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Obstetric and Gynecologic Challenges in Women With Ehlers-Danlos Syndrome

Hurst, Bradley S. MD; Lange, Sara S. MD; Kullstam, Susan M. BA; Usadi, Rebecca S. MD; Matthews, Michelle L. MD; Marshburn, Paul B. MD; Templin, Megan A. MS; Merriam, Kathryn S. BA

doi: 10.1097/AOG.0000000000000123
Contents: Original Research

OBJECTIVE: To determine how often women with Ehlers-Danlos syndrome experience obstetric and gynecologic issues both compared with the general population and within the three most common subtypes of Ehlers-Danlos syndrome.

METHODS: An anonymous, prospective, online questionnaire in English was posted to the Ehlers-Danlos National Foundation web site (http://ednf.org).

RESULTS: Of the 1,769 of those who completed the survey, 1,225 reported a typed diagnosis of Ehlers-Danlos syndrome. Further stratification to the three most common types and reproductive-aged women (n=775) allowed conclusions to be made about differences in rates of obstetric complications and gynecologic dysfunction compared with the general population and between types of Ehlers-Danlos syndrome. Rates of obstetric outcomes for women who reported at least one pregnancy included term pregnancy in 69.7%, preterm birth in 25.2%, spontaneous abortion in 57.2%, and ectopic pregnancy in 5.1%. Infertility was reported by 44.1% of survey respondents. Normal menstrual cycles were reported by only 32.8% with intermenstrual bleeding occurring in 18.6%. Heavy menstrual bleeding was reported by 32.9% survey participants. Gynecologic pain reported included dysmenorrhea by 92.5% and dyspareunia by 77.0%.

CONCLUSION: There is a much greater prevalence of obstetric and gynecologic issues reported by women with Ehlers-Danlos syndrome than in the general population. Additionally, rates differed significantly among the three most common types of Ehlers-Danlos syndrome with vascular type having the highest rates of adverse pregnancy outcomes and menstrual abnormalities. Physician providers should be aware of these challenges and should counsel patients with Ehlers-Danlos syndrome about relevant options and risks.

LEVEL OF EVIDENCE: III

Women with Ehlers-Danlos syndrome have a much greater prevalence of obstetric and gynecologic issues than do women in the general population.

Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, and Dickson Advanced Analytics, Carolinas Medical Center, Charlotte, North Carolina.

Corresponding author: Kathryn S. Merriam, Medical Student, Carolinas Medical Center, Department of Obstetrics and Gynecology, 1025 Morehead Medical Drive, Suite 500, Charlotte, NC 28204; e-mail: kathryn_merriam@med.unc.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.