The findings are especially important as advances in fertility treatment have enabled more women with endometriosis to become pregnant. By recognizing potential risks early, healthcare providers can implement more effective monitoring strategies to improve the safety of both mothers and babies.
Endometriosis is a chronic gynecological disorder in which tissue similar to the lining of the uterus grows outside the uterine cavity. According to the World Health Organization (WHO), the condition affects approximately 190 million women worldwide and is one of the leading causes of infertility among women of reproductive age.
In addition to causing chronic pelvic pain and reducing quality of life, endometriosis triggers persistent inflammation that can interfere with embryo implantation, placental development, and fetal growth. Over the past several years, numerous studies have suggested that women with a history of endometriosis face a higher risk of pregnancy complications than those without the condition. However, variations among previous studies have made a comprehensive evaluation necessary.
To provide stronger evidence, Dwi Mishelia and Risti Dwi Ocktaviani conducted a systematic review following the PRISMA 2020 guidelines. The researchers searched scientific publications from PubMed, EBSCO, and the Cochrane Library published between January 2016 and May 2026.
The initial search identified 743 articles. After removing duplicate records and applying strict scientific selection criteria, only eight high-quality studies met the eligibility requirements for detailed analysis. These studies consisted of cohort and case-control research involving pregnant women diagnosed with endometriosis.
The review revealed a consistent pattern showing that endometriosis is associated with an increased risk of several major obstetric complications.
Key Findings
- A significantly higher risk of placenta previa.
- An increased likelihood of developing preeclampsia.
- A greater risk of preterm birth.
- Higher rates of cesarean delivery.
- Increased risk of postpartum hemorrhage.
- Several studies also reported elevated risks of placental abruption, fetal growth restriction, venous thrombosis, and other adverse perinatal outcomes.
- Evidence regarding small-for-gestational-age (SGA) infants remains inconsistent, indicating the need for further research.
According to the researchers, these increased risks are likely linked to the chronic inflammatory process that characterizes endometriosis. Persistent inflammation releases various inflammatory molecules that may disrupt placental development and reduce blood flow to the fetus.
Abnormal embryo implantation is also believed to contribute to the higher incidence of placenta previa, a condition in which the placenta implants in the lower part of the uterus and may complicate vaginal delivery. In addition, inflammation-induced changes in blood vessel function may increase the risk of preeclampsia, a potentially life-threatening pregnancy disorder characterized by high blood pressure.
The review also found that women with endometriosis are more likely to undergo cesarean delivery. This higher rate is not simply due to patient preference but is largely driven by pregnancy complications such as placenta previa, preterm labor, and previous surgeries related to endometriosis.
Regarding newborn health, the findings remain mixed. Some studies reported a higher risk of low birth weight and neonatal intensive care unit (NICU) admission, while others found no significant association. These differences may be explained by variations in patient characteristics, disease severity, and study methodologies.
Dwi Mishelia and Risti Dwi Ocktaviani emphasized that these findings have important implications for maternal healthcare. Women with a history of endometriosis should be considered a high-risk pregnancy group and receive more intensive antenatal monitoring throughout pregnancy.
Recommended monitoring includes early screening for placental abnormalities, hypertensive disorders of pregnancy, and the risk of preterm birth. Preconception counseling is also recommended to help women understand potential obstetric risks and prepare appropriate preventive strategies before becoming pregnant.
Despite its valuable findings, the authors acknowledged several limitations. Most of the studies included in the review were retrospective observational studies, which may introduce bias. Differences in diagnostic methods, disease severity, and study populations also contributed to inconsistencies across the available evidence. Therefore, the researchers recommend large-scale prospective studies using standardized classifications of endometriosis to better establish causal relationships.
Overall, this systematic review reinforces growing evidence that endometriosis is not only a fertility disorder but also a significant risk factor for maternal and neonatal complications. Early diagnosis, comprehensive prenatal care, and close collaboration between obstetricians and patients may help detect complications sooner and improve pregnancy outcomes.
Author Profiles
Dwi Mishelia is a healthcare professional affiliated with Hope and Prayer Regional General Hospital, Bengkulu City, specializing in reproductive health, obstetrics, and maternal care.
Risti Dwi Ocktaviani is an academic at the University of Bengkulu whose expertise includes reproductive health, obstetrics, and evidence-based maternal and neonatal research.
Research Source
Title: Impact of Endometriosis on Pregnancy and Obstetric Outcomes: A Systematic Review
Authors: Dwi Mishelia, Risti Dwi Ocktaviani
Journal: Indonesian Journal of Advanced Research (IJAR), Vol. 5, No. 6, 2026
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