Women with PCOS at Increased Risk of Cardiovascular Complications During Pregnancy

A new study led by investigators at Johns Hopkins University School of Medicine is providing clinicians with a comprehensive overview of trends, predictors, and outcomes of cardiovascular complications among women with polycystic ovary syndrome (PCOS).

Results of the study, which leveraged data from the National Inpatient Sample from 2002-2019, detail prominent trends in cardiovascular disease among women with PCOS during delivery hospitalizations in the US, suggesting PCOS was an independent predictor of increased risk of multiple complications, including preeclampsia, eclampsia, peripartum cardiomyopathy, and heart failure compared to their counterparts without PCOS.

“Oftentimes, women with PCOS are understandably concerned about the immediate effects, like an irregular menstrual cycle, excess body hair, weight gain and acne. However, the long-term cardiovascular complications are also a serious problem,” said study investigator Erin Michos, MD, associate professor of medicine at the Johns Hopkins University School of Medicine, in a statement from Johns Hopkins Medicine.

Despite being the most common endocrine disorder impacting women of childbearing age, PCOS represents an often-overlooked aspect of women’s health in modern medicine. With this in mind, investigators sought to provide clinicians with an overview of current trends, outcomes, and predictors of cardiovascular complications among women with PCOS diagnosis during delivery hospitalizations in the US. To do so, investigators designed their study as a retrospective analysis of data from the National Inpatient Sample (NIS) in the cycles occurring from 2002-2019. Using ICD-9 and ICD-19 codes, investigators identified 73,385,669 weighted hospitalizations.

After exclusion of those aged less than 18 years, the overall study cohort included 71,436,308 weight hospitalizations for inclusion in their analyses. Of these, 195,675 had a diagnosis of PCOS. Compared to women without PCOS, women with PCOS had a greater median age (28 [24-32] vs 31 [27-34] years; P <.01), were more likely to be White race (62.1% vs 44.7%), and less likely to be Black race (8.4% vs 12%) or Hispanic ethnicity (10.5% vs 18.8%) adults. Investigators also noted multiple comorbidities were more frequent in women with PCOS, including diabetes (13.8% vs 1.7%), obesity (21.4% vs 3.6%), and dyslipidemia (2.2% vs 0.1%) (P for all<.01).

The primary outcomes of interest for the analyses were preeclampsia, peripartum cardiomyopathy, and heart failure. Secondary outcomes of interested included eclampsia, acute coronary syndrome, ischemic and hemorrhagic stroke, pulmonary edema, cardiac arrhythmias, acute kidney injury, venous thromboembolism, length of stay, and cost of hospitalization. Investigators pointed out that associated procedures and complications were identified through ICD-9 and ICD-10 codes.

Initial analysis indicated the overall prevalence of PCOS increased during the study period, from 569 per 100,000 deliveries in 2002 to 15,349 per 100,000 deliveries in 2019. Investigates also pointed out the prevalence of obesity delivery hospitalizations for women with PCOS increased from 5.7% in 2002 to 28.2% in 2019 (P <.01). Further analysis demonstrated patients with PCOS had a greater incidence of cardiovascular complications compared to their counterparts without PCOS during delivery hospitalizations. Specifically, those with PCOS had greater rates of preeclampsia (10,255 vs 4353 per 100,000 deliveries; P <.01), peripartum cardiomyopathy (81 vs 30 per 100,000 deliveries; P <.01) and heart failure (103 vs 44 per 100,000 deliveries; P <.01).

In analyses adjusted for age, race and ethnicity, comorbidities, insurance, and income, results indicated those with PCOS had a greater risk for developing preeclampsia (aOR, 1.56 [95% CI, 1.54-1.59]; P <.01), eclampsia (aOR, 1.58 [95% CI, 1.47-1.71]; P <.01), peripartum cardiomyopathy (aOR, 1.79 [95% CI, 1.49-2.13]; P <.01), pulmonary edema (aOR, 1.41 [95% CI, 1.23-1.62]; P <.01), acute kidney injury (aOR, 1.41 [95% CI, 1.22-1.61]; P <.01), and venous thromboembolism (aOR, 1.82 [95% CI, 1.57-2.12]; P <.01) during delivery hospitalizations than women without PCOS. Investigators noted the observed increase in odds of acute coronary syndrome and stroke among women with PCOS was not statistically significant compared to those without PCOS.

Additionally, in analyses further adjusted for preeclampsia and eclampsia, results suggested PCOS was independently associated with increased odds of peripartum cardiomyopathy, heart failure, pulmonary edema, acute kidney injury, cardiac arrhythmia, and venous thromboembolism. Further analysis into predictors of negative outcomes suggested, for women with PCOS, being greater than 35 years of age, being of Black race, and having diabetes, dyslipidemia, chronic hypertension, or obesity were considered independent predicts of preeclampsia.

“Our study shows that PCOS is indeed a risk factor for acute cardiac complications at the time of delivery and should be taken seriously,” said lead investigator Salman Zahid, MD, a resident physician in the Rochester General Hospital Internal Medicine Residency program, in the aforementioned statement. “We want to stress the importance of optimizing the cardiovascular health of women with PCOS with prevention efforts, especially Black women and lower socioeconomic groups because we believe that those are the most vulnerable populations and will benefit most from intervention.”

This study, “Trends, Predictors, and Outcomes of Cardiovascular Complications Associated With Polycystic Ovary Syndrome During Delivery Hospitalizations: A National Inpatient Sample Analysis (2002–2019),” was published in the Journal of the American Heart Association.