Ectopic pregnancy: perinatal outcomes of future gestations and long-term neurological morbidity of the offspring



To evaluate perinatal outcomes and long-term neurological morbidity of offspring to mothers with a history of ectopic pregnancy.


In this retrospective study, perinatal outcomes and long-term neurological morbidity of offspring were assessed among mothers with a history of ectopic pregnancy, either medically or surgically treated. The study groups were followed until 18 years of age for neurological-related morbidity. For perinatal outcomes, generalized estimated equation (GEE) models were used to control for confounders. A Kaplan–Meier survival curve was used to compare cumulative neurological morbidity incidence and Cox proportional hazards model was conducted to control for confounders.


A total of 243,682 mothers were included; 1424 mothers (0.58%) had a previous ectopic pregnancy, of which 25.6% (n = 365) were treated medically, and 74.3% (n = 1059) were treated surgically. Using GEE models, controlling for confounders, both surgically and medically treated ectopic pregnancies were noted as independent risk factors for preterm delivery in the subsequent pregnancies. Maternal history of surgically treated ectopic pregnancy was also independently associated with cesarean delivery. Offspring to mothers with previous ectopic pregnancy had comparable rates of long-term neurological morbidity. In the Cox proportional hazards model, controlling for confounders, being born to a mother with a history of previous ectopic pregnancy was not found to be independently associated with long-term neurological morbidity of offspring.


Maternal history of ectopic pregnancy is independently associated with preterm delivery. However, offspring of mothers with a history of ectopic pregnancy are not at an increased risk for long-term neurological morbidity.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. 1.

    Creanga AA, Shapiro-Mendoza CK, Bish CL et al (2011) Trends in ectopic pregnancy mortality in the United States. Obstet Gynecol 117:837–843

    Article  Google Scholar 

  2. 2.

    Abramowicz JS, Sheiner E (2008) Ultrasound of the placenta: a systematic approach. Part I: Imaging. Placenta 29:225–240

    CAS  Article  Google Scholar 

  3. 3.

    Bouyer J (2002) Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod 17:3224–3230

    CAS  Article  Google Scholar 

  4. 4.

    Chow WH, Daling JR, Cates W, Greenberg RS (1987) Epidemiology of ectopic pregnancy. Epidemiol Rev 9:70–94

    CAS  Article  Google Scholar 

  5. 5.

    Wiznitzer A, Sheiner E (2008) Ectopic and heterotopic pregnancies. Clinical obstetrics. The fetus & mother, 3rd edn. Wiley, Oxford, pp 161–176

    Google Scholar 

  6. 6.

    Karande VC, Flood JT, Heard N et al (1991) Analysis of ectopic pregnancies resulting from in-vitro fertilization and embryo transfer. Hum Reprod 6:446–449

    CAS  Article  Google Scholar 

  7. 7.

    Kårhus LL, Egerup P, Skovlund CW, Lidegaard O (2013) Long-term reproductive outcomes in women whose first pregnancy is ectopic: a national controlled follow-up study. Hum Reprod 28:241–246

    Article  Google Scholar 

  8. 8.

    Egerup P, Skovlund CW, Lidegaard Ø (2014) Improving reproductive long-term prognosis for women with a first ectopic pregnancy. A national controlled follow-up study. Acta Obstet Gynecol Scand 93:490–496

    Article  Google Scholar 

  9. 9.

    Walker JJ (2007) Ectopic pregnancy. Clin Obstet Gynecol 50:89–99

    Article  Google Scholar 

  10. 10.

    Bhattacharya S, McLernon DJ, Lee AJ, Bhattacharya S (2012) Reproductive outcomes following ectopic pregnancy: register-based retrospective cohort study. PLoS Med 9:16

    Article  Google Scholar 

  11. 11.

    Hoyos LR, Vilchez G, Allsworth JE et al (2018) Outcomes in subsequent pregnancies after wedge resection for interstitial ectopic pregnancy: a retrospective cohort study. J Matern Neonatal Med 32:2354–2360

    Article  Google Scholar 

  12. 12.

    Chouinard M, Mayrand MH, Ayoub A et al (2019) Ectopic pregnancy and outcomes of future intrauterine pregnancy. Fertil Steril 112:112–119

    Article  Google Scholar 

  13. 13.

    Trønnes H, Wilcox AJ, Lie RT et al (2014) Risk of cerebral palsy in relation to pregnancy disorders and preterm birth: a national cohort study. Dev Med Child Neurol 56:779–785

    Article  Google Scholar 

  14. 14.

    Prue Morgan JLM (2018) Cerebral palsy. Handb Clin Neurol 159:323–336

    Article  Google Scholar 

  15. 15.

    Gulati S, Sondhi V (2018) Cerebral palsy: an overview. Indian J Pediatr 85:1006–1016

    Article  Google Scholar 

  16. 16.

    Vannuccini S, Clifton VL, Fraser IS et al (2016) Infertility and reproductive disorders: impact of hormonal and inflammatory mechanisms on pregnancy outcome. Hum Reprod Update 22:104–115

    CAS  Article  Google Scholar 

  17. 17.

    Qin J, Liu X, Sheng X et al (2016) Assisted reproductive technology and the risk of pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies: a meta-analysis of cohort studies. Fertil Steril 105:73-85.e6

    Article  Google Scholar 

  18. 18.

    Strandell A, Thorburn J, Hamberger L (1999) Risk factors for ectopic pregnancy in assisted reproduction. Fertil Steril 71:282–286

    CAS  Article  Google Scholar 

  19. 19.

    Li C, Meng CX, Zhao WH et al (2014) Risk factors for ectopic pregnancy in women with planned pregnancy: a case-control study. Eur J Obstet Gynecol Reprod Biol 181:176–182

    Article  Google Scholar 

  20. 20.

    Moodley P, Sturm AW (2000) Sexually transmitted infections, adverse pregnancy outcome and neonatal infection. Semin Neonatol 5:255–269

    CAS  Article  Google Scholar 

  21. 21.

    Goldenberg RL, Culhane JF, Iams JD, Romero R (2008) Epidemiology and causes of preterm birth. Lancet 371:75–84

    Article  Google Scholar 

  22. 22.

    Marion LL, Meeks GR (2012) Ectopic pregnancy: History, incidence, epidemiology, and risk factors. Clin Obstet Gynecol 55:376–386

    Article  Google Scholar 

  23. 23.

    Chen I, Lalani S, Xie R et al (2018) Association between surgically diagnosed endometriosis and adverse pregnancy outcomes. Fertil Steril 109:142–147

    Article  Google Scholar 

  24. 24.

    Raju TNK, Buist AS, Blaisdell CJ et al (2017) Adults born preterm: a review of general health and system-specific outcomes. Acta Paediatr 106:1409–1437

    Article  Google Scholar 

  25. 25.

    Chang E (2015) Preterm birth and the role of neuroprotection. BMJ 350:g6661

    Article  Google Scholar 

  26. 26.

    Cnattingius S (2004) The epidemiology of smoking during pregnancy: smoking prevalence, maternal characteristics, and pregnancy outcomes. Nicotine Tob Res 6:S125–S140

    Article  Google Scholar 

  27. 27.

    Graham HK, Rosenbaum P, Paneth N et al (2016) Cerebral palsy. Nat Rev Dis Prim 2:15082

    Article  Google Scholar 

Download references


This study was conducted as part of the requirements for MD degree from the Goldman Medical School at the Faculty of Health Sciences, Ben-Gurion University of the Negev.

Author information




Ms. MR: Writing original draft, visualization; Dr. TW: Data analysis, conceptualization, development or design of methodology, validation, writing review and editing; Prof. ES: Conceptualization, writing review and editing, supervision; Mr. TL: Writing review and editing; Dr. GP: Conceptualization, writing review and editing, supervision.

Corresponding author

Correspondence to Eyal Sheiner.

Ethics declarations

Conflict of interest

The authors report no conflict of interest.

Ethics approval

The study was performed following the ethical standards of the 1964 declaration of Helsinki and its later amendments and approved by the Institutional Review Board Committee of SUMC (IRB number SOR-18-0383).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Roitman, M.S., Wainstock, T., Sheiner, E. et al. Ectopic pregnancy: perinatal outcomes of future gestations and long-term neurological morbidity of the offspring. Arch Gynecol Obstet (2021).

Download citation


  • Cerebral palsy
  • Ectopic pregnancy
  • Neurological morbidity
  • Pregnancy outcomes
  • Preterm birth
  • Subsequent pregnancy