Maternal uterine leiomyoma and long-term pediatric morbidity in the offspring

Objective
Short term perinatal implications in pregnancies with uterine leiomyoma include lower ongoing pregnancy rates, higher rates of fetal malpresentation and preterm delivery. The potential long-term impact on offspring however, has not been investigated. The present study aimed to investigate the long-term morbidity in offspring of mothers with uterine leiomyomas.

Study Design
A population-based cohort analysis including all singleton deliveries which occurred between the years 1991-2014 at a single regional tertiary medical center was conducted. Long-term hospitalizations of the offspring, up to the age of 18 years, due to gastrointestinal, neurological, cardiovascular, endocrine, and respiratory morbidity were assessed, following pregnancies diagnosed with and without uterine leiomyoma. Fetuses with congenital malformations and multiple pregnancies were excluded. Kaplan-Meier survival curves and a Cox survival regression models were used to compare cumulative morbidity incidence and control for confounders.

Results
During the study period, 242,232 singleton deliveries met the inclusion criteria; 0.5% of which were diagnosed with uterine leiomyoma (n=1,226). Maternal age (years) of the leiomyoma group compared to the non-leiomyoma group was significantly higher (34.22±5.5 vs. 28.13±5.8, p=0.003), and had a higher rate of preterm labor at less than 37 weeks compared to the comparison group (13.6% vs. 6.8%, p<0.001). Hospitalizations up to the age of 18 years in the different health categories were comparable between the groups except for endocrine disorders which were more common in the exposed group (1.0% vs. 0.5%, respectively, p=0.019, Table). Similarly, the Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence only for endocrine morbidity of offspring in the leiomyoma group (Figure, log rank p=0.027) but not all other evaluated morbidities. In Cox proportional hazards models, which controlled for maternal age, preterm delivery, birthweight, maternal diabetes and hypertensive disorders in pregnancy, no increased long-term endocrine or any other morbidity following pregnancies complicated by uterine leiomyoma was noted.

Conclusion
Uterine leiomyoma during pregnancy do not appear to be independently associated with long-term pediatric morbidity of the offspring up to the age of 18 years.