286 remodelling in this same junctional zone. Recent studies have suggested a link between adenomyosis and hypertensive disorders of pregnancy (4,81,281,291). Our study confirms this finding, with consistently higher aOR’s for most HDPs compared to the general population. Additionally, we report a higher prevalence of FGR and SGA infants in the adenomyosis population. This could be simultaneously attributed to impaired placental implantation in adenomyotic uteri, with subsequent placental insufficiency affecting foetal growth. Indeed, our results show a significantly increased prevalence of placental issues overall, be it malposition (i.e. previa) or problems with adherence (i.e. retention/abruption). The clearly higher prevalence of placenta previa (aOR 2.129 (95% CI 1.355 - 3.344)) may be explained by placental implantation being impaired at the site of adenomyotic lesions (most often in the corpus of the uterus), leading to aberrant localization of placental tissue. Interestingly however, despite the increased prevalence of placenta previa, women with adenomyosis did not show increased prevalence of antepartum haemorrhage. Possibly this was underreported. Alternatively, aberrant placental localization and implantation could also have formed the impetus for adenomyosis development in conjunction with the Tissue Injury and Active Repair (TIAR) theory as proposed by Leyendecker et al (9). Previous studies also support our results for neonatal outcomes, with comparable studies investigating neonatal outcomes reporting mildly significant or statistically insignificant results (81,94). It seems therefore that adenomyosis affects mostly the maternal and obstetric outcomes, without a clinically relevant effect on neonatal outcome. The results of our study support that women with subsequent proven adenomyosis more often experienced (prior) adverse obstetric outcomes. The diagnostic method referred to in this study – histopathological diagnosis mostly after hysterectomy – of course cannot be applied to pregnant women prospectively. However, the non-invasive diagnostic methods of transvaginal ultrasound and MRI can fairly accurately diagnose adenomyosis in the nonpregnant uterus (29,34,45,182). Whether adenomyosis is present at the time of the pregnancy is not proven by our study, and warrants future studies using MRI and ultrasound to shed light on directionality and causality of these
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