(1003) Prenatal polycystic ovarian syndrome is associated with an increase in severe maternal morbidity

It has been well known that polycystic ovary syndrome (PCOS) is associated with adverse perinatal outcomes such as preeclampsia, preterm birth, gestational diabetes and low birth weight; however, association between PCOS and severe maternal morbidity (SMM) is not well studied. The objective of this study is to examine the association between PCOS and SMM.

Study Design:

This is a retrospective cohort study using California’s linked vital statistics- hospital discharge data (2008-2019). We included singletons, non-anomalous births with gestational age of 23-42 weeks. Outcome of interest was SMM, which was defined as the published list of ICD-9 and ICD-10 diagnoses and procedure codes, provided by Center for Disease Control and Prevention (CDC). As blood transfusion is known to be a major contributor to SMM, we classified non-transfusion SMM (ntSMM) by excluding blood transfusion from the composite score of SMM. Chi-square and multivariable logistic regression analyses were used for analyses.

Results: A total of 4,674,311 patients were included, of whom 14,274 (0.31%) had PCOS. Majority of patients with PCOS were non-Hispanic white (38.9% vs 26.5%; p< 0.001), with private insurance (82.5% vs 47.5%; p< 0.001) and gestational diabetes (23.2% vs 9.4%; p< 0.001). After adjusting for demographics, patients with PCOS had higher odds of SMM (aOR=1.61; 95% CI: 1.42, 1.83) and ntSMM (aOR=2.09 (1.74, 2.51). Among SMM indicators, we found higher odds of blood products transfusion (aOR=1.42 (1.22, 1.65), disseminated intravascular coagulation (DIC) (aOR=1.41 (1.04, 1.92), acute renal failure (ARF) (aOR=2.68; 95% CI: 1.90, 3.80), sepsis (aOR=1.87 (1.30, 2.68), eclampsia (aOR=2.06 (1.39, 3.04), hysterectomy (aOR= 1.68 (1.07, 2.64)), shock (aOR=1.97 (1.11, 3.49)) and pulmonary edema (aOR=2.33 (1.37, 3.96)).

Conclusion: Our study found higher odds of SMM in patients with PCOS. The clinicians should keep in mind these complications while treating patients with PCOS. These patients need additional care during pregnancy and parturition.