P-601 Comparison of adverse obstetric outcomes in women with the hyperandrogenic syndromes, polycystic ovary syndrome and Cushing’s syndrome: an evaluation of a population database
Authors: Roper M , Badeghiesh A , Baghlaf H , Dahan M H 
Published: June 2023

Abstract

Study question
How does the risk for adverse obstetric outcomes differ among women with polycystic ovary syndrome (PCOS) and women with Cushing’s syndrome (CUS)?

Summary answer
PCOS increased the risk of gestational diabetes and cesarean section relative to CUS, whereas CUS increased the prevalence of operative vaginal delivery and blood transfusions.

What is known already
PCOS and CUS are hyperandrogenic disorders that have previously been associated with unique adverse obstetric outcomes. Despite there being similarities in the hyperandrogenism and insulin resistance of these disorders, there is a lack of knowledge when comparing their specific risks of pregnancy complications.

Study design, size, duration
A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS), was performed. A dataset of all deliveries between 2004 and 2014 inclusively, was created. 14 881 deliveries to women with PCOS and 134 deliveries to women with CUS were identified. The HCUP-NIS presents information on approximately 20% of admissions to US hospitals. Data was not continued into 2015 when ICD-10 codes were used, which are not comparable.

Participants/materials, setting, methods
Descriptive analyses were performed to compare the demographic features among both groups using chi-squared tests. Multivariate logistic regression analysis was performed to calculate unadjusted and adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CI). According to Tri-Council Policy statement (2018), IRB approval was not required, given data was anonymous and publicly available.

Main results and the role of chance
At baseline, CUS was associated with a higher risk of chronic hypertension (P &lt; 0.001), pregestational diabetes mellitus (P = 0.01), thyroid disease (P = 0.004), and higher rates of smoking during pregnancy (P = 0.02) whereas PCOS was associated with higher rates of obesity (P = 0.01). In terms of obstetric outcomes, PCOS increased the prevalence of gestational diabetes mellitus (P = 0.002, adjusted[a] OR 2.73; 95% CI 1.46 to 5.12), and cesarean section (P &lt; 0.001, aOR 2.63; 95% CI 1.81-3.83) in comparison to CUS. CUS increased the prevalence of operative vaginal delivery (P &lt; 0.001, aOR 0.10; 95% CI 0.06-0.14), and transfusion (P = 0.002, aOR 0.25; 95% CI 0.11-0.59) in comparison to deliveries to women with PCOS. No significant differences were found in terms of pregnancy-induced hypertension (P = 0.78), gestational hypertension (P = 0.86), preeclampsia (P = 0.25), preeclampsia or eclampsia superimposed on pre-existing hypertension (P = 0.13), premature rupture of membranes (P = 0.99), preterm delivery (P = 0.17), placental abruption (P = 0.82), chorioamnionitis (P = 0.16), spontaneous vaginal delivery (P = 0.35), postpartum hemorrhage (P = 0.29), and maternal infection (P = 0.11). In terms of neonatal outcomes, both deliveries to women with PCOS and women with CUS had similar outcomes for small for gestational age infants (P = 0.52), intrauterine fetal demise (P = 0.94), and congenital anomalies (P = 0.53).

Limitations, reasons for caution
The data within this retrospective cohort study relies on the accuracy of the individuals collecting the data. Data on medication use and compliance was unavailable.

Wider implications of the findings
Pregnant women with PCOS and CUS are at risk for certain specific obstetric complications, with most risks being similar. The magnitude of the insulin resistance in PCOS may be greater than in CUS due to the increased risk of gestational diabetes in PCOS when controlling for obesity and confounding effects.

Trial registration number
Not applicable