et al. Expression of Matrix Metalloproteinase-9 and Tissue Inhibitor of Metalloproteinase-1 in Endometriosis Menstrual Blood. Diagnostics (Basel, Switzerland). 2020; 10 (6).doi:10.3390/diagnostics10060364. Bostanci Durmus Arzu, Dincer Cengiz Sevim, Yılmaz Hakan, et al. The levels of matrix metalloproteinase-9 and neutrophil gelatinase-associated lipocalin in different stages of endometriosis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY. 2019; 39 (7)：991-995. doi:10.1080/01443615.2019.1584889. Tency I. Inflammatory response in maternal serum during preterm labour. Facts Views and Vision in ObGyn. 2014;6 (1)：19-30.doi:null. Harada T, Taniguchi F, Amano H, Kurozawa Y, Ideno Y, Hayashi K, Harada T. Japan Environment and Children’s Study Group. 2019. Adverse obstetrical outcomes for women with endometriosis and adenomyosis: A large cohort of the Japan Environment and Children’s Study. PLOS ONE 14, e0220256. Abu-Zaid Ahmed, Gari Abdulrahim, Tulbah Maha, et al. Association between endometriosis and obstetric complications: Insight from the National Inpatient Sample. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2024;292：58-62. doi:10.1016/j.ejogrb.2023.11.009. Shadjoo Khadijeh, Gorgin Atefeh, Maleki Narges, et al. Pregnancy-related complications in patients with endometriosis in different stages. Contraception and reproductive medicine. 2024;9 (1)：23.doi:10.1186/s40834-024-00280-0. Li Baijia, Zhang Yuxue, Zhang Liuhang, et al. Association between endometriosis and metabolic syndrome: a cross-sectional study based on the National Health and Nutrition Examination Survey data. GYNECOLOGICAL ENDOCRINOLOGY. 2023;39 (1)：2254844. doi:10.1080/09513590.2023.2254844. Vaduva Patricia, Laouali Nasser, Fagherazzi Guy, et al. Association between endometriosis and risk of type 2 diabetes: Results from the prospective E3N cohort. MATURITAS. 2023;177：107805.doi:10.1016/j. maturitas.2023.107805. Salmeri Noemi, Li Piani Letizia, Cavoretto Paolo Ivo, et al. Endometriosis increases the risk of gestational diabetes: a meta-analysis stratified by mode of conception, disease localization and severity. Scientific reports.2023;13 (1)：8099. doi:10.1038/s41598-023-35236-y. Bean Elisabeth M R, Knez Jure, Thanatsis Nikolaos, et al. Obstetric outcomes in women with pelvic endometriosis: a prospective cohort study.FERTILITY AND STERILITY. 2024.doi:10.1016/j.fertnstert.2024.05.162 Gebremedhin Amanuel T, Mitter Vera R, Duko Bereket, et al. Associations between endometriosis and adverse pregnancy and perinatal outcomes: a population-based cohort study.ARCHIVES OF GYNECOLOGY AND OBSTETRICS. 2024;309 (4)：1323-1331. doi:10.1007/s00404-023-07002-y. Lin Shunhe, Xie Xi, Guo Yuyan, et al.Clinical characteristics and pregnancy outcomes of infertile patients with endometriosis and endometrial polyps: A retrospective cohort study. Taiwanese Journal of Obstetrics & Gynecology. 2020;59 (6)：916-921.doi:10.1016/j.tjog.2020.09.020. Wang Lifei, Xiong Ying, Wang Hongjing, et al. High spontaneous pregnancy and live birth rate in patients with stage III-IV endometriosis following surgical management. Asian Journal of Surgery. 2022;45 (3)：912-913. doi:10.1016/j. asjsur. 2021. 12.058.I Saunders Philippa T K, Horne Andrew W. Endometriosis: Etiology, pathobiology, and therapeutic prospects. CELL.2021;184 (11)：2807-2824. doi:10.1016/j.cell. 2021. 04. 041 Dutsch-Wicherek MM, Nowakowski Blazej, Faryna Jan, et al. FOXP3-positive cell infiltration in the chorionic villi is increased in the placenta accreta and decreased in the placental abruption. Ginekologia Polska. 2023; 94 (10)：816-822. doi:10.5603/gpl.95458. Labarrere CA, DiCarlo HL, Bammerlin Elaine, et al. Failure of physiologic transformation of spiral arteries, endothelial and trophoblast cell activation, and acute atherosis in the basal plate of the placenta. AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY.2017;216 (3)：287.e1-287.e16. doi:10.1016/ j.ajog. 2016.12.029. Schatz Frederick, Guzeloglu-Kayisli Ozlem, Arlier Sefa, et al. The role of decidual cells in uterine hemostasis, menstruation, inflammation, adverse pregnancy outcomes and abnormal uterine bleeding. HUMAN REPRODUCTION UPDATE.2016;22 (4)：497-515. doi:10.1093/humupd/dmw004. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4796942","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":345126682,"identity":"20817c3d-18ba-4cf1-aa09-a74d340d18a9","order_by":0,"name":"Shunhe Lin","email":"","orcid":"","institution":"Department of Obstetrics and Gynecology, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics \u0026 Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 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16:46:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4796942/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4796942/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":66748883,"identity":"74ccfd37-c14c-41e1-accf-74a906520810","added_by":"auto","created_at":"2024-10-16 06:54:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1221684,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4796942/v1/1baad76c-2674-4980-a0e1-896cb7fc4c73.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Unveiling Hidden Risks: Obstetrical Complications in Endometriosis Associated Infertility Post-Laparoscopic Surgery","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eEndometriosis is a multifaceted gynecological condition characterized by the ectopic presence of endometrial tissue, including glands and stroma, outside the uterine cavity, most commonly affecting the ovaries and peritoneum (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Despite being a benign disorder, the incidence of endometriosis has been on the rise. Based on the location of the lesions, endometriosis is classified into peritoneal endometriosis, ovarian endometriosis, deep infiltrating endometriosis (DIE), and other less common forms (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The predominant symptoms of endometriosis include chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility, with infertility affecting approximately 30\u0026ndash;50% of women with endometriosis (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). As a hormone-dependent disease, endometriosis primarily affects women of reproductive age, with an estimated prevalence of 10% in this population and nearly 50% among infertile women (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Addressing infertility while ensuring optimal reproductive outcomes remains a significant challenge in the management of endometriosis. The advent of laparoscopic conservative surgery, combined with assisted reproductive technology (ART), has markedly improved pregnancy rates, achieving up to 80% within two years post-surgery (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn recent years, the impact of endometriosis on pregnancy outcomes has garnered increasing attention. Research on the impact of endometriosis on pregnancy outcomes is mixed, with some studies suggesting no significant effect while others indicate increased risks of complications such as preterm birth and cesarean section (\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Conversely, other studies suggest that endometriosis elevates the risk of obstetrical complications such as preterm birth, placenta previa, and cesarean section (\u003cspan additionalcitationids=\"CR11 CR12 CR13\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), particularly in women who conceive via ART. The variability in findings may be attributed to the heterogeneity of the disease, differing postoperative follow-up durations, varying definitions of pregnancy outcomes, and differences in inclusion and exclusion criteria, surgical techniques, conception methods, and sample sizes. Consequently, the definitive impact of endometriosis on pregnancy outcomes remains ambiguous. Notably, many studies have not accounted for the confounding effects of ART, nor have they detailed the specific surgical interventions undertaken. This oversight is critical, as obstetrical complications are known to increase with ART and can vary based on the surgical procedure employed (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). To the best of our knowledge, few studies have rigorously evaluated whether the complete laparoscopic excision of endometriotic lesions in women with endometriosis-associated infertility continues to confer a higher risk of obstetrical complications after adjusting for the confounding influence of ART.\u003c/p\u003e \u003cp\u003eThe objectives of this study were to evaluate the impact of laparoscopic excision of endometriotic lesions on subsequent pregnancy, delivery, and neonatal complications in patients with endometriosis-associated infertility, after adjusting for the confounding influence of ART therapies. Additionally, this study aimed to determine whether the severity of endometriosis influences the incidence and types of obstetrical complications.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eFor this case-control study, the case group comprised all infertile patients who underwent laparoscopic excision of endometriotic lesions at Fujian Maternity and Child Health Hospital from January 2014 to September 2020. A total of 151 infertile women, each with histologically confirmed complete laparoscopic excision of endometriotic lesions, who subsequently conceived and delivered a singleton at the same hospital by September 2021, were included in the study. The case group was further stratified into 88 women with prior r-AFS stage I (1\u0026ndash;5 points) or stage II (6\u0026ndash;15 points) endometriosis, and 63 women with prior r-AFS stage III (16\u0026ndash;40 points) or stage IV (\u0026gt;\u0026thinsp;40 points) endometriosis.\u003c/p\u003e \u003cp\u003eThe control group consisted of 302 women, randomly selected through a computer-generated system from all singleton births at the hospital between January 2018 and September 2021. Women with a documented history of endometriosis were excluded from the control group. This study also excluded women with pre-existing medical conditions, such as diabetes mellitus and hypertension, prior to pregnancy. All participants confirmed that they did not smoke. Women with multiple pregnancies were excluded due to their higher risk of obstetric complications. The study protocol was approved by the Research Ethics Committee of Fujian Maternal and Child Health Hospital (grant number 2021-KRD022). Informed consent was obtained from all participants, allowing the use of their medical records for research purposes. \u003cb\u003eThe appropriate norms and regulations were adhered to during the execution of all methods and procedures.\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe following variables that could potentially affect obstetric outcomes were collected: maternal age at childbirth, pre-pregnancy body mass index (BMI), history of cesarean section, parity, and mode of conception. Detailed data on specific surgical procedures, type and stage of endometriosis, as well as pregnancy, delivery, and neonatal complications were also gathered. All clinical data used in this study were extracted from the hospital\u0026rsquo;s electronic medical record system.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSURGICAL TREATMENT\u003c/h2\u003e \u003cp\u003eAll laparoscopic conservative surgeries were performed by a skilled surgical team with extensive experience in treating endometriosis. The procedures involved a comprehensive exploration of pathological changes in the uterus, fallopian tubes, ovaries, and pelvis. Following the exploratory phase, endometrioma excision, ectopic lesion removal, cauterization, pelvic adhesion separation, salpingoplasty, and salpingostomy were conducted as necessitated by the extent of endometriosis. During surgery, efforts were made to remove and electrocoagulate all visible endometriotic tissue while completely peeling off the endometrioma. Hemostasis was achieved using sutures, with particular attention paid to the ovarian anatomy to preserve ovarian function. The normal anatomical relationships among the ovaries, fallopian tubes, and uterus were then restored.\u003c/p\u003e \u003cp\u003eHysteroscopy was performed to assess the shape of the uterine cavity, the tubal openings, and any anatomical abnormalities or space-occupying lesions. In cases of endometrial hyperplasia or polyps, curettage or polypectomy was performed, while endometrial sampling was conducted for patients with a normal endometrium. For fertility purposes, bilateral tubal interstitial catheterization was performed to determine tubal patency. All patients were scored using the revised American Society for Reproductive Medicine (r-ASRM) classification and the Endometriosis Fertility Index (EFI).\u003c/p\u003e \u003cp\u003ePostoperatively, the pelvis and abdominal cavity were repeatedly irrigated with normal saline until the effluent was clear. An anti-adhesion agent was used for patients with severe adhesions. Antibiotics were routinely administered to prevent postoperative infection. All excised tissue was subjected to pathological examination. Depending on the patient\u0026rsquo;s age, ovarian reserve, and r-ASRM stage, an intramuscular injection of a gonadotropin-releasing hormone agonist (GnRH-a) at a dose of 3.75 mg every 28 days was considered as adjunctive therapy, with the treatment course ranging from 3 to 6 months.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eOBSTETRIC OUTCOME DEFINITIONS\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003ePregnancy Complications:\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003ePremature Rupture of Membranes (PROM)\u003c/strong\u003e \u003cp\u003eDefined as the spontaneous rupture of the membranes prior to labor. When occurring before 37 weeks of gestation, it is referred to as preterm premature rupture of membranes (pPROM).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eGestational Diabetes Mellitus (GDM)\u003c/strong\u003e \u003cp\u003eDefined as normal glucose metabolism before pregnancy and a positive oral glucose tolerance test during pregnancy.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHypertensive Disorders in Pregnancy (HDP)\u003c/strong\u003e \u003cp\u003eDefined as hypertension developing after 20 weeks of gestation, with a systolic blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;140 mm Hg and/or a diastolic blood pressure\u0026thinsp;\u0026ge;\u0026thinsp;90 mm Hg. This includes gestational hypertension (hypertension without proteinuria) and preeclampsia (hypertension with proteinuria\u0026thinsp;\u0026ge;\u0026thinsp;300 mg in a 24-hour urine collection or a random urine protein/creatinine ratio\u0026thinsp;\u0026ge;\u0026thinsp;0.3).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePlacenta Previa\u003c/strong\u003e \u003cp\u003eDefined as a placenta located lower than the presenting part of the fetus, attached to the lower segment of the uterus, reaching or covering the internal cervical os after 28 weeks of gestation.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePlacental Abruption\u003c/strong\u003e \u003cp\u003eDefined as partial or complete detachment of a normally positioned placenta from the uterine wall before delivery, occurring after 20 weeks of pregnancy.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePolyhydramnios\u003c/strong\u003e \u003cp\u003eDefined as an excessive amount of amniotic fluid, with an amniotic fluid index (AFI)\u0026thinsp;\u0026ge;\u0026thinsp;24 cm or a single deepest pocket\u0026thinsp;\u0026ge;\u0026thinsp;8 cm during an ultrasound scan.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eOligohydramnios\u003c/strong\u003e \u003cp\u003eDefined as a decreased amount of amniotic fluid, with an AFI\u0026thinsp;\u0026le;\u0026thinsp;5 cm or a single deepest pocket\u0026thinsp;\u0026le;\u0026thinsp;2 cm during an ultrasound scan.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eGestational Age\u003c/strong\u003e \u003cp\u003eDetermined in the first trimester using obstetric criteria based on the last menstrual period and/or an ultrasound scan.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eDelivery Complications:\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003ePreterm Birth\u003c/strong\u003e \u003cp\u003eDefined as delivery occurring between 28 weeks and less than 37 weeks of gestation.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePrecipitate Delivery\u003c/strong\u003e \u003cp\u003eDefined as a total labor duration of less than 3 hours.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003ePostpartum Hemorrhage (PPH)\u003c/strong\u003e \u003cp\u003eDefined as an estimated blood loss of \u0026ge;\u0026thinsp;500 ml within 24 hours of vaginal delivery or \u0026ge;\u0026thinsp;1000 ml after cesarean section.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eNeonatal Complications:\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eSmall-for-Gestational Age (SGA)\u003c/strong\u003e \u003cp\u003eDefined as a birth weight below the 10th percentile for gestational age.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLow Birth Weight (LBW)\u003c/strong\u003e \u003cp\u003eDefined as a birth weight less than 2.5 kg.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMacrosomia\u003c/strong\u003e \u003cp\u003eDefined as a birth weight greater than 4 kg.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStillbirth\u003c/strong\u003e \u003cp\u003eDefined as fetal death occurring in utero after 20 weeks of gestation.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eNeonatal Intensive Care Unit (NICU) Admission\u003c/strong\u003e \u003cp\u003eDefined as the admission of a newborn to the NICU after birth.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSTATISTICAL ANALYSIS\u003c/h2\u003e \u003cp\u003eStatistical analyses were performed using SPSS version 25.0 (SPSS Inc., Chicago, IL, USA). Continuous variables with a normal distribution were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD) and compared between groups using Student's t-test. Continuous variables with a non-normal distribution were expressed as median (interquartile range) [M (P25, P75)] and compared using the Mann\u0026ndash;Whitney U test. Qualitative variables were expressed as frequencies and percentages (%), and comparisons between groups were made using the chi-square test, the modified chi-square test, or Fisher\u0026rsquo;s exact test. Variables included in multivariate logistic regression models were selected based on clinical relevance and baseline characteristics that showed significant differences between study groups. A \u003cem\u003eP\u003c/em\u003e-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe case group comprised 151 infertile women who underwent complete laparoscopic excision of endometriotic lesions and subsequently delivered a singleton at Fujian Maternity and Child Health Hospital. This group included 88 women with stage I\u0026ndash;II endometriosis and 63 women with stage III\u0026ndash;IV endometriosis. Among them, 84 patients (55.63%) were diagnosed with peritoneal endometriosis, 57 patients (37.75%) with ovarian endometriosis, and 10 patients (6.62%) with deep infiltrating endometriosis (DIE). The control group consisted of 302 women who delivered a singleton at the same hospital without a documented history of endometriosis. Baseline characteristics between the groups, including maternal age at childbirth, pre-pregnancy BMI, previous cesarean section, parity, mode of conception, and type of endometriosis, are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics between women with endometriosis and women without endometriosis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEndometriosis\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;151)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-endometriosis\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;302)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaternal age at childbirth (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.58\u0026thinsp;\u0026plusmn;\u0026thinsp;3.826\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29.68\u0026thinsp;\u0026plusmn;\u0026thinsp;4.452\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePre-pregnancy BMI (kg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.87\u0026thinsp;\u0026plusmn;\u0026thinsp;2.584\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.74\u0026thinsp;\u0026plusmn;\u0026thinsp;2.582\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.602\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParity (n,%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e119(78.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e185(61.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32(21.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117(38.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrevious cesarean section (n,%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.309\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e136(90.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e262(86.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15(9.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40(13.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMode of conception (n,%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNatural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99(65.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e299 (99.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eART\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52(34.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEndometriosis stages (n,%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅠ-Ⅱ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88 (58.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eⅢ-Ⅳ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (41.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEndometriosis types (n,%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeritoneal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84 (55.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOvarian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57 (37.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDIE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (6.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eNote: BMI\u0026thinsp;=\u0026thinsp;Body mass index, ART\u0026thinsp;=\u0026thinsp;Assisted reproductive technology, DIE\u0026thinsp;=\u0026thinsp;deep infiltrating endometriosis. * \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere were no statistically significant differences between the case group and the control group in terms of pre-pregnancy BMI and previous cesarean section (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.602 and \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.309, respectively). However, pregnancies following endometriosis surgery were characterized by a higher maternal age at childbirth (32.58\u0026thinsp;\u0026plusmn;\u0026thinsp;3.26 years versus 29.68\u0026thinsp;\u0026plusmn;\u0026thinsp;4.45 years, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), lower parity (21.19% versus 38.74%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and a higher rate of conception through ART therapy (34.44% versus 0.99%, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents a comparison of pregnancy, delivery, and neonatal complications between women with endometriosis and those without. After adjusting for potential confounding factors such as maternal age at childbirth, parity, and mode of conception using multivariate logistic regression models, women with a history of laparoscopic excision of endometriosis lesions were found to have a significantly higher risk of gestational diabetes mellitus (GDM) (adjusted OR: 2.428; 95% CI: 1.383\u0026ndash;4.263; P\u0026thinsp;=\u0026thinsp;0.002). However, no statistically significant differences were observed in the rates of premature rupture of membranes (PROM), preterm premature rupture of membranes (pPROM), hypertensive disorders of pregnancy (HDP), placenta previa, placental abruption, polyhydramnios, oligohydramnios, preterm birth, precipitate delivery, cesarean section, postpartum hemorrhage (PPH), small for gestational age (SGA), low birth weight (LBW), macrosomia, stillbirth, or neonatal intensive care unit (NICU) admission between the case and control groups, with all P-values adjusted to \u0026gt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePregnancy, delivery and neonatal complications between women with endometriosis and women without endometriosis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEndometriosis\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;151)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-\u003c/p\u003e \u003cp\u003eendometriosis\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;302)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdjusted OR(95%CI)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAdjusted\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePregnancy\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePROM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44(29.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77(25.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.409\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.317(0.784\u0026ndash;2.213)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.299\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePPROM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (0.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7(2.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.121(0.007\u0026ndash;2.038)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.146\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGDM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45(29.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43(14.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.428(1.383\u0026ndash;4.263)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.002\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7(4.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(1.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.653(0.125\u0026ndash;3.406)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.994\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacenta previa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(1.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.663\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.377(0.151\u0026ndash;12.582)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.777\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacental abruption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5(1.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.584(0.073\u0026ndash;4.667)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.612\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolyhydramnios\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(0.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(0.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.067(0.166\u0026ndash;25.687)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.572\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOligohydramnios\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6(3.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(4.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.635\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.652(0.190\u0026ndash;2.242)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.498\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDelivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreterm birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6(3.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(4.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.635\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.648(0.190\u0026ndash;2.205)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.487\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrecipitate delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8(5.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(5.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.172(0.787\u0026ndash;5.993)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.134\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85(56.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104(34.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.553(0.958\u0026ndash;2.515)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.074\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePPH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7(4.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.994\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNeonatal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(1.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(4.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.312(0.066\u0026ndash;1.487)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.144\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLBWB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6(3.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12(3.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.994(0.267\u0026ndash;3.696)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.993\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMacrosomia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7(4.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11(3.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.610\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.185(0.388\u0026ndash;3.623)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.766\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStillbirth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(0.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.996\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNICU admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31(20.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46(15.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.603(0.876\u0026ndash;2.933)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: PROM\u0026thinsp;=\u0026thinsp;Premature rupture of membrane; PPROM\u0026thinsp;=\u0026thinsp;Preterm premature rupture of membrane; GDM\u0026thinsp;=\u0026thinsp;Gestational diabetes mellitus; HDP\u0026thinsp;=\u0026thinsp;Hypertensive disorders of pregnancy; PPH\u0026thinsp;=\u0026thinsp;Postpartum hemorrhage; SGA\u0026thinsp;=\u0026thinsp;Small for gestational age; LBWB\u0026thinsp;=\u0026thinsp;Low birth weight baby; NICU admission\u0026thinsp;=\u0026thinsp;Neonatal intensive care unit admission; OR\u0026thinsp;=\u0026thinsp;odds ratio; CI\u0026thinsp;=\u0026thinsp;Confidence interval. Most of \u003cem\u003eP\u003c/em\u003e values was above 0.05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003ea\u003c/sup\u003e Adjusted for childbirth age, parity, and mode of conception by multivariate logistic regression models. \u003csup\u003e*\u003c/sup\u003e \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the baseline characteristics of women with stage I\u0026ndash;II endometriosis and those with stage III\u0026ndash;IV endometriosis. No statistically significant differences were observed in baseline characteristics between the two groups (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), except for the type of endometriosis (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Peritoneal endometriosis was predominant in patients with stage I\u0026ndash;II endometriosis, whereas ovarian endometriosis was more common in patients with stage III\u0026ndash;IV endometriosis.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics between women with stage Ⅰ\u0026ndash;Ⅱ endometriosis and women with stage Ⅲ\u0026ndash;Ⅳ endometriosis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003estage Ⅰ\u0026ndash;Ⅱ\u003c/p\u003e \u003cp\u003eendometriosis\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;88)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003estage Ⅲ\u0026ndash;Ⅳ endometriosis\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;63)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaternal age at childbirth (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.63\u0026thinsp;\u0026plusmn;\u0026thinsp;4.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.52\u0026thinsp;\u0026plusmn;\u0026thinsp;3.538\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.875\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePre-pregnancy BMI(kg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.67\u0026thinsp;\u0026plusmn;\u0026thinsp;2.691\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.16\u0026thinsp;\u0026plusmn;\u0026thinsp;2.420\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.254\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParity(n,%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.342\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67(76.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52(82.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(23.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(17.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePrevious cesarean section(n,%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76(86.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60(95.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12(13.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(4.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMode of conception(n,%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.199\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNatural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54(61.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45(71.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eART\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34(38.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(28.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEndometriosis types(n,%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeritoneal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79(89.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(7.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOvarian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(4.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53(84.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDIE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5(5.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(7.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eNote: BMI\u0026thinsp;=\u0026thinsp;Body mass index; ART\u0026thinsp;=\u0026thinsp;Assisted reproductive technology; DIE\u0026thinsp;=\u0026thinsp;deep infiltrating endometriosis. * \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTables\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e present pregnancy, delivery, and neonatal complications when the case group was stratified into the stage I\u0026ndash;II endometriosis group and the stage III\u0026ndash;IV endometriosis group according to r-AFS stages. After adjusting for confounding factors such as maternal age at childbirth, parity, and mode of conception using multivariate logistic regression models, women with stage I\u0026ndash;II endometriosis (compared to women without endometriosis) had a significantly higher risk of gestational diabetes mellitus (GDM) (adjusted OR: 2.647; 95% CI: 1.357\u0026ndash;5.161; P\u0026thinsp;=\u0026thinsp;0.004) and cesarean section (adjusted OR: 1.960; 95% CI: 1.080\u0026ndash;3.555; P\u0026thinsp;=\u0026thinsp;0.027). Women with stage III\u0026ndash;IV endometriosis had a significantly higher risk of GDM (adjusted OR: 2.160; 95% CI: 1.007\u0026ndash;4.634; P\u0026thinsp;=\u0026thinsp;0.048) and premature rupture of membranes (adjusted OR: 2.053; 95% CI: 1.038\u0026ndash;4.062; P\u0026thinsp;=\u0026thinsp;0.039). Other pregnancy, delivery, and neonatal complications did not significantly differ between the stage I\u0026ndash;II endometriosis group and the control group or between the stage III\u0026ndash;IV endometriosis group and the control group (all adjusted P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eObstetrical complications between women with stage Ⅰ\u0026ndash;Ⅱ endometriosis and women without endometriosis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003estage Ⅰ\u0026ndash;Ⅱ\u003c/p\u003e \u003cp\u003eendometriosis\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;88)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-\u003c/p\u003e \u003cp\u003eendometriosis\u003c/p\u003e \u003cp\u003e( n\u0026thinsp;=\u0026thinsp;302 )\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdjusted OR(95%CI)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAdjusted\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePROM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22(25.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77(25.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.925\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.918(0.469\u0026ndash;1.797)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.803\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePPROM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7(2.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.325\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGDM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28(31.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43(14.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.647(1.357\u0026ndash;5.161)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.004\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4(4.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(1.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.341\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.071(0.169\u0026ndash;6.793)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.942\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacenta previa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(1.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.414(0.010-16.706)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.640\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacental abruption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(2.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5(1.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.059(0.131\u0026ndash;8.591)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.957\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolyhydramnios\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(0.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOligohydramnios\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(3.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(4.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.746\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.765(0.173\u0026ndash;3.378)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.724\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreterm birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(2.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(4.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.729(0.155\u0026ndash;3.423)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.689\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrecipitate delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5(5.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(5.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.988(0.591\u0026ndash;6.689)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.267\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52(59.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104(34.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.960(1.080\u0026ndash;3.555)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.027\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePPH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6(6.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.994\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeonatal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(1.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(4.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.316(0.039\u0026ndash;2.570)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.282\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLBWB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(2.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12(3.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.668\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.113(0.227\u0026ndash;5.450)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.895\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMacrosomia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4(4.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11(3.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.942\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.881(0.202\u0026ndash;3.839)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.866\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStillbirth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(0.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNICU admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14(15.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46(15.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.877\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.733(0.825\u0026ndash;3.640)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.146\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: PROM\u0026thinsp;=\u0026thinsp;Premature rupture of membrane; PPROM\u0026thinsp;=\u0026thinsp;Preterm premature rupture of membrane; GDM\u0026thinsp;=\u0026thinsp;Gestational diabetes mellitus; HDP\u0026thinsp;=\u0026thinsp;Hypertensive disorders of pregnancy; PPH\u0026thinsp;=\u0026thinsp;Postpartum hemorrhage; SGA\u0026thinsp;=\u0026thinsp;Small for gestational age; LBWB\u0026thinsp;=\u0026thinsp;Low birth weight baby; NICU admission\u0026thinsp;=\u0026thinsp;Neonatal intensive care unit admission; OR\u0026thinsp;=\u0026thinsp;odds ratio; CI\u0026thinsp;=\u0026thinsp;Confidence interval. Most of \u003cem\u003eP\u003c/em\u003e values was above 0.05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003ea\u003c/sup\u003e Adjusted for childbirth age, parity, and mode of conception by multivariate logistic regression models. \u003csup\u003e*\u003c/sup\u003e \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eObstetrical complications between women with stage Ⅲ\u0026ndash;Ⅳ endometriosis and women without endometriosis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003estage Ⅲ\u0026ndash;Ⅳ endometriosis\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;63)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-\u003c/p\u003e \u003cp\u003eendometriosis\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;302)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdjusted OR(95%CI)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAdjusted\u003c/p\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePROM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22(34.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77(25.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.053(1.038\u0026ndash;4.062)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.039\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePPROM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(1.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7(2.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.301(0.019\u0026ndash;4.681)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.391\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGDM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17(26.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43(14.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.013\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.160(1.007\u0026ndash;4.634)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.048\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(4.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(1.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.398\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.495(0.063\u0026ndash;3.901)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.504\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacenta previa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(3.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(0.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.569(0.263\u0026ndash;25.099)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.417\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacental abruption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5(1.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.592\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolyhydramnios\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(1.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(0.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.435\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.137(0.479\u0026ndash;78.615)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.163\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOligohydramnios\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(4.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(4.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.649(0.127\u0026ndash;3.316)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.603\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreterm birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4(6.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(4.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.891\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.722(0.156\u0026ndash;3.353)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.678\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrecipitate delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(4.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(5.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.412(0.592\u0026ndash;9.822)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.219\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33(52.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104(34.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.007\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.173(0.607\u0026ndash;2.266)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.634\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePPH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(1.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.994\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeonatal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(3.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(4.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.859\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.300(0.036\u0026ndash;2.469)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.263\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLBWB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4(6.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12(3.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.617\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.985(0.177\u0026ndash;5.480)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.986\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMacrosomia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(4.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11(3.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.952\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.801(0.449\u0026ndash;7.218)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.406\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStillbirth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(0.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;0.999\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.998\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNICU admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17(26.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46(15.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.025\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.466(0.666\u0026ndash;3.225)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.342\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: PROM\u0026thinsp;=\u0026thinsp;Premature rupture of membrane; PPROM\u0026thinsp;=\u0026thinsp;Preterm premature rupture of membrane; GDM\u0026thinsp;=\u0026thinsp;Gestational diabetes mellitus; HDP\u0026thinsp;=\u0026thinsp;Hypertensive disorders of pregnancy; PPH\u0026thinsp;=\u0026thinsp;Postpartum hemorrhage; SGA\u0026thinsp;=\u0026thinsp;Small for gestational age; LBWB\u0026thinsp;=\u0026thinsp;Low birth weight baby; NICU admission\u0026thinsp;=\u0026thinsp;Neonatal intensive care unit admission; OR\u0026thinsp;=\u0026thinsp;odds ratio; CI\u0026thinsp;=\u0026thinsp;Confidence interval. Most of \u003cem\u003eP\u003c/em\u003e values was above 0.05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csup\u003ea\u003c/sup\u003e Adjusted for childbirth age, parity, and mode of conception by multivariate logistic regression models. \u003csup\u003e*\u003c/sup\u003e \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05.\u003c/p\u003e \u003cp\u003eNo statistically significant differences in obstetrical complications were observed between women with stage I\u0026ndash;II endometriosis and those with stage III\u0026ndash;IV endometriosis (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eObstetrical complications between women with stage Ⅰ\u0026ndash;Ⅱ endometriosis and women with stage Ⅲ\u0026ndash;Ⅳ endometriosis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003estage Ⅰ\u0026ndash;Ⅱ\u003c/p\u003e \u003cp\u003eEndometriosis\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;88)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003estage Ⅲ\u0026ndash;Ⅳ endometriosis\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;63)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR(95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e Value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePROM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22(25.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22(34.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.397(0.852\u0026ndash;2.290)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePPROM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(1.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.417\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGDM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28(31.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17(26.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.848(0.510\u0026ndash;1.410)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.522\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4(4.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(4.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.048(0.243\u0026ndash;4.518)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacenta previa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(1.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(3.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.79(0.259\u0026ndash;30.142)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.769\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacental abruption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(2.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.510\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolyhydramnios\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(1.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.417\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOligohydramnios\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(3.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(4.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.397(0.291\u0026ndash;6.696)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreterm birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(2.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4(6.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.794(0.528\u0026ndash;14.785)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.400\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrecipitate delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5(5.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(4.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.838(0.208\u0026ndash;3.379)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52(59.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33(52.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.886(0.662\u0026ndash;1.188)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.412\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePPH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6(6.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(1.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.233(0.029\u0026ndash;1.886)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.265\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeonatal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSGA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(1.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(3.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.794(0.259\u0026ndash;30.142)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.769\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLBWB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(2.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4(6.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.794(0.528\u0026ndash;14.785)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.400\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMacrosomia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4(4.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(4.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.048(0.243\u0026ndash;4.518)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStillbirth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0(0.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNICU admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14(15.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17(26.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.696(0.904\u0026ndash;3.182)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: PROM\u0026thinsp;=\u0026thinsp;Premature rupture of membrane; PPROM\u0026thinsp;=\u0026thinsp;Preterm premature rupture of membrane; GDM\u0026thinsp;=\u0026thinsp;Gestational diabetes mellitus; HDP\u0026thinsp;=\u0026thinsp;Hypertensive disorders of pregnancy; PPH\u0026thinsp;=\u0026thinsp;Postpartum hemorrhage; SGA\u0026thinsp;=\u0026thinsp;Small for gestational age; LBWB\u0026thinsp;=\u0026thinsp;Low birth weight baby; NICU admission\u0026thinsp;=\u0026thinsp;Neonatal intensive care unit admission; OR\u0026thinsp;=\u0026thinsp;odds ratio; CI\u0026thinsp;=\u0026thinsp;Confidence interval. All \u003cem\u003eP\u003c/em\u003e values was above 0.05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOur study identified a higher prevalence of gestational diabetes mellitus (GDM) and cesarean section in women with a surgical management history of stage I\u0026ndash;II endometriosis, and a significantly higher prevalence of GDM and premature rupture of membranes (PROM) in women with a surgical management history of stage III\u0026ndash;IV endometriosis, compared to women without endometriosis. These findings suggest that, even though endometriosis lesions were completely removed by laparoscopic surgery prior to pregnancy, women previously afflicted by endometriosis remain at risk for obstetrical complications, irrespective of whether they conceived through assisted reproductive technology (ART). Additionally, the types of obstetrical complications varied depending on the severity of endometriosis.\u003c/p\u003e \u003cp\u003eStudies comprehensively evaluating pregnancy, delivery, and neonatal complications following complete laparoscopic excision of endometriosis lesions in patients with endometriosis-associated infertility are relatively rare, particularly those accounting for the confounding influence of ART therapy. Farella et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) reported that women with a history of endometriosis surgery have a higher risk of small-for-gestational-age (SGA), preterm birth, and placenta previa, particularly among those who conceived through ART therapy and those with stage III\u0026ndash;IV endometriosis or deep infiltrating endometriosis (DIE). Even after adjusting for the mode of conception, the higher incidences of SGA and preterm birth remained statistically significant. However, it is important to note that the surgical implications in patients with endometriosis in this study included factors beyond infertility, such as pain management. Infertility itself can increase the risk of adverse obstetric outcomes (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Therefore, the observed obstetric complications in patients with or without endometriosis-associated infertility may not significantly differ following surgery.\u003c/p\u003e \u003cp\u003eOur study indicates that women with stage III\u0026ndash;IV endometriosis have a higher risk of complications related to premature rupture of membranes (PROM), even after the complete removal of endometriotic lesions. This increased risk may be due to the persistent inflammatory state in endometriosis patients, irrespective of disease severity, which leads to elevated levels of inflammatory cytokines and prostaglandins (PGs). These factors can activate matrix metalloproteinase 9 (MMP-9), which is associated with the disease's aggressiveness (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Both physical and microbial inflammation can weaken the fetal membrane by increasing levels of PGs and MMP-9, resulting in collagen degradation within the fetal membrane (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Preterm premature rupture of membranes (PPROM) is the most common cause of preterm birth. In our study, we found no significant difference in the incidence rates of PPROM or preterm birth between patients with and without endometriosis, which contrasts with the findings reported by Harada et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). This discrepancy may be attributed to the effectiveness of laparoscopic surgery in removing endometriotic lesions and reducing harmful inflammatory factors, particularly in cases of stage I\u0026ndash;II endometriosis where lesions can be more thoroughly excised.\u003c/p\u003e \u003cp\u003eEndometriosis is a chronic, subclinical inflammatory disease characterized by altered immune-related cells, inflammatory cytokines, angiogenic factors, and growth factors in peritoneal fluid (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). It is also associated with oxidative stress (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Insulin resistance is considered the main cause of GDM (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Oxidative stress has been suggested to be associated with both infertility and insulin resistance(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Furthermore, changes in inflammatory factors have been observed in patients with GDM (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). These findings can explain the increased risk of GDM in women with a history of endometriosis. Consistent with previous studies (\u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), our research indicates a higher prevalence of cesarean sections among women with a history of stage I\u0026ndash;II endometriosis. This increased prevalence may be attributed to both biological and psychological factors. Women with endometriosis-associated infertility often regard their pregnancies as particularly valuable, leading to higher rates of elective cesarean sections and obstetrical interventions. Additionally, some endometriosis patients experience pelvic pain, and cesarean sections can help alleviate this pain during delivery (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Although our study found that the cesarean section rate in the stage III\u0026ndash;IV endometriosis group was higher than that in the control group, this difference was not statistically significant (adjusted OR: 1.173; 95% CI: 0.607\u0026ndash;2.266; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.634). This may be due to the small sample size of our study. Consequently, further large-scale prospective studies are necessary to evaluate the impact of endometriosis on cesarean section rates.\u003c/p\u003e \u003cp\u003eIn patients with endometriosis, factors such as chronic inflammation, junction zone thickening, defective artery transformation, placental blood perfusion insufficiency, suboptimal endometrial receptivity, progesterone resistance, abnormal uterine peristalsis and contraction, microtrauma, and placenta implantation injury may all contribute to adverse outcomes such as premature delivery, placenta previa, preeclampsia, small-for-gestational-age (SGA), placental abruption, and postpartum hemorrhage (PPH) (\u003cspan additionalcitationids=\"CR33 CR34\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). However, our study did not observe an increased rate of these obstetric complications in patients with endometriosis-associated infertility. This absence of increased risk may be attributed to the small sample size of our study or the effectiveness of the surgical intervention. Therefore, large-scale prospective studies are needed to further evaluate the impact of endometriosis on these obstetric outcomes.\u003c/p\u003e \u003cp\u003eThe strengths of this study are as follows: First, the case group included all women with endometriosis who underwent infertility surgery at the Fujian Maternity and Child Health Hospital between January 2014 and September 2020, and subsequently gave birth to singletons at this facility by September 2021. Additionally, a randomization method was employed to select the control group, effectively minimizing selection bias. Second, all clinical data were extracted from the hospital\u0026rsquo;s electronic medical record system, reducing both information and recall bias. Furthermore, this study comprehensively included most obstetric complications documented in previous research. Third, all patients with endometriosis-associated infertility were pathologically diagnosed following surgery performed by an experienced surgical team. The detailed documentation of specific surgical procedures reduces the impact of misclassification, variations in surgical techniques, and the condition of infertility itself on the results. Fourth, our analysis adjusted for the influence of conception methods on obstetric complications, providing a more accurate assessment. Fifth, the study conducted a subgroup analysis based on different stages of endometriosis, allowing for a nuanced understanding of the relationship between disease severity and obstetric outcomes.\u003c/p\u003e \u003cp\u003eHowever, this study has certain unavoidable limitations. The relatively small sample size and the retrospective design from a single medical facility may limit the generalizability of the findings. Additionally, the study did not account for different types of ART therapies, the various stages and extents of endometriosis pathology, or other potential confounding factors such as lifestyle and genetic predispositions. Future studies with larger, multi-center cohorts and prospective designs are necessary to validate these findings and explore the underlying mechanisms.\u003c/p\u003e \u003cp\u003eIn conclusion, this study demonstrates that women with a history of stage I\u0026ndash;II endometriosis have a higher risk of GDM and cesarean section during pregnancy, while those with a history of stage III\u0026ndash;IV endometriosis have a higher risk of GDM and PROM during pregnancy following laparoscopic surgical excision. Current research on this subject remains insufficient to fully elucidate the beneficial effects of endometriosis surgery on obstetric outcomes. Therefore, for infertile patients with a history of endometriosis surgery, heightened vigilance for potential obstetric complications and stringent prenatal monitoring are recommended to optimize pregnancy outcomes.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eETHICS STATEMENT\u003c/h2\u003e \u003cp\u003e The study protocol was approved by the Research Ethics Committee of the Fujian Maternal and Child Health Hospital (No. 2021KRD022). All patients included in the study had signed informed consent forms, permitting their medical records to be used for medical research.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eETHICS STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Research Ethics Committee of the Fujian Maternal and Child Health Hospital (No. 2021KRD022). All patients included in the study had signed informed consent forms, permitting their medical records to be used for medical research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShunhe Lin and Qingshan Chen conceived of this research. Qingshan Chen conducted data analysis and drafted the article. Shunhe Lin contributed to the draft and revise the article. Penghui Huang conducted data compilation and data analysis. Chaobin Liu collected medical histories and surgical procedures. Guan Lin and Wei Qi were responsible for follow-up and collecting pregnancy-related information. Yuyan Guo,\u0026nbsp;Zhenna Wang\u0026nbsp;and Xi Xie conducted the organization and implementation of the project and final approval of the version to be published as the corresponding author. All authors approved the manuscript and this submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONFLICT OF INTERESTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have stated explicitly that they don\u0026rsquo;t have direct or indirect conflict in connection with publishing this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFUNDINGS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was sponsored by grants from the Fujian Provincial Natural Science Foundation ( No. 2021J01414 and No. 2021J01421 ) and Fujian provincial health technology project ( No. 2022GGB004 ) of China.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTaylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. LANCET. 2021; 397 (10276)：839-852. doi:10.1016/S0140-6736(21)00389-5.\u003c/li\u003e\n\u003cli\u003eYe Louie, Whitaker Lucy HR, Mawson Rebecca L, et al. Endometriosis.BMJ (Clinical research ed.). 2022;379：e068950.doi:10.1136/bmj-2021-068950.\u003c/li\u003e\n\u003cli\u003eZondervan Krina T, Becker Christian M, Missmer Stacey A. Endometriosis. NEW ENGLAND JOURNAL OF MEDICINE. 2020; 382 (13)：1244-1256. doi: 10.1056/NEJMra1810764.\u003c/li\u003e\n\u003cli\u003eShafrir AL, Farland LV, Shah DK., Harris HR, Kvaskoff M, Zondervan K, and Missmer SA. 2018. Risk for and consequences of endometriosis: A critical epidemiologic review. Best Practice \u0026amp; Research Clinical Obstetrics and Gynaecology 06, 001-015.\u003c/li\u003e\n\u003cli\u003ede Ziegler D, Pirtea P, Carbonnel M, Poulain M, Cicinelli E, Bulletti C, Kostaras K, Kontopoulos G, and Keefe D. 2019. Assisted reproduction in endometriosis. Best Pract Res Clin Endocrinol Metab 33, 47\u0026ndash;59.\u003c/li\u003e\n\u003cli\u003eEkine AA, F\u0026uuml;l\u0026ouml;p I, Tekse I, R\u0026uacute;cz \u0026Aacute;, Jeges S, Kopp\u0026aacute;n \u0026Aacute;, and Kopp\u0026aacute;n M. 2020. The Surgical Benefifit of Hysterolaparoscopy in Endometriosis-Related Infertility: A Single Centre Retrospective Study with a Minimum 2-Year Follow-Up. J. Clin. Med. 9, 507-518.\u003c/li\u003e\n\u003cli\u003eSharon Nataly Zilberman, Shiber Yair, Vaknin Zvi, et al. Endometriosis and pregnancy: a complication to be aware of. ARCHIVES OF GYNECOLOGY AND OBSTETRICS. 2023;307 (1)：71-72.doi:10.1007/s00404-022-06592-3\u003c/li\u003e\n\u003cli\u003eFarella Marilena, Chanavaz-Lacheray Isabella, Verspick Eric, et al. Pregnancy outcomes in women with history of surgery for endometriosis. FERTILITY AND STERILITY. 2020;113 (5)：996-1004.doi:10.1016/j. fertnstert.2019.12.037.\u003c/li\u003e\n\u003cli\u003eSorrentino Felice, DE Padova Maristella, Falagario Maddalena, et al. Endometriosis and adverse pregnancy outcome.Minerva Obstetrics and Gynecology. 2022;74 (1)：31-44.doi:10.23736/S2724-606X.20.04718-8.\u003c/li\u003e\n\u003cli\u003eShadjoo Khadijeh, Gorgin Atefeh, Maleki Narges, et al. Pregnancy-related complications in patients with endometriosis in different stages. Contraception and reproductive medicine. 2024; 9 (1)：23.doi:10.1186/s40834-024-00280-0.\u003c/li\u003e\n\u003cli\u003eBreintoft Kjerstine, Pinnerup Regitze, Henriksen Tine Brink, et al. Endometriosis and Risk of Adverse Pregnancy Outcome: A Systematic Review and Meta-Analysis. Journal of clinical medicine. 2021;10 (4).doi:10.3390/jcm10040667.\u003c/li\u003e\n\u003cli\u003eSharon Nataly Zilberman, Shiber Yair, Vaknin Zvi, et al. Endometriosis and pregnancy: a complication to be aware of. ARCHIVES OF GYNECOLOGY AND OBSTETRICS. 2023; 307 (1)：71-72.doi:10.1007/s00404-022-06592-3.\u003c/li\u003e\n\u003cli\u003eFarland Leslie V, Prescott Jennifer, Sasamoto Naoko, et al. Endometriosis and Risk of Adverse Pregnancy Outcomes. OBSTETRICS AND GYNECOLOGY.2019;134 (3)：527-536. doi:10.1097/AOG.0000000000003410\u003c/li\u003e\n\u003cli\u003eYi Kyong Wook, Cho Geum Joon, Park KeonVin, et al. Endometriosis Is Associated with Adverse Pregnancy Outcomes: a National Population-Based Study.Reproductive Sciences. 2020;27 (5)：1175-1180.doi:10.1007/s43032-019-00109-1.\u003c/li\u003e\n\u003cli\u003eRibot Edouard, Berbis Julie, Hamouda Ilyes, et al. Pregnancy outcomes after in vitro fertilization for moderate and severe endometriosis. A case-control study. Journal of gynecology obstetrics and human reproduction. 2022;51 (2)：102274. doi:10.1016/j.jogoh.2021.102274.\u003c/li\u003e\n\u003cli\u003eIbiebele Ibinabo, Nippita Tanya, Baber Rodney, et al. Pregnancy outcomes in women with endometriosis and/or ART use: a population-based cohort study. HUMAN REPRODUCTION. 2022;37 (10)：2350-2358.doi:10.1093/humrep/deac186. \u003c/li\u003e\n\u003cli\u003eFarella M, Chanavaz-Lacheray I, Verspick E, Merlot B, Klapczynski C, Hennetier C, Tuech JJ, and Roman H. 2020. Pregnancy outcomes in women with history of surgery for endometriosis. Fertil Steril. 113, 996-1004.\u003c/li\u003e\n\u003cli\u003eWang Jian-Qing, Zhang Jia-Miao, Qian Bin. Adverse pregnancy outcomes for women with endometriosis: a systematic review and meta-analysis. Ginekologia Polska. 2021.doi:10.5603/GP.a2021.0081.\u003c/li\u003e\n\u003cli\u003eMadjid Tita Husnitawati, Ardiansyah Dennis Fachmi, Permadi Wiryawan, et al. Expression of Matrix Metalloproteinase-9 and Tissue Inhibitor of Metalloproteinase-1 in Endometriosis Menstrual Blood. Diagnostics (Basel, Switzerland). 2020; 10 (6).doi:10.3390/diagnostics10060364.\u003c/li\u003e\n\u003cli\u003eBostanci Durmus Arzu, Dincer Cengiz Sevim, Yılmaz Hakan, et al. The levels of matrix metalloproteinase-9 and neutrophil gelatinase-associated lipocalin in different stages of endometriosis. JOURNAL OF OBSTETRICS AND GYNAECOLOGY. 2019; 39 (7)：991-995. doi:10.1080/01443615.2019.1584889.\u003c/li\u003e\n\u003cli\u003eTency I. Inflammatory response in maternal serum during preterm labour. Facts Views and Vision in ObGyn. 2014;6 (1)：19-30.doi:null.\u003c/li\u003e\n\u003cli\u003eHarada T, Taniguchi F, Amano H, Kurozawa Y, Ideno Y, Hayashi K, Harada T. Japan Environment and Children\u0026rsquo;s Study Group. 2019. Adverse obstetrical outcomes for women with endometriosis and adenomyosis: A large cohort of the Japan Environment and Children\u0026rsquo;s Study. PLOS ONE 14, e0220256.\u003c/li\u003e\n\u003cli\u003eAbu-Zaid Ahmed, Gari Abdulrahim, Tulbah Maha, et al. Association between endometriosis and obstetric complications: Insight from the National Inpatient Sample. European Journal of Obstetrics \u0026amp; Gynecology and Reproductive Biology. 2024;292：58-62. doi:10.1016/j.ejogrb.2023.11.009.\u003c/li\u003e\n\u003cli\u003eShadjoo Khadijeh, Gorgin Atefeh, Maleki Narges, et al. Pregnancy-related complications in patients with endometriosis in different stages. Contraception and reproductive medicine. 2024;9 (1)：23.doi:10.1186/s40834-024-00280-0.\u003c/li\u003e\n\u003cli\u003eLi Baijia, Zhang Yuxue, Zhang Liuhang, et al. Association between endometriosis and metabolic syndrome: a cross-sectional study based on the National Health and Nutrition Examination Survey data. GYNECOLOGICAL ENDOCRINOLOGY. 2023;39 (1)：2254844. doi:10.1080/09513590.2023.2254844.\u003c/li\u003e\n\u003cli\u003eVaduva Patricia, Laouali Nasser, Fagherazzi Guy, et al. Association between endometriosis and risk of type 2 diabetes: Results from the prospective E3N cohort. MATURITAS. 2023;177：107805.doi:10.1016/j. maturitas.2023.107805.\u003c/li\u003e\n\u003cli\u003eSalmeri Noemi, Li Piani Letizia, Cavoretto Paolo Ivo, et al. Endometriosis increases the risk of gestational diabetes: a meta-analysis stratified by mode of conception, disease localization and severity. Scientific reports.2023;13 (1)：8099. doi:10.1038/s41598-023-35236-y.\u003c/li\u003e\n\u003cli\u003eBean Elisabeth M R, Knez Jure, Thanatsis Nikolaos, et al. Obstetric outcomes in women with pelvic endometriosis: a prospective cohort study.FERTILITY AND STERILITY. 2024.doi:10.1016/j.fertnstert.2024.05.162\u003c/li\u003e\n\u003cli\u003eGebremedhin Amanuel T, Mitter Vera R, Duko Bereket, et al. Associations between endometriosis and adverse pregnancy and perinatal outcomes: a population-based cohort study.ARCHIVES OF GYNECOLOGY AND OBSTETRICS. 2024;309 (4)：1323-1331. doi:10.1007/s00404-023-07002-y. \u003c/li\u003e\n\u003cli\u003eLin Shunhe, Xie Xi, Guo Yuyan, et al.Clinical characteristics and pregnancy outcomes of infertile patients with endometriosis and endometrial polyps: A retrospective cohort study. Taiwanese Journal of Obstetrics \u0026amp; Gynecology. 2020;59 (6)：916-921.doi:10.1016/j.tjog.2020.09.020. \u003c/li\u003e\n\u003cli\u003eWang Lifei, Xiong Ying, Wang Hongjing, et al. High spontaneous pregnancy and live birth rate in patients with stage III-IV endometriosis following surgical management. Asian Journal of Surgery. 2022;45 (3)：912-913. doi:10.1016/j. asjsur. 2021. 12.058.I\u003c/li\u003e\n\u003cli\u003eSaunders Philippa T K, Horne Andrew W. Endometriosis: Etiology, pathobiology, and therapeutic prospects. CELL.2021;184 (11)：2807-2824. doi:10.1016/j.cell. 2021. 04. 041\u003c/li\u003e\n\u003cli\u003eDutsch-Wicherek MM, Nowakowski Blazej, Faryna Jan, et al. FOXP3-positive cell infiltration in the chorionic villi is increased in the placenta accreta and decreased in the placental abruption. Ginekologia Polska. 2023; 94 (10)：816-822. doi:10.5603/gpl.95458.\u003c/li\u003e\n\u003cli\u003eLabarrere CA, DiCarlo HL, Bammerlin Elaine, et al. Failure of physiologic transformation of spiral arteries, endothelial and trophoblast cell activation, and acute atherosis in the basal plate of the placenta. AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY.2017;216 (3)：287.e1-287.e16. doi:10.1016/ j.ajog. 2016.12.029.\u003c/li\u003e\n\u003cli\u003eSchatz Frederick, Guzeloglu-Kayisli Ozlem, Arlier Sefa, et al. The role of decidual cells in uterine hemostasis, menstruation, inflammation, adverse pregnancy outcomes and abnormal uterine bleeding. HUMAN REPRODUCTION UPDATE.2016;22 (4)：497-515. doi:10.1093/humupd/dmw004.\u003c/li\u003e\n\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Endometriosis, Infertility, Laparoscopy, Conservative surgery, Pregnancy outcomes","lastPublishedDoi":"10.21203/rs.3.rs-4796942/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4796942/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aims to elucidate the spectrum of obstetrical complications in patients with endometriosis-associated infertility following complete laparoscopic excision of endometriosis lesions, and to assess the impact of endometriosis severity on these outcomes.\u003c/p\u003e\u003ch2\u003eStudy design:\u003c/h2\u003e \u003cp\u003eThis case-control study enrolled 151 women who underwent laparoscopic surgery for endometriosis-associated infertility at Fujian Maternity and Child Health Hospital between January 2014 and September 2020, and who subsequently gave birth to a singleton at the same hospital by September 2021. Participants were divided into a stage I\u0026ndash;II endometriosis group (n\u0026thinsp;=\u0026thinsp;88) and a stage III\u0026ndash;IV endometriosis group (n\u0026thinsp;=\u0026thinsp;63). A control group consisted of 302 women without endometriosis who delivered a singleton at the same hospital during the same period. Clinical data and complications during pregnancy, delivery, and the neonatal stages were collected from the hospital\u0026rsquo;s medical record system.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAfter adjusting for confounding factors, women in the stage I\u0026ndash;II endometriosis group had a significantly higher risk of gestational diabetes mellitus (GDM) (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004) and cesarean section (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.027) compared to the control group. Women in the stage III\u0026ndash;IV endometriosis group exhibited a higher risk of GDM (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.048) and premature rupture of membranes (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.039). No statistically significant differences were observed in other obstetrical complications between the endometriosis and control groups.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eWomen with a history of stage I\u0026ndash;II endometriosis who have undergone laparoscopic conservative surgery face a higher risk of GDM and cesarean section during pregnancy. Those with a history of stage III\u0026ndash;IV endometriosis are at an elevated risk of GDM and premature rupture of membranes. These findings underscore the need for heightened monitoring and management of pregnancies in women with prior endometriosis.\u003c/p\u003e","manuscriptTitle":"Unveiling Hidden Risks: Obstetrical Complications in Endometriosis Associated Infertility Post-Laparoscopic Surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-28 11:38:52","doi":"10.21203/rs.3.rs-4796942/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"386372a1-9d59-42be-b8ee-5d912fee450e","owner":[],"postedDate":"August 28th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-10-16T06:54:26+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-28 11:38:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4796942","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4796942","identity":"rs-4796942","version":["v1"]},"buildId":"WvIrzKhiLBfengagbw6Ux","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}