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Setiawan A, Anwar R, Syamsunarno MRAA, Mose JC, Santoso B, Maskoen AM, Permadi W, Setiabudiawan B, Dhamayanti M, Hidayat YM. Epigenetic Regulation Interplays with Endometriosis Pathogenesis in Low-Birth-Weight Patients via the Progesterone Receptor B-VEGF-DNMT1 Axis. Diagnostics (Basel) 2023; 13:2085. [PMID: 37370979 DOI: 10.3390/diagnostics13122085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/04/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Low birth weight (LBW) is a risk factor associated with endometriosis. Our study aimed to analyze the risk of endometriosis in women with a LBW history and the relationships of progesterone receptor B (PR-B) gene promoter methylation, DNA methyltransferase-1 (DNMT1) expression, PR-B expression, and vascular endothelial growth factors (VEGF) with endometriosis. METHODS This study was conducted in two stages, a retrospective case-control design and a cross-sectional design, with 52 cases of endometriosis and 30 controls, which were further subdivided into LBW and non-LBW groups, at Hasan Sadikin General Hospital and its hospital networks from October 2017 to August 2021. Menstrual blood was taken from subjects and analyzed using pyrosequencing techniques to assess DNA methylation, while q-RT PCR was used to assess gene expression. RESULTS There were significant differences in PR-B methylation, DNMT1 expression, PR-B expression, and VEGF expression (p < 0.001) between the case and control groups. There was a significant negative correlation between PR-B methylation and PR-B expression (r = -0.558; p = 0.047). Based on a multiple logistic analysis, the most dominant factor affecting endometriosis incidence is PR-B (OR 10.40, 95% CI 3.24-33.4, R2 = 45.8). We found that patients with a low birth weight history had a 1.41-times-higher risk of developing endometriosis (95% CI 0.57-3.49, p = 0.113), although the relationship was not statistically significant. CONCLUSION Endometriosis is associated with PR-B gene promoter hypermethylation, decreased PR-B expression, and increased DNMT1 and VEGF expression. The methylation of PR-B is the most dominant factor affecting endometriosis incidence.
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Affiliation(s)
- Arief Setiawan
- Endocrinology Reproduction and Fertilisation Division, Department of Obstetrics and Gynaecology, Hasan Sadikin Hospital, Bandung 40161, Indonesia
| | - Ruswana Anwar
- Endocrinology Reproduction and Fertilisation Division, Department of Obstetrics and Gynaecology, Hasan Sadikin Hospital, Bandung 40161, Indonesia
| | | | | | - Budi Santoso
- Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia
| | | | - Wiryawan Permadi
- Endocrinology Reproduction and Fertilisation Division, Department of Obstetrics and Gynaecology, Hasan Sadikin Hospital, Bandung 40161, Indonesia
| | | | - Meita Dhamayanti
- Faculty of Medicine, Universitas Padjadjaran, Bandung 40161, Indonesia
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Monnin N, Fattet AJ, Koscinski I. Endometriosis: Update of Pathophysiology, (Epi) Genetic and Environmental Involvement. Biomedicines 2023; 11:biomedicines11030978. [PMID: 36979957 PMCID: PMC10046867 DOI: 10.3390/biomedicines11030978] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Endometriosis is a chronic disease caused by ectopic endometrial tissue. Endometriotic implants induce inflammation, leading to chronic pain and impaired fertility. Characterized by their dependence on estradiol (via estrogen receptor β (ESRβ)) and their resistance to progesterone, endometriotic implants produce their own source of estradiol through active aromatase. Steroidogenic factor-1 (SF1) is a key transcription factor that promotes aromatase synthesis. The expression of SF1 and ESRβ is enhanced by the demethylation of their promoter in progenitor cells of the female reproductive system. High local concentrations of estrogen are involved in the chronic inflammatory environment favoring the implantation and development of endometriotic implants. Similar local conditions can promote, directly and indirectly, the appearance and development of genital cancer. Recently, certain components of the microbiota have been identified as potentially promoting a high level of estrogen in the blood. Many environmental factors are also suspected of increasing the estrogen concentration, especially prenatal exposure to estrogen-like endocrine disruptors such as DES and bisphenol A. Phthalates are also suspected of promoting endometriosis but throughmeans other than binding to estradiol receptors. The impact of dioxin or tobacco seems to be more controversial.
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Affiliation(s)
- Nicolas Monnin
- Majorelle Clinic, Atoutbio Laboratory, Laboratory of Biology of Reproduction, 54000 Nancy, France
| | - Anne Julie Fattet
- Majorelle Clinic, Atoutbio Laboratory, Laboratory of Biology of Reproduction, 54000 Nancy, France
| | - Isabelle Koscinski
- Laboratory of Biology of Reproduction, Hospital Saint Joseph, 13008 Marseille, France
- NGERE Inserm 1256, 54505 Vandoeuvre les Nancy, France
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Environmental Factors and Endometriosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111025. [PMID: 34769544 PMCID: PMC8582818 DOI: 10.3390/ijerph182111025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 11/16/2022]
Abstract
Endometriosis is a common disease, affecting up to 60-80% of women, with pelvic pain or/and infertility. Despite years of studies, its pathogenesis still remains enigmatic. Genetic, hormonal, environmental, and lifestyle-related factors may be involved in its pathogenesis. Thus, the design of the review was to discuss the possible role of environmental factors in the development of endometriosis. The results of individual studies greatly differ, making it very difficult to draw any definite conclusions. There is no reasonable consistency in the role of environmental factors in endometriosis etiopathogenesis.
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Effects of Breastfeeding on Endometriosis-Related Pain: A Prospective Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010602. [PMID: 34682348 PMCID: PMC8535640 DOI: 10.3390/ijerph182010602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 01/01/2023]
Abstract
Endometriosis is a gynecological estrogen-dependent disease whose commonest pain symptoms are dysmenorrhea, dyspareunia, and acyclic chronic pelvic pain (CPP). Hormonal changes occurring during breastfeeding seem to reduce pain and disease recurrence. The aim of this observational prospective study was to assess the effect of breastfeeding on pain and endometriotic lesions in patients with endometriosis and to evaluate a possible correlation between the duration of breastfeeding, postpartum amenorrhea, and pain. Out of 156 pregnant women with endometriosis enrolled, 123 who breastfed were included in the study and were monitored for 2 years after delivery; 96/123 exclusively breastfed for at least 1 month. Mode of delivery, type and duration of breastfeeding, intensity of pain symptoms, and lesion size before pregnancy and during the 24-month follow-up were analyzed. All patients experienced a significant reduction in dysmenorrhea proportional to the duration of breastfeeding. CPP was significantly reduced only in women who exclusively breastfed. No significant improvement in dyspareunia was observed. Ovarian endometriomas were significantly reduced. Therefore, breastfeeding, particularly if exclusive, may cause improvement in dysmenorrhea and CPP proportional to the duration of breastfeeding, as well as a reduction in the size of ovarian endometriomas.
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Olšarová K, Mishra GD. Early life factors for endometriosis: a systematic review. Hum Reprod Update 2020; 26:412-422. [PMID: 32141508 DOI: 10.1093/humupd/dmaa002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 12/29/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite its high prevalence and health burden, many aspects of endometriosis remain unclear, including risk factors and the underlying biological mechanisms. Exposures during early life, including in utero, are thought to play an important role in the subsequent onset of the condition. To date, however, much of the evidence from studies on early life exposures and diagnosed endometriosis appears mixed and difficult to assess. OBJECTIVE AND RATIONALE This study aims to provide a systematic review of the epidemiologic evidence on early life factors associated with the subsequent diagnosis of endometriosis. In utero and early life exposures have previously been linked to a range of adult health outcomes, including infertility. SEARCH METHODS A systematic review of case-control, cross-sectional and cohort studies was conducted using the search terms 'endometriosis'[MeSH] AND ('risk factors'[MeSH] OR 'protective factors'[MeSH]) AND ('in utero', 'fetal', 'neonatal, 'perinatal', 'developmental origins', 'early life', 'childhood' OR 'life course') in Embase, PubMed and Scopus databases. The review included articles published in English until 10 June 2018 with original data from studies with diagnosed endometriosis. The quality of primary studies was evaluated using the Newcastle-Ottawa Scale by both authors independently. Due to the degree of inconsistency in the measurements and study methods, a qualitative assessment of findings was undertaken rather than meta-analysis. OUTCOMES The search retrieved 70 records without duplicates that contained 20 records on human case-control, cross-sectional or cohort studies, from which 11 papers/studies were selected based on their assessment score. The majority of studies found that women born with low birthweight (<2.5 kg or <5.5 lb) were more likely to be diagnosed with endometriosis. For other early life factors, the evidence is mixed or limited, with further research needed on the association of endometriosis with preterm birth, in utero exposure to diethylstilbestrol and to maternal smoking, passive smoking in early life, and infant formula feeding (compared with breastfeeding). WIDER IMPLICATIONS While the weight of evidence points to low birthweight as a risk factor for diagnosis of endometriosis, future research is warranted on this and other key early life exposures where the findings are mixed to provide more robust evidence and for insights on potential causal pathways. Such research, however, needs to address current methodological issues, such as the use of prospective data from large population-based studies, better diagnostic methods to confirm disease free status, more consistent definitions of variables and consideration of potential biological mechanisms to guide the analyses. The improvements will advance the future synthesis of evidence to support clinically relevant risk assessment for a more timely diagnosis and treatment of endometriosis.
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Affiliation(s)
- Karolína Olšarová
- Faculty of Science, Charles University, Albertov 6, 128 43 Prague, Czech Republic
| | - Gita D Mishra
- School of Public Health, University of Queensland, 288 Herston Road, 4006 Herston, Queensland, Australia
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Ottolina J, Schimberni M, Makieva S, Bartiromo L, Fazia T, Bernardinelli L, Viganò P, Candiani M, Gentilini D. Early-life factors, in-utero exposures and endometriosis risk: a meta-analysis. Reprod Biomed Online 2020; 41:279-289. [PMID: 32532666 DOI: 10.1016/j.rbmo.2020.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/25/2020] [Accepted: 04/07/2020] [Indexed: 02/07/2023]
Abstract
This meta-analysis aimed to offer a general picture of the available data on the effects of early-life factors on the risk of developing endometriosis in adult life. An advanced, systematic search of the online medical databases PubMed, EMBASE and CINAHL was limited to full-length manuscripts published in English in peer-reviewed journals up to February 2019. Log of relative risk (RR) was employed to calculate the pooled effect sizes using both fixed and random effects modelling and I-squared tests to assess heterogeneity. Funnel plots were used to investigation publication bias. The meta-analysis was registered in PROSPERO (ID CRD42019138668). Six studies that included a total of 2360 women affected by endometriosis were analysed. The pooled results showed that the risk of developing endometriosis in adult life was significantly increased by being born prematurely (logRR 0.21, 95% CI -0.03 to 0.40), having a low birthweight (logRR 0.35, 95% CI -0.15 to 0.54), being formula-fed (logRR 0.65, 95% CI -0.35 to 0.95) and having been exposed to diethylstilbestrol (DES) in utero (logRR 0.65, 95% CI 0.26 to 1.04. Among intrauterine and early neonatal exposures, prematurity, birthweight, formula feeding and DES were risk factors for the development of endometriosis in adult life.
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Affiliation(s)
- Jessica Ottolina
- Gynecol/Obstet Unit, San Raffaele Scientific Institute, Milan, Italy.
| | - Matteo Schimberni
- Gynecol/Obstet Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Sofia Makieva
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
| | | | - Teresa Fazia
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Luisa Bernardinelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paola Viganò
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Candiani
- Gynecol/Obstet Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Davide Gentilini
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; Istituto Auxologico Italiano IRCCS, Bioinformatics and Statistical Genomics Unit, Cusano MilaninoMilan, Italy
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Dai Y, Zhang X, Xue M, Zhou Y, Sun P, Leng J. Not Having Been Breastfed May Protect Chinese Women From Developing Deep Infiltrating Endometriosis: Results From Subgroup Analyses of the FEELING Study. Reprod Sci 2019; 26:1158-1167. [PMID: 30669944 PMCID: PMC6873220 DOI: 10.1177/1933719118820469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background: This study aimed to investigate potential factors, especially early-life exposures,
associated with endometrioma (OMA) and/or deep infiltrating endometriosis (DIE) in
Chinese women. Methods: This is a subgroup analyses of the FEELING study, which was a case–control study that
investigated the clinical, lifestyle, and environmental factors associated with OMA
and/or DIE in China, Russia, and France. In this subgroup analysis, the data for the
Chinese participants were further analyzed using logistic regression model. Results: All women (N = 546) had fully completed the questionnaire. The mean age of the
participants was 31.8 (range: 18-41) years. Univariable analysis showed that noncyclic
chronic pelvic pain, dysmenorrhea intensity class, and whether breastfed during infancy
were distributed differently between patients with OMA or DIE and those with no
endometriosis (non-EM) or superficial peritoneal endometriosis (SUP; P
< .05). Multivariable analysis revealed that not having been breastfed was a
protective factor against OMA and DIE (odds ratio [OR] = 0.33, 95% confidence interval
[CI]: 0.16-0.69). Further analysis indicated not having been breastfed was a protective
factor for DIE compared with non-EM (OR = 0.13, 95% CI: 0.02-0.88) and with OMA + SUP
(OR = 0.19, 95% CI: 0.04-0.85) but was not a protective factor for OMA compared with
non-EM (OR = 0.66, 95% CI: 0.32-1.36) and with SUP (OR = 0.63, 95% CI: 0.31-1.30). Conclusion: This is the first study suggesting that not having been breastfed might protect against
DIE in Chinese women.
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Affiliation(s)
- Yi Dai
- 1 Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xinmei Zhang
- 2 Women's Hospital School of Medicine, Zhejiang University, Hangzhou, China
| | - Min Xue
- 3 The Third Xiangya Hospital of Central South University, Changsha, China
| | | | - Pengran Sun
- 5 Ipsen (Beijing) Pharmaceutical Science and Technology Development Co, Ltd, Beijing, China
| | - Jinhua Leng
- 1 Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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New adverse obstetrics outcomes associated with endometriosis: a retrospective cohort study. Arch Gynecol Obstet 2016; 295:141-151. [DOI: 10.1007/s00404-016-4222-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 10/14/2016] [Indexed: 02/06/2023]
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Potential influence of in utero and early neonatal exposures on the later development of endometriosis. Fertil Steril 2016; 105:997-1002. [DOI: 10.1016/j.fertnstert.2015.12.127] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 12/20/2015] [Accepted: 12/22/2015] [Indexed: 12/31/2022]
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Brosens I, Gargett CE, Guo SW, Puttemans P, Gordts S, Brosens JJ, Benagiano G. Origins and Progression of Adolescent Endometriosis. Reprod Sci 2016; 23:1282-8. [DOI: 10.1177/1933719116637919] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ivo Brosens
- Leuven Institute for Fertility and Embryology, Leuven, Belgium
| | - Caroline E. Gargett
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Obstetrics and Gynaecology Monash University, Clayton, Australia
| | - Sun-Wei Guo
- Department of Gynecology, Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People’s Republic of China
| | | | - Stephan Gordts
- Leuven Institute for Fertility and Embryology, Leuven, Belgium
| | - Jan J. Brosens
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Giuseppe Benagiano
- Department of Gynaecology, Obstetrics and Urology, “Sapienza” University, Rome, Italy
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Wei M, Chen X, Zhao Y, Cao B, Zhao W. Effects of Prenatal Environmental Exposures on the Development of Endometriosis in Female Offspring. Reprod Sci 2016; 23:1129-38. [DOI: 10.1177/1933719116630418] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ming Wei
- Department of Obstetrics and Gynecology, Nankai Hospital, Tianjin Academy of Integrative Medicine, Tianjin, China
| | - Xinyuan Chen
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Ye Zhao
- Department of Clinical Research, Nankai Hospital, Tianjin Academy of Integrative Medicine, Tianjin, China
| | - Baoli Cao
- Department of Obstetrics and Gynecology, Nankai Hospital, Tianjin Academy of Integrative Medicine, Tianjin, China
| | - Wenli Zhao
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
- Department of Neurology, Nankai Hospital, Tianjin Academy of Integrative Medicine, Tianjin, China
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Borghese B, Sibiude J, Santulli P, Lafay Pillet MC, Marcellin L, Brosens I, Chapron C. Low birth weight is strongly associated with the risk of deep infiltrating endometriosis: results of a 743 case-control study. PLoS One 2015; 10:e0117387. [PMID: 25679207 PMCID: PMC4332485 DOI: 10.1371/journal.pone.0117387] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/24/2014] [Indexed: 11/19/2022] Open
Abstract
The influence of intrauterine environment on the risk of endometriosis is still controversial. Whether birth weight modifies the risk of endometriosis in adulthood remains an open question. For this purpose, we designed a case-control study involving 743 women operated on for benign gynecological indications from January 2004 to December 2011. Study group included 368 patients with histologically proven endometriosis: 54 superficial endometriosis (SUP), 79 endometriomas (OMA) and 235 deep infiltrating endometriosis (DIE). Control group included 375 patients without endometriosis as surgically checked. Mean birth weights were compared between patients and controls, according to endometriosis groups and rAFS stages. Mean birth weight was significantly lower for patients with endometriosis as compared to controls (3,119 g ± 614 and 3,251 g ± 557 respectively; p = 0.002). When compared to controls, patients with DIE had the lowest birth weight with a highly significant difference (3,103 g ± 620, p = 0.002). In univariate analysis, patients with low birth weight (LBW), defined as a BW < 2,500 g, had a higher risk of endometriosis, especially DIE, as compared to the reference group (OR = 1.5, 95%CI: 1.0-2.3 and OR = 1.7, 95%CI: 1.0-2.7, respectively). Multivariate analysis, adjusted on ethnicity and smoking status, showed the persistence of a significant association between endometriosis and LBW with a slight increase in the magnitude of the association (aOR = 1.7, 95%CI: 1.0-2.6 for endometriosis, aOR = 1.8; 95%CI: 1.1-2.9 for DIE). In conclusion, LBW is independently associated with the risk of endometriosis in our population. Among patients with LBW, the risk is almost two-times higher to develop DIE. This association could reflect common signaling pathways between endometriosis and fetal growth regulation. There is also the possibility of a role played by placental insufficiency on the development of the neonate's pelvis and the occurrence of neonatal uterine bleeding that could have consequences on the risk of severe endometriosis.
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Affiliation(s)
- Bruno Borghese
- Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, CNRS UMR 8104, Paris, France
- Inserm, U1016, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Service de Gynécologie Obstétrique 2 et Médecine de la Reproduction, Groupe Hospitalier Cochin, AP-HP, Paris, France
- * E-mail:
| | - Jeanne Sibiude
- Université Paris Descartes, Sorbonne Paris Cité, Service de Gynécologie Obstétrique 2 et Médecine de la Reproduction, Groupe Hospitalier Cochin, AP-HP, Paris, France
| | - Pietro Santulli
- Université Paris Descartes, Sorbonne Paris Cité, Service de Gynécologie Obstétrique 2 et Médecine de la Reproduction, Groupe Hospitalier Cochin, AP-HP, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, EA 1833, ERTi, Groupe Hospitalier Cochin, AP-HP, Paris, France
| | - Marie-Christine Lafay Pillet
- Université Paris Descartes, Sorbonne Paris Cité, Service de Gynécologie Obstétrique 2 et Médecine de la Reproduction, Groupe Hospitalier Cochin, AP-HP, Paris, France
| | - Louis Marcellin
- Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, CNRS UMR 8104, Paris, France
- Inserm, U1016, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Service de Gynécologie Obstétrique 2 et Médecine de la Reproduction, Groupe Hospitalier Cochin, AP-HP, Paris, France
| | - Ivo Brosens
- Catholic University of Leuven, and Leuven Institute for Fertility and Embryology, Leuven, Belgium
| | - Charles Chapron
- Institut Cochin, Université Paris Descartes, Sorbonne Paris Cité, CNRS UMR 8104, Paris, France
- Inserm, U1016, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Service de Gynécologie Obstétrique 2 et Médecine de la Reproduction, Groupe Hospitalier Cochin, AP-HP, Paris, France
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