Hum. Reprod. Advance Access published online on April 23, 2007
Human Reproduction, doi:10.1093/humrep/dem072
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Endometriosis is associated with a decreased risk of pre-eclampsia
1 Leuven Institute for Fertility and Embryology, Tiensevest 168, B-3000 Leuven, Belgium 2 Infertility Centre, University Hospital Gent, Belgium 3 Institute of Reproductive and Developmental Biology, Imperial College London, Hammersmith Campus, London, UK
4 Correspondence address. Tel: +32 16 270190; Fax: +32 16 270197; E-mail: ivo.brosens{at}med.kuleuven.ac.be
BACKGROUND: We postulated that impaired endometrial differentiation in women with pelvic endometriosis predisposes for pre-eclampsia.
METHODS: A retrospective case–control study set at the University of Ghent IVF centre. The incidence of pre-eclampsia and pregnancy-induced hypertension (PIH) following the clinical and/or laparoscopic diagnosis of endometriosis-associated infertility (case group; n = 245 pregnancies) was compared with the incidence of these obstetric complications in pregnancies following treatment for male-factor infertility (control group; n = 274 pregnancies). Pregnancy data were obtained by searching electronic databases and postal questionnaires. The case and control groups were matched for age, parity and multiple pregnancies.
RESULTS: The incidence of pre-eclampsia was significantly lower in the case group (0.8%) when compared with control group (5.8%) (P = 0.002; odds ratio (OR) = 7.5, 95% confidence interval (CI): 1.7–33.3). Analysis of obstetric outcome in the subgroup of patients with laparoscopic data confirmed the lower risk of pre-eclampsia in the case (1.2%) versus control (7.4%) groups (P = 0.032; OR = 6.6, 95% CI: 1.2–37). PIH occurred in 3.5% and 8.7% of case and control pregnancies, respectively (P = 0.018; OR = 2.6, 95% CI: 1.2–6.0). The odds of developing pre-eclampsia were 5.67 times higher in the control group than in pregnancies following endometriosis-associated infertility. In multiple pregnancies, the odds of developing pre-eclampsia increased 1.93 times per additional child, with or without endometriosis.
CONCLUSIONS: We found no evidence that endometriosis predisposes for pre-eclampsia. Instead, the risk of hypertensive disorder in pregnancy is significantly reduced in women with endometriosis-associated infertility.
Key words: endometriosis/pre-eclampsia/pregnancy-induced hypertension/incidence/angiogenesis
Submitted on October 16, 2006; resubmitted on January 24, 2007; accepted on February 27, 2007.
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