The Role of Ethnicity and Polycystic Ovary Syndrome on Pregnancy Complications. An Analysis of a Population Database.

Abstract

Objective: To determine the independent effect of ethnicity on obstetrical outcomes in women with polycystic ovary syndrome (PCOS).

Design: This was a retrospective, population-based cohort study utilizing data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) from 2004 to 2014. Women with PCOS were identified using ICD-9-CM codes. Pregnancy, delivery, and neonatal outcomes were compared across ethnic groups. Chi-square tests assessed baseline characteristics, and logistic regression was used to evaluate associations between ethnicity and outcomes, estimating odds ratios (ORs) and 95% confidence intervals (CIs).

Subjects: A total of 12,782 pregnant women with PCOS were identified between 2004 and 2014, categorized by ethnicity: Caucasian (n=9,107), African American (n=1,098), Hispanic (n=1,288), and Asian (n=741).

Exposure: The exposure of interest was maternal ethnicity and its association with pregnancy, delivery, and neonatal outcomes among women with PCOS.

Main outcomes: Pregnancy, delivery, and neonatal complications were assessed across ethnic groups.

Results: Asian women had a higher odds of having gestational diabetes (aOR1.96,95%CI 1.49-2.58,p<0.001), chorioamnionitis (aOR3.41, 95%CI 2.12-5.47,p<0.0001), operative vaginal delivery (aOR2.42, 95%CI 1.65-3.56,p<0.001), postpartum hemorrhage (aOR2.07,95%CI 1.25-3.43,p=0.004) and maternal infection (aOR2.84,95%CI 1.80-4.49,p<0.001). African Americans had a higher risk of pregnancy-induced hypertension (aOR1.38,95% CI 1.06-1.80,p=0.02), preeclampsia (aOR1.68,95% CI 1.15-2.45,p=0.007), preterm premature rupture of membrane (aOR2.75,95%CI 1.58-4.78,p<0.001), chorioamnionitis (aOR1.83 95%CI 1.12-2.98,p=0.016) and cesarean sections (aOR1.69,95%CI 1.32-2.15,p<0.001) and lower risk of operative vaginal delivery (aOR0.53,95%CI 0.31-0.93,p=0.03), spontaneous vaginal delivery (aOR0.67,95%CI 0.52-0.85,p<0.001), and maternal infection (aOR1.91,95%CI 1.21-3.00,p=0.005). The risk of gestational diabetes (aOR1.36,95%CI 1.06-1.73,p<0.014) and postpartum hemorrhage (aOR1.58,95%CI 1.01-2.47,p=0.045) was increased among Hispanic patients. Caucasian patients were at lower risk of gestational diabetes (aOR0.67,95%CI 0.57-0.79,p<0.0001), chorioamnionitis (aOR0.39,95%CI 0.28-0.55,p<0.0001), cesarean section (aOR0.83,95%CI 0.73-0.95,p<0.008), postpartum hemorrhage (aOR0.70,95% CI0.50-0.98,p<0.035), blood transfusion (aOR0.49,95%CI 0.29-0.83,p<0.007), maternal infection (aOR0.34,95% CI 0.27-0.51,p<0.0001) and small for gestational age infants (aOR0.64,95%CI 0.44-0.93,p<0.018), and had higher odds of having a spontaneous vaginal delivery (aOR1.25,95% CI1.10-1.43,p<0.001).

Conclusions: Among women with PCOS, African Americans are at the greatest's number of increased pregnancy complications, followed by Asians and then Hispanics. Caucasians with PCOS have the lowest risk of pregnancy complications.