Developmental origins of endometriosis: a Swedish cohort study

Menghan Gao, Peter Alle­beck, Peter Allebeck, Gita D Mishra, Ilona Koupil
Journal of Epidemiology and Community Health · 2019 · vol. 73(4) , pp. 353–359 · doi:10.1136/jech-2018-211811 · PMID:30661033 · PMC6581098 · W2908954109
article OA: gold CC0 ⤵ 26 in-corpus citations
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Lower standardized birth weight for gestational age is associated with an increased rate of endometriosis, particularly external endometriosis, in reproductive years.

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Abstract

BACKGROUND: Endometriosis is a chronic condition affecting women of reproductive age and is associated with multiple health burdens. Yet, findings regarding its 'developmental origins' are inconsistent. We aimed to investigate the associations of birth characteristics with endometriosis. We also explored potential mediation by adult social and reproductive factors. METHODS: This cohort study consisted of 3406 women born in Uppsala, Sweden, between 1933 and 1972. We used data from archived birth records and endometriosis diagnoses at ages 15-50 recorded in the national patient registers. Socioeconomic and reproductive characteristics were obtained from routine registers. HRs were estimated from Cox regression. RESULTS: During the follow-up, 111 women have been diagnosed with endometriosis, and most cases are external endometriosis (ie, outside the uterus, n=91). Lower standardised birth weight for gestational age was associated with increased rate of endometriosis (HR 1.35 per standard deviation decrease; 95% CI 1.08 to 1.67). This increased rate was also detected among women with fewer number of live births (HR 2.38; 95% CI 1.40 to 4.07 for one child vs ≥2 children; HR 6.09; 95% CI 3.88 to 9.57 for no child vs ≥2 children) and diagnosed infertility problem (HR 2.00; 95% CI 1.10 to 3.61) prior to endometriosis diagnosis. All the observed associations were stronger for external endometriosis. However, no evidence was found that number of births was the mediator of the inverse association between standardised birth weight and endometriosis. CONCLUSION: This study supports the developmental origins theory and suggests that exposure to growth restriction during the fetal period is associated with increased risk of endometriosis during reproductive years.

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Condition tags

endometriosisinfertility

MeSH descriptors

Birth Weight Endometriosis Endometriosis Infertility, Female Adolescent Adult Birth Certificates Cohort Studies Endometriosis Endometriosis Female Fetal Growth Retardation Fetal Growth Retardation Humans Incidence Infant, Small for Gestational Age Infertility, Female Infertility, Female Middle Aged Sweden

Funding

funders
[{'doi': None, 'name': 'Australian NHMRC Principal Research Fellowship', 'awards': []}, {'doi': None, 'name': 'European Union’s Horizon 2020 research and innovation programme', 'awards': []}, {'doi': '10.13039/501100004543', 'name': 'China Scholarship Council', 'awards': []}, {'doi': '10.13039/501100004359', 'name': 'Swedish Research Council', 'awards': []}, {'doi': '10.13039/501100006636', 'name': 'Swedish Research Council for Health, Working Life and Welfare', 'awards': []}]

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Cited by (26)

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