A Comparison of Pregnancy and Neonatal Outcomes in Women with the Hyperandrogenic Disorders Polycystic Ovary syndrome and Cushing’s Syndrome

Research Question: How does the risk for adverse obstetric outcomes differ among women with polycystic ovary syndrome (PCOS) and women with Cushing’s syndrome (CUS)? Design: A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS), 2004-2014. 14, 881 deliveries to women with PCOS and 134 deliveries to women with CUS were identified. Associations between PCOS, CUS, pregnancy, delivery, and neonatal outcomes were analyzed with multivariate logistic regression analysis. Results: At baseline, CUS was associated with a higher risk of chronic hypertension (P<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<0.001, aOR 2.63; 95% CI 1.81-3.83) in comparison to CUS. CUS increased the prevalence of operative vaginal delivery (P<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). Conclusion: PCOS increases the risk of gestational diabetes and cesarean section relative to CUS, whereas CUS increases the prevalence of operative vaginal delivery and blood transfusions.