{"paper_id":"34746791-fd64-467d-ba3e-4eeee20754e5","body_text":"Abstract\nPurpose\nPCOS and endometriosis are independent risk factors for perinatal outcomes. Little research has evaluated the concomitant effects of these conditions, nor have studies been conducted on a population database. We sought to identify the pregnancy, delivery, and neonatal outcomes in women with polycystic ovary syndrome (PCOS) and endometriosis vs. PCOS without endometriosis.\nMethods\nA retrospective population-based cohort study was performed extracting data using ICD-9 codes from the HCUP-NIS Database from 2004 to 2014. Endometriosis in women with PCOS represented the study group (n = 163), and the remaining PCOS, non-endometriosis patients constituted the reference group (n = 14,719). Subjects were included once per delivery. Demographics were compared using chi-squared tests. Confounding effects in pregnancy outcomes were controlled using binary logistic regression analysis.\nResults\nConcomitant endometriosis and PCOS patients were more likely to be white (88.5% vs.71.0%, p < 0.001), with BMI < 30 kg/m2 (87.1% vs.77.8%, p < 0.004) and from lower income quartiles (27.1% vs.17.1%, p < 0.017) when compared to PCOS without endometriosis. Comparing pregnancy complication rates, placental abruption (p < 0.018, aOR 3.01, 95% CI 1.21–7.50), Cesarean section (p < 0.003, aOR 1.75, 95% CI 1.21–2.53), deep venous thromboses (p < 0.002, aOR 74.31, 95% CI 4.57–1209.21), and venous thromboembolic events (p < 0.031, aOR 10.40, 95% CI 1.24–87.37), were increased in the study group compared to the reference group.\nConclusion\nWomen with PCOS and endometriosis were more likely to be white, of lower socioeconomic status, lean, and experience abruptio-placenta, cesarean deliveries, and venous thromboembolisms. Since little was previously known about the combined outcomes of PCOS and endometriosis, it is difficult to counsel patients on risks. Our findings can help clinicians manage pregnant PCOS patients with endometriosis to minimize complications such as abruptio placenta and VTE.\nSimilar content being viewed by others\nData availability\nThe HCUP data are publicly available.\nReferences\nLalani S et al (2018) Endometriosis and adverse maternal, fetal and neonatal outcomes, a systematic review and meta-analysis. Hum Reprod 33(10):1854–1865\nLiu X, Zhang J, Wang S (2024) Global, regional, and national burden of infertility attributable to PCOS, 1990–2019. Hum Reprod 39(1):108–118\nSchliep KC et al (2023) Examining the co-occurrence of endometriosis and polycystic ovarian syndrome. AJOG Glob Rep 3(3):100259\nParasar P, Ozcan P, Terry KL (2017) Endometriosis: epidemiology, diagnosis and clinical management. Curr Obstet Gynecol Rep 6(1):34–41\nAbu-Zaid A et al (2024) Association between endometriosis and obstetric complications: insight from the national Inpatient Sample. Eur J Obstet Gynecol Reprod Biol 292:58–62\nChrist JP, Cedars MI (2023) Current guidelines for diagnosing PCOS. Diagnostics (Basel) 13(6):1113\nMyers SH et al (2024) PCOS phenotype focus: phenotype D under the magnifying glass. Arch Gynecol Obstet 309(6):2307–2313\nFarland LV et al (2022) Polycystic ovary syndrome and risk of adverse pregnancy outcomes: a registry linkage study from Massachusetts. Hum Reprod 37(11):2690–2699\nMills G et al (2020) Associations between polycystic ovary syndrome and adverse obstetric and neonatal outcomes: a population study of million births. Hum Reprod 35(8):1914–1921\nPalomba S et al (2015) Pregnancy complications in women with polycystic ovary syndrome. Hum Reprod Update 21(5):575–592\nDinsdale NL, Crespi BJ (2021) Endometriosis and polycystic ovary syndrome are diametric disorders. Evol Appl 14(7):1693–1715\nFranks S, Stark J, Hardy K (2008) Follicle dynamics and anovulation in polycystic ovary syndrome. Hum Reprod Update 14(4):367–378\nSalmeri N et al (2024) The kisspeptin system in and beyond reproduction: exploring intricate pathways and potential links between endometriosis and polycystic ovary syndrome. Rev Endocr Metab Disord 25(2):239–257\nZheng L et al (2023) Obesity and its impact on female reproductive health: unraveling the connections. Front Endocrinol (Lausanne) 14:1326546\nFerreira LZ et al (2024) A composite index; socioeconomic deprivation and coverage of reproductive and maternal health interventions. Bull World Health Organ 102(2):105–116\nHager M et al (2019) The prevalence of incidental endometriosis in women undergoing laparoscopic ovarian drilling for clomiphene-resistant polycystic ovary syndrome: a retrospective cohort study and meta-analysis. J Clin Med 8(8):1210\nTissot M et al (2017) Clinical presentation of endometriosis identified at interval laparoscopic tubal sterilization: prospective series of 465 cases. J Gynecol Obstet Hum Reprod 46(8):647–650\nRawson JM (1991) Prevalence of endometriosis in asymptomatic women. J Reprod Med 36(7):513–515\nWHO. Endometriosis. 24 March 2023 27 May 2024.\nFarland LV et al (2017) Associations among body size across the life course, adult height and endometriosis. Hum Reprod 32(8):1732–1742\nHolschbach V et al (2023) Patient- and cycle-specific factors affecting the outcome of frozen-thawed embryo transfers. Arch Gynecol Obstet 307(6):2001–2010\nKoster MP et al (2015) Placental characteristics in women with polycystic ovary syndrome. Hum Reprod 30(12):2829–2837\nLaschke MW, Menger MD (2018) Basic mechanisms of vascularization in endometriosis and their clinical implications. Hum Reprod Update 24(2):207–224\nSzydelko-Gorzkowicz M et al (2022) The role of kisspeptin in the pathogenesis of pregnancy complications: a narrative review. Int J Mol Sci 23(12):6611\nHe Y et al (2016) Administration of atosiban in patients with endometriosis undergoing frozen-thawed embryo transfer: a prospective, randomized study. Fertil Steril 106(2):416–422\nLeyendecker G et al (2004) Uterine peristaltic activity and the development of endometriosis. Ann N Y Acad Sci 1034:338–355\nJahromi BN et al (2018) Assessment of oxytocin level, glucose metabolism components and cutoff values for oxytocin and anti-mullerian hormone in infertile PCOS women. Taiwan J Obstet Gynecol 57(4):555–559\nMaggiore LR, U. et al (2016) A systematic review on endometriosis during pregnancy: diagnosis, misdiagnosis, complications and outcomes. Hum Reprod Update 22(1):70–103\nTai W, Hu L, Wen J (2022) Maternal and neonatal outcomes after assisted reproductive technology: a retrospective cohort study in China. Front Med (Lausanne) 9:837762\nMills G et al (2020) Polycystic ovary syndrome as an independent risk factor for gestational diabetes and hypertensive disorders of pregnancy: a population-based study on 9.1 million pregnancies. Hum Reprod 35(7):1666–1674\nRandeva HS et al (2012) Cardiometabolic aspects of the polycystic ovary syndrome. Endocr Rev 33(5):812–841\nDing D et al (2015) Platelets are an unindicted culprit in the development of endometriosis: clinical and experimental evidence. Hum Reprod 30(4):812–832\nMu F et al (2017) Association between endometriosis and hypercholesterolemia or hypertension. Hypertension 70(1):59–65\nBahriKhomami M et al (2019) Increased maternal pregnancy complications in polycystic ovary syndrome appear to be independent of obesity—a systematic review, meta-analysis, and meta-regression. Obes Rev 20(5):659–674\nChrist JP et al (2019) Pre-conception characteristics predict obstetrical and neonatal outcomes in women with polycystic ovary syndrome. J Clin Endocrinol Metab 104(3):809–818\nMoore JE, Witt WP, Elixhauser A (2006) Complicating Conditions Associated With Childbirth, by Delivery Method and Payer, 2011, in Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Agency for Healthcare Research and Quality (US), Rockville\nFunding\nThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\nAuthor information\nAuthors and Affiliations\nContributions\nS Ismail: project development, data analysis, manuscript writing and editing. C Majdell: manuscript writing and editing. A Badgheish: data collection, management, and analysis. H Baghlaf: data collection and management. M Dahan: manuscript editing, project development, acted as the senior author for this study.\nCorresponding author\nEthics declarations\nConflict of interest\nThe authors have no relevant financial or non-financial interests to disclose.\nEthical approval\nNot applicable.\nConsent to participate\nInformed consent was obtained from all individual participants included in the study.\nConsent to publish\nNot applicable.\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nRights and permissions\nSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.\nAbout this article\nCite this article\nIsmail, S., Majdell, C., Badgheish, A. et al. Pregnancy, delivery, and neonatal outcomes among women with PCOS and endometriosis: a population database cohort. Arch Gynecol Obstet 310, 1235–1243 (2024). https://doi.org/10.1007/s00404-024-07589-w\nReceived:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00404-024-07589-w","source_license":"CC0","license_restricted":false}