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

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

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.

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

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.

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.