OBJECTIVE To evaluate whether perinatal and infant outcomes differ between singleton births following assisted reproductive technology (ART) in women with endometriosis alone and those with other causes of infertility. DESIGN Population-based data linkage cohort study. SUBJECTS A total of 29,152 ART-conceived singleton births from 24,116 mothers, 2010-2017, New South Wales, Australia. EXPOSURE Endometriosis, identified from the Australian and New Zealand Assisted Reproduction Database (ANZARD), hospital admissions and dispensed medication records. Cause of infertility was categorised as: endometriosis alone, endometriosis plus other cause(s) of infertility, infertility other than endometriosis, and unstated cause of infertility. The endometriosis alone group was further classified using ICD-10 codes (N80.0-80.9) into superficial, ovarian, deep, and other endometriosis. MAIN OUTCOME MEASURES Perinatal and infant outcomes, including preterm birth (< 37 weeks), very preterm birth (< 32 weeks), small-for-gestational-age (SGA), large-for-gestational-age (LGA), admission to neonatal intensive care unit, perinatal death, and infant hospitalisation up to 2 years of age. Generalized estimating equations (GEE) were used to investigate independent associations between endometriosis and study outcomes. RESULTS Of the 29,152 ART-conceived singleton births, 19.9% (5,806/29,152) were from mothers with a diagnosis of endometriosis. Among these, 23.8% (1,379/5,806) from mothers with an endometriosis alone diagnosis and 76.2% (4,427/5,806) from mothers with endometriosis plus other cause(s) of infertility. There were 74.8% (21,795/29,152) births from mothers without endometriosis and 5.3% (1,551/29,152) from mothers with an unstated cause of infertility. After adjusting for maternal age at the time of birth, parity, ART treatment characteristics, gestational hypertension and diabetes, smoking, and socioeconomic status, there was no overall association between endometriosis and perinatal and infant outcomes. However, compared to women without endometriosis, those with deep endometriosis had a higher risk of preterm birth (adjusted relative risk [aRR] 1.75, 95% confidence interval [CI] 1.12-2.75) and SGA (aRR=1.58, 95% CI 1.05-2.37). CONCLUSION Reassuringly, perinatal and infant outcomes are generally comparable for ART-conceived infants born to mothers with endometriosis alone and those with other causes of infertility when considered as a singular disease entity. Larger studies are needed to confirm the differential risk associated with endometriosis phenotypes but for patients with deep endometriosis undergoing ART, the risks of preterm birth and SGA may be increased. Clinicians should be aware of the potential of these risks.

中文翻译：

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与其他原因的不孕症相比，单独 ART 治疗子宫内膜异位症后的围产期和婴儿结局：一项数据连锁队列研究。


目的 评估单独子宫内膜异位症女性和有其他原因导致不孕症的女性在辅助生殖技术 （ART） 后单胎分娩的围产期和婴儿结局是否不同。设计 基于人群的数据关联队列研究。对象 29,152 年至 2010 年，澳大利亚新南威尔士州 24,116 名母亲共 2017 例 ART 受孕单胎分娩。暴露 子宫内膜异位症，从澳大利亚和新西兰辅助生殖数据库 （ANZARD） 中确定，入院和配药记录。不孕的原因分为：单独的子宫内膜异位症、子宫内膜异位症加其他不孕原因、子宫内膜异位症以外的不孕症以及未说明的不孕原因。使用 ICD-10 代码 （N80.0-80.9） 将单独子宫内膜异位症组进一步分为浅表、卵巢、深部和其他子宫内膜异位症。主要结局指标围产期和婴儿结局，包括早产 （< 37 周）、极早产 （< 32 周）、小于胎龄儿 （SGA）、大于胎龄儿 （LGA）、入住新生儿重症监护病房、围产期死亡和 2 岁以下婴儿住院治疗。广义估计方程 （GEE） 用于研究子宫内膜异位症与研究结果之间的独立关联。结果 在 29,152 例 ART 受孕的单胎婴儿中，19.9% （5,806/29,152） 来自诊断为子宫内膜异位症的母亲。其中，23.8% （1,379/5,806） 来自单独诊断为子宫内膜异位症的母亲，76.2% （4,427/5,806） 来自患有子宫内膜异位症和其他不孕原因的母亲。有 74.8% （21,795/29,152） 的出生来自没有子宫内膜异位症的母亲，5.3% （1,551/29,152） 来自不孕原因未说明的母亲。 在调整了产妇出生时的年龄、胎次、ART 治疗特征、妊娠高血压和糖尿病、吸烟和社会经济地位后，子宫内膜异位症与围产期和婴儿结局之间没有总体关联。然而，与无子宫内膜异位症的妇女相比，患有深部子宫内膜异位症的妇女早产风险更高 （校正相对风险 [aRR] 1.75,95% 置信区间 [CI] 1.12-2.75） 和 SGA （aRR=1.58,95% CI 1.05-2.37）。结论 令人欣慰的是，当被视为单一疾病实体时，仅患有子宫内膜异位症的母亲所生的 ART 受孕婴儿和具有其他不孕原因的婴儿的围产期和婴儿结局通常具有可比性。需要更大规模的研究来证实与子宫内膜异位症表型相关的差异风险，但对于接受 ART 的深部子宫内膜异位症患者，早产和 SGA 的风险可能会增加。临床医生应了解这些风险的可能性。