{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T22:19:10Z","timestamp":1793830750273,"version":"4.6.1"},"reference-count":52,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T00:00:00Z","timestamp":1747267200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: This study investigates the impact of ovarian endometriosis on pregnancy outcomes. Methods: A retrospective analysis was conducted at Etlik Z\u00fcbeyde Han\u0131m Women\u2019s Diseases Training and Research Hospital between January 2019 and December 2024, including 1127 pregnant women\u2014170 with ovarian endometriosis and 957 healthy controls. Pregnancies achieved via assisted reproductive techniques were excluded. Statistical analyses were performed using appropriate tests, and a p-value &lt; 0.05 was considered significant. Results: Women with ovarian endometriosis had higher rates of miscarriage (21.8% vs. 7.5%), preterm birth (15.0% vs. 8.8%), and placenta previa (4.7% vs. 0.6%), with adjusted odds ratios (OR) of 3.41, 1.84, and 7.82, respectively. No significant differences were observed in terms of gestational diabetes, hypertensive disorders, fetal growth restriction (FGR), intrahepatic cholestasis of pregnancy (ICP), placental abruption, or preterm premature rupture of membranes (PPROM). Cyst size and bilaterality were not associated with complications. Conclusions: Spontaneously conceiving women with ovarian endometriosis are at increased risk for miscarriage, placenta previa, and preterm birth. Prospective randomized studies are warranted to validate these findings.<\/jats:p>","DOI":"10.3390\/jcm14103468","type":"journal-article","created":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T09:58:27Z","timestamp":1747303107000},"page":"3468","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Effect of Ovarian Endometriosis on Pregnancy Outcomes in Spontaneous Pregnancies"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4202-1681","authenticated-orcid":false,"given":"Halis Dogukan","family":"Ozkan","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, L\u00f6sante Children and Adults Hospital, Ankara 06830, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2437-9719","authenticated-orcid":false,"given":"Merve Ayas","family":"Ozkan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik City Hospital, Ankara 06710, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6137-0270","authenticated-orcid":false,"given":"Ahmet Arif","family":"Filiz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Perinatology, Ankara Etlik City Hospital, Ankara 06710, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2797-9505","authenticated-orcid":false,"given":"Muhammed Enes","family":"Karakaya","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Etlik Z\u00fcbeyde Han\u0131m Women\u2019s Diseases Training and Research Hospital, Ankara 06010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1011-3848","authenticated-orcid":false,"given":"Yaprak","family":"Engin-Ustun","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Etlik Z\u00fcbeyde Han\u0131m Women\u2019s Diseases Training and Research Hospital, Ankara 06010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Smolarz, B., Szy\u0142\u0142o, K., and Romanowicz, H. (2021). Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature). Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms221910554"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1016\/j.molmed.2018.07.004","article-title":"The Immunopathophysiology of Endometriosis","volume":"24","author":"Symons","year":"2018","journal-title":"Trends Mol. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1097\/PAP.0000000000000288","article-title":"Endometriosis: A Comprehensive Review","volume":"28","author":"Arafah","year":"2021","journal-title":"Adv. Anat. Pathol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Li, Y., Adur, M., Kannan, A., Davila, J., Zhao, Y., Nowak, R., Bagchi, M., Bagchi, I., and Li, Q. (2016). Progesterone Alleviates Endometriosis via Inhibition of Uterine Cell Proliferation, Inflammation and Angiogenesis in an Immunocompetent Mouse Model. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0165347"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1097\/AOG.0000000000003410","article-title":"Endometriosis and Risk of Adverse Pregnancy Outcomes","volume":"134","author":"Farland","year":"2019","journal-title":"Obstet. Gynecol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1007\/s43032-019-00118-0","article-title":"A Relationship Between Endometriosis and Obstetric Complications","volume":"27","author":"Kobayashi","year":"2020","journal-title":"Reprod. Sci."},{"key":"ref_7","first-page":"564","article-title":"The endometrial immune environment of women with endometriosis","volume":"25","author":"Houshdaran","year":"2019","journal-title":"Hum. Reprod. Update"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1016\/j.fertnstert.2020.12.010","article-title":"Endometrial causes of recurrent pregnancy losses: Endometriosis, adenomyosis, and chronic endometritis","volume":"115","author":"Pirtea","year":"2021","journal-title":"Fertil. Steril."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Nagase, Y., Matsuzaki, S., Ueda, Y., Kakuda, M., Kakuda, S., Sakaguchi, H., Maeda, M., Hisa, T., and Kamiura, S. (2022). Association between Endometriosis and Delivery Outcomes: A Systematic Review and Meta-Analysis. Biomedicines, 10.","DOI":"10.3390\/biomedicines10020478"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1093\/humupd\/dmz012","article-title":"Reproductive, obstetric, and perinatal outcomes of women with adenomyosis and endometriosis: A systematic review and meta-analysis","volume":"25","author":"Horton","year":"2019","journal-title":"Hum. Reprod. Update"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1854","DOI":"10.1093\/humrep\/dey269","article-title":"Endometriosis and adverse maternal, fetal and neonatal outcomes, a systematic review and meta-analysis","volume":"33","author":"Lalani","year":"2018","journal-title":"Hum. Reprod."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Tsikouras, P., Oikonomou, E., Bothou, A., Chaitidou, P., Kyriakou, D., Nikolettos, K., Andreou, S., Gaitatzi, F., Nalbanti, T., and Peitsidis, P. (2024). The Impact of Endometriosis on Pregnancy. J. Pers. Med., 14.","DOI":"10.3390\/jpm14010126"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.ejogrb.2013.10.024","article-title":"Endometriosis and pregnancy outcome: Are pregnancies complicated by endometriosis a high-risk group?","volume":"172","author":"Mekaru","year":"2014","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"hoac009","DOI":"10.1093\/hropen\/hoac009","article-title":"ESHRE guideline: Endometriosis","volume":"2022","author":"Becker","year":"2022","journal-title":"Hum. Reprod. Open"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.fertnstert.2015.09.007","article-title":"Assisted reproductive technology and the risk of pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies: A meta-analysis of cohort studies","volume":"105","author":"Qin","year":"2016","journal-title":"Fertil. Steril."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"102430","DOI":"10.1016\/j.bpobgyn.2023.102430","article-title":"Impact of endometriosis on the ovarian follicles","volume":"92","author":"Casalechi","year":"2024","journal-title":"Best. Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1016\/j.fertnstert.2017.10.026","article-title":"Diagnosis of deep endometriosis: Clinical examination, ultrasonography, magnetic resonance imaging, and other techniques","volume":"108","author":"Bazot","year":"2017","journal-title":"Fertil. Steril."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"S91","DOI":"10.1055\/s-0039-1692130","article-title":"Pregnancy after Endometriosis: Maternal and Neonatal Outcomes according to the Location of the Disease","volume":"36","author":"Uccella","year":"2019","journal-title":"Am. J. Perinatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1111\/j.1471-0528.2012.03466.x","article-title":"Pregnancy outcome in women with peritoneal, ovarian and rectovaginal endometriosis: A retrospective cohort study","volume":"119","author":"Vercellini","year":"2012","journal-title":"BJOG"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1097\/01.AOG.0000266983.77458.71","article-title":"Recurrence of ischemic placental disease","volume":"110","author":"Ananth","year":"2007","journal-title":"Obstet. Gynecol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Zhang, L., Bi, S., Du, L., Gong, J., Chen, J., Sun, W., Shen, X., Tang, J., Ren, L., and Chai, G. (2020). Effect of previous placenta previa on outcome of next pregnancy: A 10-year retrospective cohort study. BMC Pregnancy Childbirth, 20.","DOI":"10.1186\/s12884-020-02890-3"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.bpobgyn.2018.01.013","article-title":"van Ultrasound diagnosis of endometriosis and adenomyosis: State of the art","volume":"51","author":"Bosch","year":"2018","journal-title":"Best. Pract. research. Clin. Obstet. Gynaecol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1097\/AOG.0000000000004612","article-title":"Prediction and Prevention of Spontaneous Preterm Birth: ACOG Practice Bulletin, Number 234","volume":"138","author":"Hoffman","year":"2021","journal-title":"Obstet. Gynecol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"(2020). Prelabor Rupture of Membranes: ACOG Practice Bulletin, Number 217. Obstet. Gynecol., 135, e80\u2013e97.","DOI":"10.1097\/AOG.0000000000003700"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"(2018). ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet. Gynecol., 131, e49\u2013e64.","DOI":"10.1097\/AOG.0000000000002501"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"(2020). Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet. Gynecol., 135, e237\u2013e260.","DOI":"10.1097\/AOG.0000000000003891"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"(2017). Clinical Updates in Women\u2019s Health Care Summary: Liver Disease: Reproductive Considerations. Obstet. Gynecol., 129, 236.","DOI":"10.1097\/AOG.0000000000001858"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1002\/uog.15884","article-title":"Consensus definition of fetal growth restriction: A Delphi procedure","volume":"48","author":"Gordijn","year":"2016","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1002\/ijgo.12408","article-title":"FIGO consensus guidelines on placenta accreta spectrum disorders: Prenatal diagnosis and screening","volume":"140","author":"Jauniaux","year":"2018","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1093\/humupd\/dmt053","article-title":"The distinguishing cellular and molecular features of the endometriotic ovarian cyst: From pathophysiology to the potential endometrioma-mediated damage to the ovary","volume":"20","author":"Sanchez","year":"2014","journal-title":"Hum. Reprod. Update"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1016\/j.fertnstert.2017.03.013","article-title":"Peritoneal fluid cytokines related to endometriosis in patients evaluated for infertility","volume":"107","author":"Hill","year":"2017","journal-title":"Fertil. Steril."},{"key":"ref_32","first-page":"2513","article-title":"Inflammatory cytokines IL-6, IL-10, IL-13, TNF-\u03b1 and peritoneal fluid flora were associated with infertility in patients with endometriosis","volume":"22","author":"Wang","year":"2018","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Cuadrado-Torroglosa, I., Garc\u00eda-Velasco, J.A., and Alecsandru, D. (2024). The Impacts of Inflammatory and Autoimmune Conditions on the Endometrium and Reproductive Outcomes. J. Clin. Med., 13.","DOI":"10.3390\/jcm13133724"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Ng, S.-W., Norwitz, G.A., Pavlicev, M., Tilburgs, T., Sim\u00f3n, C., and Norwitz, E.R. (2020). Endometrial Decidualization: The Primary Driver of Pregnancy Health. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21114092"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1111\/aji.12466","article-title":"Decidual Control of Trophoblast Invasion","volume":"75","author":"Sharma","year":"2016","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"19384","DOI":"10.1002\/jcp.28666","article-title":"The role of inflammation, oxidative stress, angiogenesis, and apoptosis in the pathophysiology of endometriosis: Basic science and new insights based on gene expression","volume":"234","author":"Samimi","year":"2019","journal-title":"J. Cell. Physiol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Breintoft, K., Pinnerup, R., Henriksen, T., Rytter, D., Uldbjerg, N., Forman, A., and Arendt, L.H. (2021). Endometriosis and Risk of Adverse Pregnancy Outcome: A Systematic Review and Meta-Analysis. J. Clin. Med., 10.","DOI":"10.3390\/jcm10040667"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Lim, H.J., Sun, J., Min, B., Song, M., Kim, T.H., Kim, B., Hwang, K., Lee, T., Jeon, H., and Kim, S. (2023). Endometriosis and Adverse Pregnancy Outcomes: A Nationwide Population-Based Study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12165392"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1016\/j.fertnstert.2017.07.019","article-title":"Endometriosis and obstetrics complications: A systematic review and meta-analysis","volume":"108","author":"Zullo","year":"2017","journal-title":"Fertil. Steril."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"297","DOI":"10.17219\/acem\/154858","article-title":"Expression of NF-\u03baB and VEGF in normal placenta and placenta previa patients","volume":"32","year":"2022","journal-title":"Adv. Clin. Exp. Med. Off. Organ. Wroc. Med. Univ."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1675","DOI":"10.1111\/jog.15254","article-title":"Systemic immune-inflammation index to predict placenta accreta spectrum and its histological subtypes","volume":"48","author":"Keles","year":"2022","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1093\/humupd\/dmv045","article-title":"A systematic review on endometriosis during pregnancy: Diagnosis, misdiagnosis, complications and outcomes","volume":"22","author":"Ferrero","year":"2016","journal-title":"Hum. Reprod. Update"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1016\/j.fertnstert.2015.01.015","article-title":"Assisted reproductive technology and the risk of preterm birth among primiparas","volume":"103","author":"Dunietz","year":"2015","journal-title":"Fertil. Steril."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/j.fertnstert.2008.01.096","article-title":"Preterm birth, ovarian endometriomata, and assisted reproduction technologies","volume":"91","author":"Fernando","year":"2009","journal-title":"Fertil. Steril."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1038\/nrendo.2013.255","article-title":"Endometriosis: Pathogenesis and treatment","volume":"10","author":"Vercellini","year":"2014","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Porpora, M.G., Tomao, F., Ticino, A., Piacenti, I., Scaramuzzino, S., Simonetti, S., Imperiale, L., Sangiuliano, C., Masciullo, L., and Manganaro, L. (2020). Endometriosis and Pregnancy: A Single Institution Experience. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17020401"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Huang, Y., Zhao, X., Chen, Y., Wang, J., Zheng, W., and Cao, L. (2020). Miscarriage on Endometriosis and Adenomyosis in Women by Assisted Reproductive Technology or with Spontaneous Conception: A Systematic Review and Meta-Analysis. BioMed Res. Int., 2020.","DOI":"10.1155\/2020\/4381346"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.ajog.2021.06.067","article-title":"Incidence, prevalence, and trends in endometriosis diagnosis: A United States population-based study from 2006 to 2015","volume":"225","author":"Christ","year":"2021","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"(2022). Pregnancy at Age 35 Years or Older: ACOG Obstetric Care Consensus No. 11. Obstet. Gynecol., 140, 348\u2013366.","DOI":"10.1097\/AOG.0000000000004873"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1007\/s00404-016-4222-7","article-title":"New adverse obstetrics outcomes associated with endometriosis: A retrospective cohort study","volume":"295","author":"Mannini","year":"2016","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_51","first-page":"e220070","article-title":"The role of parity in the relationship between endometriosis and pregnancy outcomes: A systematic review and meta-analysis","volume":"4","author":"Ranjan","year":"2023","journal-title":"Reprod Fertil."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s40834-024-00280-0","article-title":"Pregnancy-related complications in patients with endometriosis in different stages","volume":"9","author":"Shadjoo","year":"2024","journal-title":"Contracept. Reprod. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/10\/3468\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:33:23Z","timestamp":1760031203000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/10\/3468"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,15]]},"references-count":52,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["jcm14103468"],"URL":"https:\/\/doi.org\/10.3390\/jcm14103468","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,15]]}}}