The impact of endometriosis on long-term neurologic morbidity of the offspring: a population-based analysis

OBJECTIVE: Endometriosis, a chronic inflammatory disease, has been associated with adverse pregnancy and perinatal outcomes, which in turn have been linked to long-term neurological morbidity in the offspring. This study aimed to determine whether maternal endometriosis is associated with long-term neurological morbidity in the offspring, independent of these perinatal complications. METHODS: We conducted a retrospective, population-based cohort study comparing offspring of mothers with a documented diagnosis of endometriosis to those without endometriosis. Offspring long-term neurological morbidity data was obtained using inpatient and outpatient records. Kaplan-Meier survival analysis was used to compare the cumulative incidence of neurological morbidity, and a Cox regression model was applied to adjust for potential confounders. RESULTS: A total of 232,476 singleton deliveries were included; of them, 224 deliveries were of mothers with a documented diagnosis of endometriosis. The overall neurological morbidity (26.8% vs. 17.4%) as well as the cumulative incidence (log rank, p < 0.001) was higher in children born to mothers with endometriosis. In a Cox regression model adjusted for maternal age, gestational age at birth, use of fertility treatments, cesarean delivery, ethnicity, hypertensive disorders and diabetes mellitus, maternal endometriosis remained independently associated with long-term neurological morbidity of the offspring (adjusted HR = 1.34, 95% CI 1.04-1.73, p = 0.023). CONCLUSION: Maternal endometriosis was associated with an increased risk of long-term neurological morbidity in offspring. These findings should be interpreted cautiously given the retrospective design and the small number of exposed pregnancies and diagnosis-specific events, and further research is warranted.