The aim of this study is to investigate potential differences in pregnancy, delivery, and neonatal outcomes between two hyperandrogenic conditions in reproductive-aged women; polycystic ovary syndrome (PCOS) and congenital adrenal hyperplasia (CAH). Retrospective population-based study with data from the Health Care Cost and Utilization Project-Nationwide Inpatient Sample database (HCUP-NIS) from 2004 to 2014. 14,881 women with polycystic ovary syndrome (PCOS) and 298 women with congenital adrenal hyperplasia (CAH). Gestational diabetes mellitus, placenta previa, pregnancy-induced hypertension, gestational hypertension, preeclampsia, eclampsia, preeclampsia and eclampsia superimposed on hypertension, preterm birth, preterm premature rupture of membrane, abruptio placenta, chorioamnionitis, mode of delivery, maternal infection, hysterectomy, blood transfusion, venous thromboembolism (deep vein thrombosis and pulmonary embolism during pregnancy, intrapartum, or postpartum), maternal death, chorioamnionitis, septicemia during labor, postpartum endometritis, septic pelvic, peritonitis, small for gestational age, congenital anomalies, intrauterine fetal demise. After adjusting for potential confounders we found that women with PCOS were at increased risk of developing pregnancy-induced hypertension (adjusted OR=1.76; 95% CI: 1.12-2.77; p=0.015) and gestational diabetes (adjusted OR=1.68; 95% CI: 1.12-2.52; p=0.012) when compared to women with CAH. Contrary women with CAH were at increased risk for delivery via cesarean section (adjusted OR 0.59; 95% CI: 0.44-0.80; p<0.001) and small for gestational age neonates (adjusted OR 0.32; 95% CI: 0.20-0.52; p<0.001). This study is the first to directly compare obstetrical and neonatal outcomes between patients with PCOS and CAH. Despite the similar phenotypes and some common hormonal and biochemical profiles such as insulin resistance, hyperinsulinemia, and hyperandrogenism, our results suggest the existence of additional metabolic pathways implicated in the pathogenesis of pregnancy complications.