The effect of socioeconomic status on adverse obstetric and perinatal outcomes in women with polycystic ovary syndrome—An evaluation of a population database

Abstract

ObjectiveTo evaluate the modifying effect of low socioeconomic status (SES) on polycystic ovary syndrome (PCOS) women's pregnancy and neonatal complications.MethodsA retrospective population‐based cohort study including all women with an ICD‐9 diagnosis of PCOS in the US between 2004 and 2014, who delivered in the third trimester or had a maternal death. SES was defined according to the total annual family income quartile for the entire population studied. We compared women in the lowest income quartile (<$39 000 annually) to those in the higher income quartiles combined (≥$39 000 annually). Pregnancy, delivery, and neonatal outcomes were compared between the two groups.ResultsOverall, 9 096 788 women delivered between 2004 and 2014, of which 12 322 had a PCOS diagnosis and evidence of SES classification. Of these, 2117 (17.2%) were in the lowest SES group, and 10 205 (82.8%) were in the higher SES group. PCOS patients in the lowest SES group, compared to the higher SES group, were more likely to be younger, obese (body mass index ≥30 kg/m2), to have smoked tobacco during pregnancy, and to have chronic hypertension and pregestational diabetes mellitus (DM) (P < 0.05). In a multivariate logistic regression, women in the lowest SES group, compared to the higher SES group, had increased odds of pregnancy‐induced hypertension (aOR 1.27, 95% CI: 1.12–1.46, P < 0.001), pre‐eclampsia (aOR 1.37, 95% CI: 1.14–1.65, P < 0.001), and cesarean delivery (aOR 1.21, 95% CI: 1.09–1.34, P < 0.001), with other comparable pregnancy, delivery and neonatal outcomes.ConclusionIn PCOS patients, low SES increases the risk for pregnancy‐induced hypertension, pre‐eclampsia and CD, highlighting the importance of diligent pregnancy follow‐up and pre‐eclampsia prevention in these patients.