The influence of uterine fibroids on adverse outcomes in pregnant women: a meta-analysis

BMC Pregnancy Childbirth. 2024 May 6;24(1):345. doi: 10.1186/s12884-024-06545-5.

Abstract

Objective: The objective of the meta-analysis was to determine the influence of uterine fibroids on adverse outcomes, with specific emphasis on multiple or large (≥ 5 cm in diameter) fibroids.

Materials and methods: We searched PubMed, Embase, Web of Science, ClinicalTrials.gov, China National Knowledge Infrastructure (CNKI), and SinoMed databases for eligible studies that investigated the influence of uterine fibroids on adverse outcomes in pregnancy. The pooled risk ratio (RR) of the variables was estimated with fixed effect or random effect models.

Results: Twenty-four studies with 237 509 participants were included. The pooled results showed that fibroids elevated the risk of adverse outcomes, including preterm birth, cesarean delivery, placenta previa, miscarriage, preterm premature rupture of membranes (PPROM), placental abruption, postpartum hemorrhage (PPH), fetal distress, malposition, intrauterine fetal death, low birth weight, breech presentation, and preeclampsia. However, after adjusting for the potential factors, negative effects were only seen for preterm birth, cesarean delivery, placenta previa, placental abruption, PPH, intrauterine fetal death, breech presentation, and preeclampsia. Subgroup analysis showed an association between larger fibroids and significantly elevated risks of breech presentation, PPH, and placenta previa in comparison with small fibroids. Multiple fibroids did not increase the risk of breech presentation, placental abruption, cesarean delivery, PPH, placenta previa, PPROM, preterm birth, and intrauterine growth restriction. Meta-regression analyses indicated that maternal age only affected the relationship between uterine fibroids and preterm birth, and BMI influenced the relationship between uterine fibroids and intrauterine fetal death. Other potential confounding factors had no impact on malposition, fetal distress, PPROM, miscarriage, placenta previa, placental abruption, and PPH.

Conclusion: The presence of uterine fibroids poses increased risks of adverse pregnancy and obstetric outcomes. Fibroid size influenced the risk of breech presentation, PPH, and placenta previa, while fibroid numbers had no impact on the risk of these outcomes.

Keywords: Meta-analysis; Obstetric outcome; Pregnancy; Uterine fibroids.

Publication types

  • Meta-Analysis

MeSH terms

  • Abortion, Spontaneous / epidemiology
  • Abortion, Spontaneous / etiology
  • Abruptio Placentae / epidemiology
  • Abruptio Placentae / etiology
  • Breech Presentation / epidemiology
  • Cesarean Section* / statistics & numerical data
  • Female
  • Fetal Membranes, Premature Rupture / epidemiology
  • Fetal Membranes, Premature Rupture / etiology
  • Humans
  • Leiomyoma* / complications
  • Leiomyoma* / epidemiology
  • Placenta Previa / epidemiology
  • Postpartum Hemorrhage / epidemiology
  • Postpartum Hemorrhage / etiology
  • Pregnancy
  • Pregnancy Complications, Neoplastic / epidemiology
  • Pregnancy Outcome* / epidemiology
  • Premature Birth* / epidemiology
  • Premature Birth* / etiology
  • Risk Factors
  • Uterine Neoplasms* / complications
  • Uterine Neoplasms* / epidemiology