Optimal Time Interval from Myomectomy for Better Pregnancy Outcomes

A time interval from myomectomy to pregnancy of 6 to 11 months is associated with lower risks of gestational hypertensive disorders and neonatal death compared to both shorter (<6 months) and longer (≥12 months) intervals, particularly for women aged 35 years and older. These findings were published in The International Journal of Gynecology & Obstetrics.¹

A retrospective population-based cohort study was conducted between 2008 and 2017, utilizing data from the National Health Insurance Research Database and the Taiwan Maternal and Child Health Database. The study included a total of 2,024,379 births from 1,391,856 pregnancies. Eligible cases were found through diagnostic and procedure codes, resulting in the identification of 4,006 first singleton births among 4,006 women following their first laparotomic myomectomy. The risks of pregnancy and obstetric outcomes were assessed based on the time interval from myomectomy to pregnancy, categorized as <6 months, 6–11 months, and ≥12 months. Subgroup analyses were conducted by further stratifying the cohort according to maternal age at birth (18–34 years vs. ≥35 years).

This study attempted to decipher the associations between the time interval from myomectomy to pregnancy (TIMP) and pregnancy outcomes such as uterine rupture, preterm delivery, or miscarriage. It also sought to examine whether younger or older maternal age influences how TIMP impacts outcomes.

The study observed that a shorter time interval from myomectomy to pregnancy (TIMP) of <6 months was associated with significantly higher risks of gestational hypertensive disorders and neonatal deaths. The risk of gestational hypertensive disorders was nearly doubled with adjusted odds ratio (aOR) of 1.97. The risk of neonatal deaths increased 4.5 times with aOR of 4.59. Showing a similar trend, a TIMP of ≥12 months was linked to an increased risk of gestational hypertensive disorders (aOR 1.72) and neonatal death (aOR 3.27) compared to a TIMP of 6–11 months.

Subgroup analysis revealed that women aged 35 years and older continued to face higher risks of gestational hypertensive disorders when the TIMP was <6 months (aOR 2.26) or ≥12 months (aOR 2.04). These women also had a higher risk of neonatal death when the TIMP was <6 months (aOR 4.05). Conversely, women aged 18–34 years did not show these associations.

The study concluded that a TIMP of 6–11 months appears optimal, particularly for women over 35 years, to reduce adverse pregnancy outcomes like hypertensive disorders and neonatal death.

Reference

1.   Wen-Hsin Chen, et al. Associations between the time interval from myomectomy to subsequent pregnancy and the obstetric outcomes: A population-based cohort study. Int J Gynaecol Obstet. 2024 Nov;167(2):631-640.  doi: 10.1002/ijgo.15610.