Racial Disparities in Severe Maternal Morbidity Among Patients with Polycystic Ovarian Syndrome

Abstract

Objective:

To evaluate the association between race and severe maternal morbidity (SMM) in delivery hospitalizations with polycystic ovarian syndrome (PCOS).

Design:

Retrospective cross-sectional study using the Nationwide Inpatient Sample (Q4 2015–2019). SMM was defined by the CDC algorithm of 21 ICD-10 indicators. Multivariable logistic regression assessed associations between race and SMM, adjusting for demographics, insurance, hospital type, obesity, hypertension, and diabetes.

Subjects:

Delivery hospitalizations with PCOS (ICD-10 E28.2).

Results:

Of 3.1 million deliveries, 19,962 (0.64%) had PCOS; 444 (2.22%) experienced SMM. Patients were predominantly White (66.7%) and <35 years (76.9%). Common comorbidities included obesity (30.2%), hypertension (9.5%), and diabetes (5.1%). Unadjusted analyses showed the highest SMM among Black (3.4%), Native American/Other (3.0%), and Asian/Pacific Islander (2.7%) patients. SMM was also more common among those ≥35 years, with public insurance, and at urban teaching hospitals. In adjusted models, Native American/Other (adjusted odds ratio [AOR] 1.44, 95% confidence interval [CI] 1.07–1.92), Black (AOR 1.42, 95% CI 1.11–1.81), and Asian/Pacific Islander (AOR 1.40, 95% CI 1.07–1.83) patients had significantly higher odds of SMM compared with White patients. Additional predictors included age ≥35 years (AOR 1.54, 95% CI 1.31–1.80), obesity (AOR 1.19, 95% CI 1.01–1.39), hypertension (AOR 1.65, 95% CI 1.32–2.04), and public insurance (AOR 1.35, 95% CI 1.14–1.60). Urban nonteaching hospitals (AOR 0.63, 95% CI 0.50–0.79) and Midwest hospital region (AOR 0.76, 95% CI 0.62–0.93) were associated with reduced odds of SMM.

Conclusion:

Racial disparities in SMM persisted among patients with PCOS despite adjustment for comorbidities and hospital factors. Race-conscious prenatal care and structural interventions are needed to reduce inequities.