Postpartum complications increased in women with polycystic ovary syndrome

• Published in: American journal of obstetrics and gynecology 2021-03, Vol.224 (3), p.280.e1-280.e13
• Main Authors: Alur-Gupta, Snigdha, Boland, Mary Regina, Barnhart, Kurt T., Sammel, Mary D., Dokras, Anuja
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; cardiomyopathy; cardiovascular; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; claims database; Cohort Studies; depression; Depression - epidemiology; Depression - etiology; Depression, Postpartum - epidemiology; Depression, Postpartum - etiology; Female; fourth trimester; Humans; hypertension; Middle Aged; Optum; PCOS; Polycystic Ovary Syndrome - complications; postpartum; preeclampsia; Pregnancy; Pregnancy Complications - epidemiology; Pregnancy Complications - etiology; Puerperal Disorders - epidemiology; Puerperal Disorders - etiology; Retrospective Studies; Risk Assessment; Young Adult
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2020.08.048

Women with polycystic ovary syndrome are at a higher risk of cardiometabolic and psychiatric comorbidities and preconception and antepartum complications, but the impact of polycystic ovary syndrome during the postpartum period is unknown. This study aimed to investigate the risk of postpartum cardiovascular disease complications and perinatal and postpartum depression. This was a retrospective cohort study conducted using a United States insurance claims database. Women with and without polycystic ovary syndrome aged 18 to 50 years enrolled continuously in a single health plan during the preconception, antepartum, and postpartum periods between 2000 and 2016 were included. The primary outcome was postpartum cardiovascular disease and depression (perinatal and postpartum). Multivariable logistic regression was used to adjust for covariates including age, geographic location, preterm delivery, assisted reproductive technology use, multiple births, prepregnancy depression, prepregnancy diabetes, prepregnancy hypertension, gestational diabetes, gestational hypertension, obesity, history of hyperlipidemia, smoking, and race. We identified 42,391 unique women with polycystic ovary syndrome and 795,480 women without polycystic ovary syndrome. In multivariable models, women with polycystic ovary syndrome had significantly higher odds of cardiovascular disease complications, including postpartum preeclampsia (adjusted odds ratio, 1.30; 95% confidence interval, 1.17–1.45), eclampsia (adjusted odds ratio, 1.45; 95% confidence interval, 1.14–1.86) cardiomyopathy (adjusted odds ratio, 1.26; 95% confidence interval, 1.03–1.54), hypertensive heart disease (adjusted odds ratio, 1.32: 95% confidence interval, 1.07–1.64), thrombotic disease (adjusted odds ratio, 1.50; 95% confidence interval, 1.20–1.87), congestive heart failure (adjusted odds ratio, 1.35; 95% confidence interval, 1.13–1.61), and cerebrovascular accidents (adjusted odds ratio, 1.21; 95% confidence interval, 1.14–1.29), than those without polycystic ovary syndrome, as well as both perinatal (adjusted odds ratio, 1.27; 95% confidence interval, 1.22–1.33) and postpartum depression (adjusted odds ratio, 1.46; 95% confidence interval, 1.36–1.57). Nonobese women with polycystic ovary syndrome had higher odds of postpartum eclampsia (adjusted odds ratio 1.72; 95% confidence interval, 1.31–2.26), peripartum cardiomyopathy (adjusted odds ratio, 1.43; 95% confidence interval, 1.14–1.79), and cerebrovascular accident