PREGNANCY

Pregnancy complications linked to heightened risk of heart disease and stroke in later life

Pregnancy complications linked to heightened risk of heart disease and stroke in later life

Pregnancy complications such as miscarriage, pre-eclampsia, diabetes in pregnancy (gestational diabetes) and pre-term birth are linked to a heightened risk of heart disease in later life, suggests an overarching (umbrella) analysis of data.

Several other factors related to fertility and pregnancy also seem to be associated with subsequent cardiovascular disease, say the researchers, including starting periods early, use of combined oral contraceptives, polycystic ovary syndrome, and early menopause.

However, a longer length of breastfeeding was associated with a reduced risk of cardiovascular disease.

Previous research has suggested that risk factors specific to women may be linked to cardiovascular disease and stroke, but clarity on the quality of the evidence is lacking and on how the findings can be translated into public health and clinical practice.

So a team of UK researchers searched relevant research databases for published systematic reviews and meta-analyses that investigated links between reproductive factors in women of reproductive age and their subsequent risk of cardiovascular disease.

A total of 32 reviews were included, evaluating multiple risk factors over an average follow-up period of 7-10 years.

The researchers found that several factors, including starting periods early (early menarche), use of combined oral contraceptives, polycystic ovary syndrome, miscarriage, stillbirth, pre-eclampsia, diabetes during pregnancy, pre-term birth, low birth weight, and early menopause were associated with an up to twofold risk of cardiovascular outcomes.

Pre-eclampsia was associated with a fourfold risk of heart failure.

Possible explanations for these associations include family medical history, genetics, weight, high blood pressure and cholesterol levels, and chemical imbalances from use of hormonal contraceptives.

However, no association was found between cardiovascular disease outcomes and current use of progesterone only contraceptives, use of non-oral hormonal contraceptive agents, or fertility treatment.

What’s more, breastfeeding was associated with a lower risk of cardiovascular disease.

The researchers point to some limitations, such as missing data and the fact that reviews were largely based on observational evidence, so they cannot rule out the possibility that other unmeasured (confounding) factors may have had an effect.

Nevertheless, they say the evidence reported in this umbrella review suggests that, from menarche to menopause, the reproductive profile of women is associated with their future risk of cardiovascular disease.

It also provides clarity on the quality of the evidence, identifies gaps in evidence and practice, and provides recommendations that could be incorporated into guidelines, such as incorporating reproductive risk factors as part of the risk assessment for cardiovascular disease, they conclude.

Read more: https://www.bmj.com/content/371/bmj.m3502

New study reveals why flu can be devastating for pregnant women

New study reveals why flu can be devastating for pregnant women

New research helps explain why flu can lead to life-threatening complications during pregnancy, suggesting the virus does not stay in the lungs but spreads throughout the mother’s body.

The pre-clinical study has overturned current scientific thinking on the reasons why flu infections affect pregnant women and their babies so severely.

The findings could also help researchers working to understand the fundamental biology of how COVID-19 spreads from the lungs into the body.

The research, in animal models, showed that during pregnancy flu spreads from the lungs through the blood vessels into the circulatory system, triggering a damaging hyperactive immune response.

Led by RMIT University in collaboration with researchers and clinicians from Ireland and Australia, the new study is published in the Proceedings of the National Academy of Sciences.

Lead author Dr Stella Liong said the research suggests the vascular system is at the heart of the potentially devastating complications caused by influenza during pregnancy.

“We’ve known for a long time that flu can cause serious maternal and fetal complications, but how this happens has not been clearly understood,” Liong, a Vice-Chancellor’s Postdoctoral Fellow at RMIT, said.

“Conventional thinking has blamed the suppressed immune system that occurs in pregnancy but what we see is the opposite effect — flu infection leads to a drastically heightened immune response.

“The inflammation we found in the circulatory system is so overwhelming, it’s like a vascular storm wreaking havoc throughout the body.

“We need further research to clinically validate our findings but the discovery of this new mechanism is a crucial step towards the development of flu therapies designed specifically for pregnant women.”

Professor John O’Leary, Trinity College Dublin, said the study represented a landmark advance in our understanding of viral infections and pregnancy.

“The discovery of an influenza-induced ‘vascular storm‘ is one of the most significant developments in inflammatory infectious diseases over the last 30 years and has significant implications for other viral infections, including COVID-19,” he said.

Understanding flu and pregnancy

Influenza is not directly passed from mother to baby, but its potentially devastating effect on the mother is closely connected to the complications suffered by the baby.

Pregnant women who develop influenza are at higher risk of hospitalisation with pneumonia and other complications, while babies of mothers severely affected by flu are at increased risk of fetal growth restriction, miscarriage and preterm births.

Scientists have previously thought the reason flu has such serious health impacts is because the immune system is suppressed during pregnancy to enable the fetus to thrive, making it harder to fight infections.

But the new research on Influenza A shows the virus behaves very differently in the bodies of pregnant and non-pregnant mice.

In non-pregnant mice, the flu infection remains localised to the lungs. But in pregnant mice, the virus spreads into the circulatory system via the blood vessels.

This leads to intense inflammation that drastically affects the function of large blood vessels, which severely impacts on the health of the mother and can also restrict blood flow to the growing fetus.

Flu-induced vascular storm

In the new study, researchers found pregnant mice with flu had severe inflammation in the large blood vessels and the aorta, the major conduit artery from the heart.

While a healthy blood vessel dilates 90-100% to let blood flow freely, the flu-infected blood vessels functioned at only 20-30% of capacity.

Lead investigator Associate Professor Stavros Selemidis, RMIT, said even a small change in the diameter of a blood vessel could have profound changes to blood flow.

“We found a dramatic difference in these inflamed blood vessels, which can seriously affect how much blood makes it to the placenta and all the organs that help support the growing baby,” Selemidis said.

“We’ve known that flu infection in pregnancy results in an increased risk of babies being smaller and suffering oxygen starvation.

“Our research shows the critical role that the vascular system could be playing in this, with inflammation in the blood vessels reducing blood flow and nutrient transfer from mum to baby.”

While the researchers did not directly measure blood flow, the study found an increase in biomarkers for oxygen starvation in the fetuses of the flu-infected mice.

Why pregnancy makes a difference

During pregnancy, the placenta secretes proteins and releases fetal DNA into the mother’s blood, which can cause underlying inflammation.

The new study suggests the influenza infection may tip that underlying inflammation in the mother’s body over the edge, into a full-blown systemic inflammatory event.

Selemidis said the research also revealed a new connection to pre-eclampsia, a dangerous pregnancy complication characterised by high blood pressure.

“We found the same protein that is elevated in pre-eclampsia is also significantly elevated with flu,” he said.

“While it will take further research to unpack this link, it could mean drugs targeting vascular inflammation that are currently being tested could potentially be repurposed in future for flu infection in pregnancy.”

Coronavirus connection

Liong said the research also has implications for our understanding of how the COVID-19 virus may be affecting the vascular system.

Flu and coronavirus are different but there are parallels and we do know that COVID-19 causes vascular dysfunction, which can lead to strokes and other cardiovascular problems,” she said.

“Our studies in pregnancy offer new insights into the fundamental biology of how respiratory viruses can drive dysfunction in the vascular system.

“This could be valuable knowledge for those scientists working directly on treatments and vaccines for COVID-19.”

The new study is the culmination of over 10 years’ work by researchers in the School of Health and Biomedical Sciences at RMIT, leading a global collaboration.

The research was supported by an Australian Research Council (ARC) Future Fellowship and funding from the National Health and Medical Research Council of Australia (NHMRC).

Source: https://www.sciencedaily.com/releases/2020/09/200921151321.htm 

Endometriosis fertility index predicts if a woman needs IVF

Endometriosis fertility index predicts if a woman needs IVF

The Endometriosis Fertility Index (EFI) is a good indicator for predicting pregnancy achieved without use of assisted reproductive technology (ART), according to a meta-analysis of 17 studies involving 4,598 women.

Patients with low Endometriosis Fertility Index (EFI) scores may not have a strong chance of a pregnancy achieved without use of assisted reproductive technology (ART), according to a meta-analysis from BJOG.

The Iranian authors of the review in BJOG noted that study results to evaluate the EFI score for predicting non-ART pregnancy have been inconsistent.

The cumulative rate of non-ART pregnancy at 36 months was 10% for women with an EFI of 0 to 2, which significantly increased to 69% for women with an EFI of 9 to 10. Furthermore, compared to women with an EFI of 3 to 4 combined cumulative non-ART pregnancies were 44% for women with an EFT of 5 to 6, and 55% for women with an EFI of 7 to 8. A significant difference existed between all categories.

The odds ratio (OR) for EFI was 1.33 and the summary area under the curve (AUC) was 72%.

Conclusions

The authors stated that the existing revised American Fertility Society (rAFS) score for staging endometriosis has considerable limitations, including arbitrary point scores and wide score ranges within the categories. There is also the “potential for observer error because of numerous morphological presentations, some subtle and microscopic and the timing of the laparoscopy, and whether the staging is performed at laparoscopy or laparotomy,” they wrote.

Furthermore, there is poor correlation between the extent of disease and pelvic pain and rAFS stages align poorly with infertility. For these and many other reasons, EFI has been proposed as having greater predictive power than rAFS for a successful pregnancy, with or without ART, in endometriosis patients.

Specifically, patients with an EFI score of 0 to 3 should be informed as to the low likelihood of non-ART pregnancy; therefore, ART should be strongly recommended.

Women unlikely to achieve non-ART pregnancy or spontaneous pregnancy, based on their EFI score, might be candidates for earlier in vitro fertilization and embryo transfer to prevent treatment delays and increase their chances for pregnancy.

The non-ART pregnancy rate might be linked with duration before attempting ART. For fertility management, EFI can be used as a predictive factor for a spontaneous second pregnancy.

Despite the review concluding that the EFI score is a good predictor for non-ART pregnancy, “these findings should be considered with caution due to the substantial heterogeneity between studies,” the authors said.

Read more: https://pubmed.ncbi.nlm.nih.gov/31967727/

Placentas from COVID-19-positive pregnant women show injury

Placentas from COVID-19-positive pregnant women show injury

Findings suggest abnormal blood flow between mothers and babies in utero

The placentas from 16 women who tested positive for COVID-19 while pregnant showed evidence of injury, according to pathological exams completed directly following birth.

Αccording to the findings of a new Northwestern Medicine study, the type of injury seen in the placentas shows abnormal blood flow between the mothers and their babies in utero, pointing to a new complication of COVID-19. The findings, though early, could help inform how pregnant women should be clinically monitored during the pandemic.

The study was published in the journal American Journal of Clinical Pathology. It is the largest study to examine the health of placentas in women who tested positive for COVID-19.

“Most of these babies were delivered full-term after otherwise normal pregnancies, so you wouldn’t expect to find anything wrong with the placentas, but this virus appears to be inducing some injury in the placenta,” said senior author Dr. Jeffrey Goldstein, assistant professor of pathology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine pathologist.

“It doesn’t appear to be inducing negative outcomes in live-born infants, based on our limited data, but it does validate the idea that women with COVID should be monitored more closely.”

This increased monitoring might come in the form of non-stress tests, which examine how well the placenta is delivering oxygen, or growth ultrasounds, which measure if the baby is growing at a healthy rate, said co-author Dr. Emily Miller, assistant professor of obstetrics and gynecology at Feinberg and a Northwestern Medicine obstetrician.

“Not to paint a scary picture, but these findings worry me,” Miller said. “I don’t want to draw sweeping conclusions from a small study, but this preliminary glimpse into how COVID-19 might cause changes in the placenta carries some pretty significant implications for the health of a pregnancy. We must discuss whether we should change how we monitor pregnant women right now.”

Fifteen patients delivered live infants in the third trimester, however one patient had a miscarriage in the second trimester. “That patient was asymptomatic, so we don’t know whether the virus caused the miscarriage or it was unrelated,” Goldstein said, “We are aware of four other cases of miscarriage with COVID. The other reported patients had symptoms and three of four had severe inflammation in the placenta. I’d like to see more before drawing any conclusions”, Goldstein said.

The placenta is the first organ to form in fetal development. It acts as the fetus’ lungs, gut, kidneys and liver, taking oxygen and nutrients from the mother’s blood stream and exchanging waste. The placenta also is responsible for many of the hormonal changes within the mother’s body.

Examining a woman’s placenta allows a pathologist to follow a retroactive roadmap of a woman’s pregnancy to learn what happened to the baby in utero or what could happen to both the mother and the infant after birth.

“The placenta acts like a ventilator for the fetus, and if it gets damaged, there can be dire outcomes,” Miller said. “In this very limited study, these findings provide some signs that the ventilator might not work as well for as long as we’d like it to if the mother tests positive for SARS-CoV2.”

The placentas in these patients had two common abnormalities: insufficient blood flow from the mother to the fetus with abnormal blood vessels called maternal vascular malperfusion (MVM) and blood clots in the placenta, called intervillous thrombi.

In normal cases of MVM, the mother’s blood pressure is higher than normal. This condition is typically seen in women with preeclampsia or hypertension. Interestingly, only one of the 15 patients in this study had preeclampsia or hypertension.

“There is an emerging consensus that there are problems with coagulation and blood vessel injury in COVID-19 patients,” Goldstein said. “Our finding support that there might be something clot-forming about coronavirus, and it’s happening in the placenta.”

Between 30 and 40 patients deliver at Prentice daily. The team began testing placentas of COVID-19-positive mothers in early April. Fourteen of the live-born infants in the study were born full term and with normal weights and Apgar scores. One live-born infant was premature.

“They were healthy, full-term, beautifully normal babies, but our findings indicate a lot of the blood flow was blocked off and many of the placentas were smaller than they should have been,” Miller said. “Placentas get built with an enormous amount of redundancy. Even with only half of it working, babies are often completely fine. Still, while most babies will be fine, there’s a risk that some pregnancies could be compromised.”

Read more: https://academic.oup.com/ajcp/advance-article/doi/10.1093/ajcp/aqaa089/5842018

Benefits of exercise during pregnancy

Benefits of exercise during pregnancy

Physical fitness is important for pregnant women. It also helps to keep anxiety at bay and maintain the well-being.

The more active and fit you are during a normal pregnancy, the easier it will be for you to adapt to your changing shape and weight gain. It will also help you to cope with labour and get back into shape after the birth.

Keep up your normal daily physical activity or exercise (sport, running, yoga, walking) for as long as you feel comfortable.

Exercise is not dangerous for your baby. There is some evidence that active women are less likely to experience problems in later pregnancy and labour.

You should always ask your doctor if exercise is recommended for you during pregnancy.

Exercise tips for pregnancy

  • Do not exhaust yourself. You may need to slow down as your pregnancy progresses or if your maternity team advises you to.

  • As a general rule, you should be able to hold a conversation as you exercise when pregnant. If you become breathless as you talk, then you’re probably exercising too strenuously.

  • If you were not active before you got pregnant, do not suddenly take up strenuous exercise. If you start an aerobic exercise programme begin with no more than 15 minutes of continuous exercise, 3 times a week. Increase this gradually to daily 30-minute sessions.

  • Remember that exercise does not have to be strenuous to be beneficial.

It is important to remember:

  • always warm up before exercising, and cool down afterwards

  • try to keep active on a daily basis – 30 minutes of walking each day can be enough, but if you cannot manage that, any amount is better than nothing

  • avoid any strenuous exercise in hot weather

  • drink plenty of water and other fluids

  • exercises that have a risk of falling, should only be done with caution Falls carry a risk of damage to your baby

Exercises to avoid in pregnancy:

  • do not lie flat on your back for long periods, particularly after 16 weeks, because the weight of your bump presses on the main blood vessel bringing blood back to your heart and this can make you feel faint

  • do not take part sports where there’s a risk of being hit

Exercises for a fitter pregnancy

If you are pregnant, try to fit the exercises listed in this section into your daily routine. These types of exercise will strengthen your muscles to help you carry the extra weight of pregnancy. They’ll also make your joints stronger, improve circulation, ease backache, and generally help you feel well.

Stomach-strengthening exercises

As your baby gets bigger, you may find that the hollow in your lower back increases and this can give you backache. These exercises strengthen stomach (abdominal) muscles and may ease backache, which can be a problem in pregnancy:

  • start in a box position (on all 4s) with knees under hips, hands under shoulders, with fingers facing forward and abdominals lifted to keep your back straight

  • pull in your stomach muscles and raise your back up towards the ceiling, curling your trunk and allowing your head to relax gently forward, do not let your elbows lock

  • hold for a few seconds then slowly return to the box position

  • take care not to hollow your back: it should always return to a straight/neutral position

  • do this slowly and rhythmically 10 times, making your muscles work hard and moving your back carefully

  • only move your back as far as you can comfortably

Pelvic tilt exercises

  • stand with your shoulders and bottom against a wall

  • keep your knees soft

  • pull your belly button towards your spine, so that your back flattens against the wall: hold for 4 seconds then release

  • repeat up to 10 times

Pelvic floor exercises

Pelvic floor exercises help to strengthen the muscles of the pelvic floor, which come under great strain in pregnancy and childbirth. The pelvic floor consists of layers of muscles that stretch like a supportive hammock from the pubic bone (in front) to the end of the backbone (spine).

If your pelvic floor muscles are weak, you may find that you leak urine when you cough, sneeze or strain. This is quite common, and there is no reason to feel embarrassed. It’s known as stress incontinence and it can continue after pregnancy.

You can strengthen these muscles by doing pelvic floor exercises. This helps to reduce or avoid stress incontinence after pregnancy. All pregnant women should do pelvic floor exercises, even if you’re young and not suffering from stress incontinence now.

How to do pelvic floor exercises:

  • close up your bottom, as if you’re trying to stop yourself going to the toilet

  • at the same time, draw in your vagina as if you’re gripping a tampon, and your urethra as if to stop the flow of urine

  • at first, do this exercise quickly, tightening and releasing the muscles immediately

  • then do it slowly, holding the contractions for as long as you can before you relax: try to count to 10

  • try to do 3 sets of 8 squeezes every day: to help you remember, you could do a set at each meal

As well as these exercises, practice tightening the pelvic floor muscles before and during coughing and sneezing.

Source: https://www.nhs.uk/conditions/pregnancy-and-baby/pregnancy-exercise

OB-GYNs hesitate to talk about fertility

OB-GYNs hesitate to talk about fertility

Many OB-GYNs are uncomfortable counseling their patients on fertility at a time when more women are delaying pregnancy and needing their doctors to be more vigilant about this education, according to a new study.

“We found that most OB-GYNs don’t bring up fertility with every patient, often because they believe the patient would bring it up if she wanted to discuss it,” said Rashmi Kudesia, M.D., reproductive endocrinology and infertility specialist at Houston Methodist and CCRM Houston and lead author on the study, published in the Journal of Reproductive Medicine. “It’s a missed opportunity when OB-GYNs don’t start the conversation because many women are routinely exposed to conflicting information about fertility, leading many to believe that they’ll have no issues conceiving and delivering.”

In fact, 82% of OB-GYNs surveyed believe women receive mixed messages about their optimal fertility window, and 68% said women seem to believe they can indefinitely postpone making childbearing plans.

“It isn’t unusual for women to believe that assisted reproductive technologies like IVF are their safety net because they hear so many success stories,” Kudesia said. “The reality is that IVF only has a 5% success rate for women in their mid-40s.”

Kudesia and her co-authors found that OB-GYNs were more likely to provide fertility counseling to married women between the ages of 27-40. For all age groups, single and lesbian women were less likely to receive fertility counseling than married women. It was also found that the 117 physicians who participated provided more counseling on contraception than fertility in nearly all age and relationship status groups.

“The results tell me that regardless of current relationship status or future plans for pregnancy, women need to bring up fertility at their next well-woman exam or ask for a referral to a fertility specialist,” Kudesia said. “Women who want to wait several years and even those who think they don’t want kids at all should still talk to their doctor about fertility so that they can make an informed decision about what is best for them.”

Source: https://www.houstonmethodist.org/newsroom/research-shows-ob-gyns-hesitate-to-talk-about-fertility/

Read more: http://www.reproductivemedicine.com/toc/auto_abstract.php?id=24782

Individualised approach to ‘fertile windows’ could help couples understand when pregnancy is likely to occur

Individualised approach to ‘fertile windows’ could help couples understand when pregnancy is likely to occur

Only 13% of women having menstrual cycles that last 28 days, according to a new study led by UCL and Natural Cycles, a contraceptive app.

The study, published in Nature Digital Medicine is one of the biggest overviews of menstrual cycles to date and analysed data over 600,000 menstrual cycles and 124,648 women from Sweden, USA and the UK. It could help couples better understand when pregnancy is likely and unlikely to occur.

Researchers set out to investigate menstrual cycle characteristics and associations with age, BMI and body temperatures. The findings show an average cycle length is 29.3 days and only around 13% of cycles are 28 days in length. Across the study, 65% of women had cycles that lasted between 25 and 30 days.

The menstrual cycle begins and ends with menstrual bleeding and is divided by ovulation into two phases: the follicular and luteal phases. Researchers found the average follicular phase length was 16.9 days and the average luteal phase length was 12.4 days. The average cycle length decreased by 0.18 days and average follicular phase length decreased by 0.19 days per year of age from 25 to 45 years. The average variation of cycle length for obese women was 0.4 days or 14% higher. Cycle length variability was observed to a lesser extent in non-obese and underweight women.

Co-author, Professor Joyce Harper (UCL Institute for Women’s Health), said: “Our study is unique in analysing over half a million cycles and re-writing our understanding of the key stages. Traditionally studies have concentrated on women who have approximately 28 day cycles and these studies have formed our understanding of the menstrual cycle.

“For the first time our study shows that few women have the text book 28 day cycle, with some experiencing very short or very long cycles. We studied all women who used the app.

“We also demonstrate that ovulation does not occur consistently on day 14 and therefore it is important that women who wish to plan a pregnancy are having intercourse on their fertile days. In order to identify the fertile period, it is important to track other measures such as basal body temperature as cycle dates alone are not informative.”

Co-author, Dr Simon Rowland, Head of Medical Affairs at Natural Cycles, said: “Given the variations in cycle length and follicular phase length that we have described, especially for cycles outside the average range (25-30 days), an individualised approach to identify the fertile window should be adopted.

“Apps giving predictions of fertile days based solely on cycle dates could completely miss the fertile window and it is therefore unsurprising that several studies have shown that calendar apps are not accurate in identifying the fertile window.

“Besides the potential benefits to the individual, fertility awareness apps and the associated databases of fertility data provide a unique opportunity to examine a large number of menstrual cycles in order to improve understanding.”

Data was collected from women using the app between September 2016 and February 2019 aged 18 to 45 and had a BMI between 15 and 50 and had not been using hormonal contraception within the 12 months prior to registration. Users who stated at registration that they had a pre-existing medical condition (polycystic ovarian syndrome, hypothyroidism or endometriosis) or who had menopausal symptoms were excluded.

The authors note the main limitation of this study is that the study population is derived solely from users of the app who may not be representative of the wider population. In particular, only 8% of women in our study were obese compared to 15% of women in the general population.

Professor Harper added, “The widespread use of mobile phone apps for personal health monitoring is generating large amounts of data on the menstrual cycle. Provided that the real-world data can be validated against traditional clinical studies done in controlled settings, there is enormous potential to uncover new scientific discoveries.

“This is one of the largest ever analyses of menstrual cycle characteristics. These initial results only scratch the surface of what can be achieved. We hope to stimulate greater interest in this field of research for the benefit of public health.”

Read more: https://www.nature.com/articles/s41746-019-0152-7

Source: https://www.ucl.ac.uk/news/2019/aug/individualised-approach-fertile-windows-could-benefit-many-women

Women with endometriosis and diffuse adenomyosis at higher risk for smaller babies, study suggests

Women with endometriosis and diffuse adenomyosis at higher risk for smaller babies, study suggests

By I.Soussis, MD, MSc,FRCOG

Fertility Specialist

Researchers have found that pregnant women with both endometriosis and diffuse adenomyosis have a nearly four times greater risk of carrying a baby that is small for its gestational age.

The study from Italy, was published in the journal Ultrasound in Obstetrics and Gynecology.

In the last decade, many studies have reported an association between endometriosis and major pregnancy-related complications, including spontaneous late miscarriage, preterm labor, fetuses small for gestational age (SGA), hypertension, pre-eclampsia, and other issues. But other studies have not reached similar conclusions.

Endometriosis is the disease that the endometrium, the tissue lining the uterus is located outside the uterus. Often is accompanied by adenomyosis, which refers to a condition where the tissue lining the uterus grows into the muscular wall of the uterus.

The reported prevalence of adenomyosis in patients with endometriosis ranges from 20% to 50%. Previous studies have shown that adenomyosis can lead to an increased risk of adverse events in pregnancy, but few studies have paid close attention to the correlation between adenomyosis and pregnancy outcomes in patients with concurrent endometriosis.

Researchers set out to determine whether the maternal and fetal outcomes were different in women with endometriosis alone compared to endometriosis with either diffuse or focal adenomyosis.

Focal adenomyosis occurs in one particular site of the uterus, while diffuse adenomyosis is when the condition is spread throughout the uterus.

Researchers conducted a retrospective analysis of 206 pregnant women with endometriosis, of which 71.8% had endometriosis alone, 18.4% had endometriosis with focal adenomyosis (EFA) and 9.7% had endometriosis with diffuse adenomyosis (EDA).

Conventional risk factors associated with placental insufficiency such as BMI, PAPP-A levels, and mean uterine artery pulsatility index (UtA PI) in the first and the second trimester were found to be significantly associated with EDA, compared to patients with endometriosis alone. There were no statistically significant differences found in EFA patients.

 Interestingly, an analysis showed that EDA was the only independent risk factor for babies who were small for gestational age (SGA), with an overall higher risk of 3.74 in women with EDA compared to those with endometriosis alone.

SGA is a term used to describe a fetus that is smaller than average for the number of weeks of pregnancy.

One explanation for this result is that women with adenomyosis have imbalanced blood flow, with higher blood flow to the uterine adenomyosis area and lower blood flow to the placenta, which could lead to the reduced growth of the fetus.

“The current study shows that diffuse adenomyosis in pregnant women with endometriosis is strongly associated with SGA infants,” the study’s authors concluded.

They added that women with EDA should be treated as high-risk patients for placental dysfunction and should be more closely monitored.

Source: https://endometriosisnews.com/2018/01/03/women-endometriosis-diffuse-adenomyosis-higher-risk-smaller-babies/

Image credit:https://www.healthline.com/health/pregnancy/getting-pregnant-with-endometriosis

Visit Us On FacebookVisit Us On Google PlusVisit Us On Linkedin