Clinical implication
Several evidences suggest that endometriosis is associated with the risk
of several chronic diseases such as asthma, allergies, and coronary
heart disease (CHD). Although the aetiology of endometriosis remains
poorly understood, the levels of inflammation-related factors, such as
interleukin (IL)-1 and IL-6 and tumour necrosis factor (TNF)-alpha, have
been reported to increase in the peritoneal fluid and peripheral blood
of women with endometriosis.25,26 These reports
suggest that endometriosis is associated with local and systemic
inflammations. Because chronic inflammation plays key roles in the
pathogenesis of allergy-related conditions and CHD, endometriosis may
increase the risk of these conditions. Although endometriosis is related
to fertility and chronic diseases, clinical importance also focuses on
association with adverse obstetric outcomes. In a systematic review and
meta-analysis, Zullo et al. reported that women with endometriosis have
higher risk of several adverse obstetric complications such as
PTB.6 Using preliminary JECS dataset, Harada et al.
already reported that endometriosis significantly increased the
incidence of PTB-related condition such as preterm premature rupture of
the membrane.27 Pro-inflammatory cytokines, such as IL
and TNF, produce prostaglandin (PG) and matrix-degrading enzymes. PG
stimulates uterine contractions, whereas degradation of the
extracellular matrix leads to preterm rupture of fetal membranes,
resulting in PTB. Therefore, anti-inflammatory diet against
endometriosis, which is a pro-inflammatory condition, is thought to be
plausible for PTB prevention.
Recently, interest in
preconception health has been increasing,28 as
preconception is a crucial period for influencing not only pregnancy
outcomes but also the long-term health of the mother and her child.
Because endometriosis is a chronic
health condition, clinical management of women with endometriosis is
essential not only for short-term outcomes including successful
implantation and pregnancy, but also for promotion of long-term health.
The preconception period could be regarded as a ‘window of opportunity’
to promote maternal health because it represents a time when women are
most willing to abandon unhealthy habits.29 Until now,
preconception care for women with endometriosis was not adequately
discussed, considering the need to improve obstetric outcomes and future
health. Additionally, preconception diet counselling could assist in
providing the motivation to alter food-intake behaviour during
pregnancy,30preconception counselling to alter
usual diet habit for an anti-inflammatory diet could become a potential
management for women with endometriosis to reduce the risk of obstetric
complication and promote long-term health.