Pregnancy Outcomes in Women With Endometriosis: A Systematic Review and Meta-Analysis of Maternal and Neonatal Complications

Endometriosis may influence pregnancy beyond its established association with infertility by affecting placentation, gestational duration, maternal health, and neonatal outcomes.This systematic review and meta-analysis aimed to determine whether endometriosis is associated with adverse maternal, fetal, and neonatal complications.PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, Web of Science, and Google Scholar were searched from inception to June 30, 2026, using controlled vocabulary and free-text terms related to endometriosis and pregnancy outcomes.Comparative observational studies involving pregnant women with and without endometriosis were included.Two reviewers independently screened studies, extracted adjusted effect estimates, and assessed risk of bias using Risk of Bias in Non-randomized Studies-of Exposures (ROBINS-E).Random-effects meta-analysis was performed when at least three clinically comparable studies provided extractable data; the remaining outcomes were synthesized narratively.Ten studies were included.Women with endometriosis had significantly higher odds of placenta previa (pooled OR 2.98, 95% CI 2.00-4.45;I²=34.5%) and a higher risk of preterm birth (pooled adjusted OR/RR sensitivity estimate 1.24, 95% CI 1.14-1.36;I²=10.2%).Narrative findings also suggested increased frequencies of hypertensive disorders, hemorrhage, cesarean delivery, fetal growth abnormalities, stillbirth, neonatal intensive care admission, and respiratory morbidity, although consistency varied.Endometriosis is associated with clinically important obstetric and neonatal risks, particularly placenta previa and preterm birth, supporting individualized antenatal surveillance and delivery planning.