Healthcare Cost And Utilization Project Nationwide Inpatient Sample Research Articles

P-288 How do pregnancy complications, intrapartum, and neonatal risks differ in bicornuate and didelphys uteri. A population-based study

Abstract Study question Are there differences between didelphys and bicornuate uteri regarding obstetrical and neonatal outcomes based on an analysis of a population database? Summary answer Didelphys uteri present higher risks of preeclampsia, preterm delivery, PPROM, and cesarean delivery; while bicornuate uteri present higher risks of placenta previa, and placental abruption. What is known already Didelphys and bicornuate uteri are similar congenital anomalies with duplication of the uterine corpus. It is thought that both defects are similar when it comes to pregnancy complications, with increased risks of preterm delivery (PTD), malpresentation, and cesarean delivery, when compared to women without uterine anomalies. The didelphys uterus has two cervixes and a double vagina while the bicornuate uterus has one cervix and a single vagina. This minor difference may or may not alter the risks of pregnancy complications in these groups. However, obstetric and perinatal outcomes for didelphys and bicornuate uteri have never been directly compared. Study design, size, duration This retrospective population-based cohort study utilized data from the Healthcare-Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) from 2010 to 2014, inclusively. There were 3,846,342 births between 2010 and 2014, 1146 women with didelphys uteri and 6327 women with bicornuate uteri were included in the database and the study. Women were included only once per pregnancy. Participants/materials, setting, methods HCUP-NIS is the largest inpatient database in the USA and is comprised of hospitalizations throughout the USA. It provides information relating to seven-million inpatient stays yearly, includes 20% of admissions, and represents over 96% of Americans. Multivariate logistic regression was conducted to explore associations between bicornuate uteri and delivery outcomes while controlling for confounding effects. According to the Tri-Council Policy Statement (2018), IRB approval was not required, given data was anonymous and publicly available. Main results and the role of chance No significant difference was seen between the groups in regard to age, income, medical insurance plan, rates of obesity, illicit drug use, chronic hypertension, diabetes, thyroid disease, HIV, tobacco smoking during pregnancy, previous cesareans, pregnancy from IVF, and multiple gestations (P > 0.05). The only difference was in racial distribution, which was controlled for in the subsequent analysis (p < 0.05).In comparison to pregnant women with bicornuate uteri, patients with didelphys uteri were more likely to experience preeclampsia (aOR 1.38 95%CI: 1.05-1.80 P = 0.020), preterm premature rupture of membranes (PPROM) (aOR 1.76 95%CI1.32-2.34 P = 0.000), preterm delivery (aOR 1.39 95% CI1.18-1.64P=0.000), and higher chances of cesarean delivery (aOR 1.41 95% CI1.20-1.64 P = 0.000), after controlling for confounding demographics. Additionally, women with didelphys uteri have less risks of developing placenta previa (aOR 0.26 95%CI: 0.08-0.84 P = 0.024) and Abruptio placenta (aOR 0.52 95%CI 0.31-0.87 P = 0.013). No significant difference was seen between the groups regarding pregnancy induced hypertension, eclampsia, gestational diabetes, chorioamnionitis, operative vaginal delivery, hysterectomy, post-partum hemorrhage, wound complications, blood transfusion, maternal death, maternal infection, venous thromboembolism, pulmonary embolism or DIC (P > 0.05). Moreover, there was no significant difference between the two groups when comparing neonatal outcomes, including small for gestational age fetuses and intrauterine fetal demise (P > 0.05). Limitations, reasons for caution The limitation of our study are related to its retrospective nature and use of administrative database, which relies on the accuracy, and consistency of the individual coding the data, and the masking of undetected bias. Wider implications of the findings The present study demonstrates that women with bicornuate and didelphys uteri have certain differences when it comes to pregnancy, and intrapartum complications, including rates of preeclampsia, placenta previa, placental abruption, cesarean section, PPROM, and preterm delivery. These findings emphasize the importance of individualized perinatal care in these two cases. Trial registration number not applicable

P-625 Association between advanced maternal age in women with polycystic ovary syndrome and adverse obstetric outcomes

Abstract Study question What is the effect of advanced maternal on the likelihood of experiencing adverse pregnancy, delivery, and neonatal outcomes in pregnant women with PCOS? Summary answer Advanced maternal age in women with polycystic ovary syndrome confers an additional risk of pregnancy induced hypertension, preeclampsia, preterm delivery, c-section, and placenta previa. What is known already Women with PCOS have an increased risk of obstetric complications, including preterm delivery, PROM, hypertensive disorders, gestational diabetes, cesarean section, and placental abruption. Similarly, the impact of advanced maternal age on pregnancy outcomes has been widely studied. Studies have highlighted the association between advanced maternal age and increased risks of preeclampsia, gestational diabetes mellitus, preterm labor, cesarean section, stillbirth, and fetal growth restriction. The role of advanced maternal age on pregnancy complications in PCOS in a population database has not been thoroughly evaluated. Study design, size, duration A retrospective population-based study using data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database was performed. All deliveries between 2004 to 2014, inclusively, were studied using ICD-9 codes. Within the study period, 14,846 women had a diagnosis of PCOS, of which 943 (6.35%) were of significant advanced maternal age (38-43 years/old). The study could not be extended since in 2015 ICD-10 codes were used which are not compatible with ICD-9 codes. Participants/materials, setting, methods Chi-squared tests were used for comparison of demographics. Multivariate logistic regression analysis was performed to calculate unadjusted and adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CI), controlling for confounding effects. According to Tri-Council Policy statement (2018), IRB approval was not required, given data was anonymous and publicly available Main results and the role of chance Women with PCOS and advanced maternal age were more likely to develop pregnancy complications, including pregnancy induced hypertension (aOR 1.32; 95% CI: 1.09-1.59; p = 0.004), preeclampsia (aOR 1.51; 95% CI: 1.16-1.98; p = 0.003), and gestational diabetes mellitus (aOR 1.66; 95% CI: 1.40-1.97; p < 0.001), after controlling for confounding demographics. Women with PCOS of advanced maternal age were also at increased risk of delivery by cesarean section (aOR 1.20 95% CI: 1.10-1.43; p < 0.001). Women with PCOS and advanced maternal age were not at an increased risk of preterm delivery, PPROM, placental abruption, chorioamnionitis, operative vaginal delivery, post-partum hemorrhage, wound complications, transfusion, maternal infection, deep vein thrombosis, pulmonary embolism, venous thromboembolism, disseminated intravascular coagulation and eclampsia (p > 0.05 in all cases). Results demonstrated no difference in the rate of women who gave birth to SGA infants, the rate of IUFDs, and the rate of infants with congenital anomalies between the two groups. Limitations, reasons for caution The limitations of our study are its retrospective nature and use of an administrative database which relies on the accuracy and consistency of the individuals coding the data. There are known limitations in how accurately hospital coding is able to capture perinatal conditions and complications. Wider implications of the findings The impact of advanced maternal age on the relationship between PCOS and pregnancy outcomes should be considered when counseling and planning care for pregnant women affected by these conditions. This emphasizes the importance of optimal perinatal care in older women with PCOS as they have higher risks of obstetric complications. Trial registration number NA

The association between attention deficit hyperactivity disorder and pregnancy, delivery and neonatal outcomes—an evaluation of a population database

BackgroundAttention deficit hyperactivity disorder (ADHD) is one of the more common neuropsychiatric disorders in women of reproductive age. Our objective was to compare perinatal outcomes between women with an ADHD diagnosis and those without.MethodsA retrospective population-based cohort study utilizing the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS) United States database. The study included all women who either delivered or experienced maternal death from 2004 to 2014. Perinatal outcomes were compared between women with an ICD-9 diagnosis of ADHD and those without.ResultsOverall, 9,096,788 women met the inclusion criteria. Amongst them, 10,031 women had a diagnosis of ADHD. Women with ADHD, compared to those without, were more likely to be younger than 25 years of age; white; to smoke tobacco during pregnancy; to use illicit drugs; and to suffer from chronic hypertension, thyroid disorders, and obesity (p < 0.001 for all). Women in the ADHD group, compared to those without, had a higher rate of hypertensive disorders of pregnancy (HDP) (aOR 1.36, 95% CI 1.28–1.45, p < 0.001), cesarean delivery (aOR 1.19, 95% CI 1.13–1.25, p < 0.001), chorioamnionitis (aOR 1.34, 95% CI 1.17–1.52, p < 0.001), and maternal infection (aOR 1.33, 95% CI 1.19–1.5, p < 0.001). Regarding neonatal outcomes, patients with ADHD, compared to those without, had a higher rate of small-for-gestational-age neonate (SGA) (aOR 1.3, 95% CI 1.17–1.43, p < 0.001), and congenital anomalies (aOR 2.77, 95% CI 2.36–3.26, p < 0.001).ConclusionWomen with a diagnosis of ADHD had a higher incidence of a myriad of maternal and neonatal complications, including cesarean delivery, HDP, and SGA neonates.

Maternal and Fetal Outcomes Among Pregnant Women With Endometriosis [ID 2683578

INTRODUCTION: Endometriosis, a prevalent disorder affecting around 10% of reproductive-aged women, has been linked to obstetric complications during pregnancy. This study aims to evaluate endometriosis prevalence in pregnancy and its effect on maternal and newborn outcomes. METHODS: A retrospective cohort study was conducted using data from the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS) database from the United States between 1999 and 2019. Multivariate logistic regression analysis, controlling for diverse baseline maternal characteristics, was used to investigate pregnancy and newborn outcomes in births to women diagnosed with endometriosis as compared to those without. RESULTS: The cohort consisted of 16,911,497 births to women without endometriosis and 14,956 pregnant women diagnosed with endometriosis. Over the 20-year period, there was a significant upward trend in prevalence of endometriosis among births, rising from 34.9 to 160.6/100,000 births. Births to women with endometriosis exhibited distinctive demographic characteristics: being of advanced maternal age, predominantly of Caucasian ethnicity, belonging to higher income quartiles, obese, smokers, and having private insurance coverage. Births to women with endometriosis were at heightened risk of experiencing obstetric complications, including gestational diabetes, preeclampsia, preterm birth, and postpartum hemorrhage. Neonates born to mothers with endometriosis also demonstrated an elevated likelihood of growth restriction and congenital anomalies. CONCLUSION: The study highlights the evolving prevalence of endometriosis among pregnant women and establishes a strong connection between endometriosis and adverse maternal and newborn outcomes. These findings emphasize the importance of vigilant monitoring to enhance obstetrical and fetal outcomes in pregnant women with endometriosis.

The relationship between socioeconomic status and perinatal outcomes in in vitro fertilization conceptions

ObjectiveTo evaluate whether socioeconomic status has an impact on perinatal outcomes in in-vitro-fertilization pregnancies. We hypothesize that with greater coverage there may be an alleviation of the financial burden of IVF which can facilitates application of evidence-based practices. BackgroundIn-vitro fertilization (IVF) is the most used assisted reproductive technology in the United States, with growing efficiency and demand for in-vitro fertilization. Certain states have mandated coverage that enable low-income individuals to undergo in-vitro fertilization treatment. Study DesignA retrospective population-based observational study was conducted in accordance with the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database over the six-year period from 2008 to 2014 examining 10,000 in-vitro-fertilization deliveries. Maternal outcomes of interest included preterm pre-labor rupture of membranes (PPROM), preterm birth (i.e., before 37 weeks of gestation), placental abruption, Caesarean Section (C/S), operative vaginal delivery, spontaneous vaginal delivery (SVD), maternal infection, chorioamnionitis, hysterectomy, and postpartum hemorrhage. Neonatal outcomes included small for gestational age (SGA) defined as birth weight less than tenth percentile, intrauterine fetal death (IUFD), and congenital anomalies. ResultsOur study found that socioeconomic status did not have a statistically relevant effect on perinatal outcomes in women who underwent in-vitro-fertilization to conceive after adjusting for the potential confounding effects of maternal demographic, pre-existing clinical characteristics, and comorbidities. ConclusionThe literature suggests that in states with mandated in-vitro-fertilization coverage, there are better perinatal outcomes due in part to greater utilization of best IVF practices, such as single-embryo transfers. Moreover, the quality of medical care in states with coverage is in the highest quartile in the country. Therefore, our findings of equivalent perinatal outcomes in IVF care irrelevant of socio-economic status suggests that a possibly of lack of access to quality medical care may be a factor in the health disparities usually seen in lower socioeconomic status individuals.

Transient ischemic attack and pregnancy, delivery and neonatal outcomes-An evaluation of a population database.

Transient ischemic attack (TIA) is rare in women of reproductive age. We aimed to compare perinatal outcomes between women who suffered from a TIA to those who did not. A retrospective population-based cohort study utilizing the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS). All women who delivered or had a maternal death in the US (2004-2014) were included in the study. Pregnancy, delivery, and neonatal outcomes were compared between women with an ICD-9 diagnosis of a TIA to those without. Overall, 9 096 788 women met the inclusion criteria. Of these, 203 women (2.2/100000) had a TIA (either before or during pregnancy). Women with TIA, compared to those without, were more likely to be older than 35 years of age, white, in the highest income quartile, be insured by private insurance and suffer from obesity and chronic hypertension. Patients in the TIA group, compared to those without, had a higher rate of pregnancy-induced hypertension (aOR 2.5, 95% CI: 1.55-4.05, P < 0.001), pre-eclampsia (aOR 3.77, 95% CI: 2.15-6.62, P < 0.001), eclampsia (aOR 28.05, 95% CI: 6.91-113.95, P < 0.001), preterm delivery (aOR 1.78, 95% CI: 1.03-3.07, P = 0.039), and maternal complications such as deep vein thrombosis (aOR 33.3, 95% CI: 8.07-137.42, P < 0.001). Regarding neonatal outcomes, patients with a TIA, compared to those without, had a higher rate of congenital anomalies (aOR 7.04, 95% CI: 2.86-17.32, P < 0.001). Women with a TIA diagnosis before or during pregnancy had a higher rate of maternal complications, including hypertensive disorders of pregnancy and venous thromboembolism, as well as an increased risk of congenital anomalies.

Amniotic fluid embolism: 20-year incidence and case-fatality trends in the United States

ObjectiveTo estimate incidence and case-fatality rates of amniotic fluid embolism (AFE) and to examine their temporal trends. Study designPopulation-based retrospective cohort study using the 2000–2019 Health Care Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS). Annual population rates were estimated using HCUP-NIS specific weighting. Descriptive analyses and logistic regression described trends within the cohort. ResultsOver the study period, AFE incidence rate remained stable (mean 4.9 cases/100,000 deliveries) and the case-fatality rate declined (mean 17.7 %,95 % CI 16.40–10.09). Highest AFE incidence rates and fatality rates were in women ≥ 35 years, African-Americans, and in urban-teaching hospitals. AFE mortality rates decreased among Hispanics. ConclusionAFE rates remained stable and fatality rates declined over time. Highest rates of AFE occurrence and death were in women who typically have greater risk of experiencing adverse obstetrical outcomes. Continued research into early diagnostic methods and effective treatments are needed to further improve AFE incidence and mortality rates.

How does the need for IVF affect pregnancy complications among multiple gestations? The study of a large American population database including almost 100,000 multiple gestations

ObjectiveThis study’s aim is to compare pregnancy outcomes in multifetal gestations that were conceived spontaneously compared to in vitro fertilization (IVF). Few population-based studies have addressed this topic. Study designThis is a retrospective cohort study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database. Our study cohort included 90,552 multifetal gestations conceived spontaneously and 3219 IVF conceptions, from 2008 to 2014, inclusively. Multivariate logistic regression analyses were performed comparing maternal and neonatal outcomes, whilst adjusting for confounding variables. Subject was conducted using ICD-9 codes for multifetal gestation: 651. X and 76.1 and ICD-9 code for IVF: 23.85. Each pregnancy was included once. Results and conclusionIVF multifetal gestations had increased risk of pregnancy-induced hypertension (aOR 1.31, 95 % CI 1.20–1.43), gestational hypertension (aOR 1.21, 95 % CI 1.04–1.41), preeclampsia (aOR 1.31, 95 % CI 1.19–1.45), gestational diabetes (aOR 1.26, 95 % CI 1.13–1.41) and placenta previa (aOR 1.7, 95 % CI 1.32–2.19). IVF delivery outcomes were more likely complicated by cesarean section (aOR 1.21, 95 % CI 1.10–1.33), preterm premature rupture of membranes (aOR 1.33, 95 % CI 1.16–1.52), chorioamnionitis (aOR 1.71, 95 % CI 1.37–2.14), postpartum hemorrhage (aOR 1.44, 95 % CI 1.26–1.63) and transfusions (aOR 1.48, 95 %CI 1.26–1.74). IVF neonatal outcomes were more likely complicated by small for gestational age (aOR 1.26, 95 % CI 1.12–1.41) and congenital anomalies (aOR 1.82, 95 % CI 1.29–2.57). IVF was not found to increase risks of eclampsia, preterm delivery, operative vaginal delivery, hysterectomy, or intrauterine fetal demise.IVF increased the risk of pregnancy, delivery, and neonatal outcomes in multifetal pregnancies with risks increased from 20 % to 70 %. The role of infertility versus the need for IVF and the type of IVF protocol used should be further evaluated.

Associations between hypothyroidism and adverse obstetric and neonatal outcomes: a study of a population database including over 184,000 women with hypothyroidism

Background Maternal hypothyroidism has been associated with multiple adverse pregnancy outcomes. These findings have not been confirmed in a large population database study. Therefore, a large population-based cohort study was established to study the associations between maternal hypothyroidism and pregnancy and perinatal complications. Methods This is a retrospective population-based cohort study utilizing data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) over 11 years from 2004 to 2014. A cohort of all deliveries between 2004 and 2014 inclusive, was created. Within this group, all deliveries to women with hypothyroidism were identified as part of the study group (n = 184,869), and the remaining deliveries were categorized as non-hypothyroidism births and comprised the reference group (n = 8,911,919). The main outcome measures were pregnancy and perinatal complications. Results Maternal hypothyroidism is associated with several pregnancy and perinatal complications, including gestational diabetes mellitus (aOR 1.43, 95%CI 1.38–1.47), gestational hypertension (aOR 1.17, 95%CI 1.11–1.22) and preeclampsia (aOR 1.21, 95%CI 1.16–1.27) (all p < 0.001). These patients are more likely to experience preterm premature rupture of membranes (aOR 1.19, 95%CI 1.09–1.29, p < 0.001), preterm delivery (aOR 1.12 95%CI 1.08–1.17, p < 0.001), are more likely to deliver by cesarean section (aOR 1.21, 95% CI 1.18–1.24, p < 0.001), and suffer from postpartum hemorrhage (aOR 1.07, 95%CI 1.01–1.13, p = 0.012), disseminated intravascular coagulation (aOR 1.20, 95%CI 1.00-1.43, p = 0.046), and undergo hysterectomy (aOR 1.42, 95% CI 1.13–1.80, p = 0.003). As for neonatal outcomes, small for gestational age and congenital anomalies are more likely to occur in the offspring of women with hypothyroidism (aOR 1.20, 95% CI 1.14–1.27 and aOR 1.34, 95% CI 1.22–1.48, both p < 0.001). Conclusions Women with hypothyroidism are more likely to experience pregnancy, delivery and neonatal complications. We found an association between hypothyroidism and hypertensive disorders, postpartum hemorrhage, transfusions, infections, preterm delivery and hysterectomy, among other problems. This data from a population sized database confirms the findings of smaller previous studies in the literature.

Catamenial pneumothorax: A population-based study

Study objective: To characterize the incidence, clinical features, and demographic characteristics of women with catamenial pneumothorax with the use of a large national database in the United States. Design: Retrospective case control study of the Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (HCUP-NIS) database between 2004 and 2014. Setting: Not applicable. Patients: Women, aged 18–50 years, who were diagnosed with a pneumothorax between 2004 and 2014. Intervention: Not applicable. Measurements: The cohort was constructed using the appropriate ICD-9 codes utilizing HCUP-NIS, checking for women with spontaneous and catamenial pneumothorax . Main results: Of a total 6234 women with spontaneous pneumothorax, 80 women (1.3%) had a diagnosis of catamenial pneumothorax. Women with catamenial pneumothorax were more likely to be black, have private insurance and be treated in an urban hospital. In addition, fewer patients in this group reported a history of tobacco consumption. Patients in the study group were more likely to have concomitant pelvic endometriosis, dysmenorrhea, and infertility. Compared to women with non-catamenial pneumothorax, those with catamenial pneumothorax were more frequently treated with thoracic drainage and underwent pleural and diaphragm biopsies. Conclusion: Catamenial pneumothorax is a rare entity with a distinct clinical profile. This condition is associated with pelvic endometriosis, has a predilection for surgical intervention and is associated with lower rates of smoking.

How does high socioeconomic status affect maternal and neonatal pregnancy outcomes? A population-based study among American women

ObjectivesThe purpose of this study was to evaluate the effect of high SES on multiple pregnancy outcomes, while controlling for confounding factors. MethodsUsing the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS), the largest American medical database including 20 % of annual hospital admissions, we studied the years 2004–2014 inclusively. We conducted a population-based retrospective cohort study consisting of women from different median household income quartiles throughout the United States. Women in the highest household income quartile were compared to those in all other lower income quartiles combined. Chi-square and Fischer exact tests were used to compare demographic and baseline characteristics. Univariate and multivariate regression analyses were carried to adjust for confounding factors, including ethnicity, pre-existing conditions, smoking status, obesity, illicit drug use and insurance type. ResultsAmong 5,448,255 deliveries during the study period with income data, 1,218,989 deliveries were to women from the wealthiest median household income. These women were more likely to be older, Caucasian, and have private medical insurance (P < 0.05, all). They were less likely to smoke, have chronic hypertension, pre-gestational diabetes, and use illicit drugs (P < 0.05, all). They were less likely to develop complications including gestational hypertension (aOR 0.87 95 %CI 0.85–0.88), preeclampsia (aOR 0.88 95 %CI 0.86–0.89), eclampsia (aOR 0.81 95 %CI 0.66–0.99), gestational diabetes (aOR 0.91 95 %CI 0.89–0.92), preterm premature rupture of membranes (PPROM) (aOR 0.92 95 %CI 0.88–0.96), preterm birth (aOR 0.90 95 %CI 0.89–0.92), and placental abruption (aOR 0.89 95 %CI 0.85–0.93). They were less likely to have an intra-uterine fetal death (IUFD) (aOR 0.80 95 %CI 0.74–0.86), but more likely to deliver neonates with congenital anomalies (aOR 1.10 95 %CI 1.04–1.20). ConclusionsHigher SES predisposes to better pregnancy outcomes, even when controlled for confounding factors such as ethnicity and underlying baseline health status. Efforts are required in order to eliminate health disparities in pregnancy.

Pregnancy, delivery and neonatal outcomes among women with hypoparathyroidism-A population-based study.

Data are inconclusive regarding pregnancy complications associated with maternal chronic hypoparathyroidism. Therefore, we aimed to compare pregnancy, delivery and neonatal outcomes in patients affected by chronic hypoparathyroidism to those without chronic hypoparathyroidism. A retrospective population-based study utilising data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) database over 11 years from 2004 to 2014 inclusively. Multivariate logistic regression was used to control for confounders. Patients with chronic hypoparathyroidism compared with those without. Obstetric and neonatal outcomes. We identified 204 pregnancies in mothers with chronic hypoparathyroidism and 9,096,584 pregnancies without chronic hypoparathyroidism. After adjusting for age, insurance plan type, obesity, chronic hypertension, thyroid disease, pregestational diabetes mellitus, and previous caesarean section, patients in the hypoparathyroidism group, compared with those without hypoparathyroidism, were found to have an increased rate of preterm birth (<37 weeks) (19.1% vs. 7.2%, aOR: 2.49, 95% confidence interval [CI]: 1.74-3.54, p < 0.0001, respectively); and blood transfusions (4.9% vs. 1.0%, aOR: 4.07, 95% CI: 2.15-7.73, p < -0.0001). Neonates to mothers with chronic hypoparathyroidism had a higher rate of congenital anomalies (4.4% vs. 0.4%, aOR: 6.50, 95% CI: 3.31-12.75, p < 0.0001), with comparable rates of small-for-gestational-age neonates and intrauterine foetal death. This is the largest study of chronic hypoparathyroidism in pregnancy to date. We found significant increases in the rates of preterm birth, blood transfusions and congenital anomalies in chronic hypoparathyroidism. Our findings highlight the importance of identifying chronic hypoparathyroidism as a risk factor for pregnancy and neonatal complications, although it remains unknown if maintaining calcium in the target range will mitigate these risks.

Pregnancy, delivery and neonatal outcomes in women with gastrointestinal system cancer in pregnancy. An evaluation of a population database.

Gastrointestinal system (GIS) cancer in pregnancy is a rare disease. Our aim was to evaluate the association between this type of cancer and pregnancy, delivery and neonatal outcomes. We conducted a retrospective population-based cohort study using the Healthcare Cost and Utilization Project, Nation-wide Inpatient Sample (HCUP-NIS). We included all women who delivered or had a maternal death in the US between 2004 and 2014. We compared women with an ICD-9 diagnosis of GIS cancer to those without. Pregnancy, delivery, and neonatal outcomes were compared between the two groups. A total of 9,096,788 women met inclusion criteria. Amongst them, 194 women (2/100,000) had a diagnosis of GIS cancer during pregnancy. Women with GIS cancer, compared to those without, were more likely to be Caucasian, older than 35 years of age, and to suffer from obesity, chronic hypertension, pregestational diabetes and thyroid disease. The cancer group had a lower rate of spontaneous vaginal delivery (aOR 0.2, 95 % CI 0.13-0.27, p<0.001), and a higher rate of preterm delivery (aOR 1.85, 95 % CI 1.21-2.82, p=0.04), and of maternal complications such as blood transfusion (aOR 24.7, 95 % CI 17.11-35.66, p<0.001), disseminated intravascular coagulation (aOR 14.56, 95 % CI 3.56-59.55, p<0.001), venous thromboembolism (aOR 9.4, 95 % CI 2.3-38.42, p=0.002) and maternal death (aOR 8.02, 95 % CI 2.55-25.34, p<0.001). Neonatal outcomes were comparable between the two groups. Women with a diagnosis of GIS cancer in pregnancy have a higher incidence of maternal complications including maternal death, without any differences in neonatal outcomes.

A Comparison of Pregnancy and Neonatal Outcomes in Women with the Hyperandrogenic Disorders Polycystic Ovary syndrome and Cushing’s Syndrome

Research Question: How does the risk for adverse obstetric outcomes differ among women with polycystic ovary syndrome (PCOS) and women with Cushing’s syndrome (CUS)? Design: A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS), 2004-2014. 14, 881 deliveries to women with PCOS and 134 deliveries to women with CUS were identified. Associations between PCOS, CUS, pregnancy, delivery, and neonatal outcomes were analyzed with multivariate logistic regression analysis. Results: At baseline, CUS was associated with a higher risk of chronic hypertension (P&lt;0.001), pregestational diabetes mellitus (P=0.01), thyroid disease (P=0.004), and higher rates of smoking during pregnancy (P=0.02) whereas PCOS was associated with higher rates of obesity (P=0.01). In terms of obstetric outcomes, PCOS increased the prevalence of gestational diabetes mellitus (P=0.002, adjusted[a] OR 2.73; 95% CI 1.46 to 5.12), and cesarean section (P&lt;0.001, aOR 2.63; 95% CI 1.81-3.83) in comparison to CUS. CUS increased the prevalence of operative vaginal delivery (P&lt;0.001, aOR 0.10; 95% CI 0.06-0.14), and transfusion (P=0.002, aOR 0.25; 95% CI 0.11-0.59) in comparison to deliveries to women with PCOS. No significant differences were found in terms of pregnancy-induced hypertension (P=0.78), gestational hypertension (P=0.86), preeclampsia (P=0.25), preeclampsia or eclampsia superimposed on pre-existing hypertension (P=0.13). Conclusion: PCOS increases the risk of gestational diabetes and cesarean section relative to CUS, whereas CUS increases the prevalence of operative vaginal delivery and blood transfusions.

P-588 A comparison of obstetrical and neonatal outcomes in patients with the hyperandrogenic states, polycystic ovarian syndrome(PCOS) and congenital adrenal hyperplasia(CAH): a retrospective population-database study.

Abstract Study question PCOS and CAH are associated with increases in pregnancy complications. Therefore, we evaluated differences in pregnancy and neonatal outcomes between women with PCOS and CAH. Summary answer When comparing these conditions PCOS was associated with pregnancy-induced hypertension and gestational diabetes, whereas CAH had more cesarean sections and small for gestational age infants. What is known already PCOS and CAH are causes of hyperandrogenism among women of reproductive age. Apart from causing hyperandrogenism, they also share characteristics such as menstrual irregularity, polycystic ovaries and insulin resistance with central adiposity. Several meta-analyses have associated PCOS with adverse obstetrical and neonatal outcomes with most studies finding an increased frequency of pregnancy-induced hypertension (PIH), preeclampsia, gestational diabetes (GDM), cesarean section (CS) and preterm delivery. CAH on the other hand, is associated with higher rates of CS and inconsistent evidence about increases in GDM, chorioamnionitis and congenital anomalies. Study design, size, duration A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS), was performed. A dataset of all deliveries between 2004 and 2014 inclusively, was created. Within this group, all deliveries to women who had a diagnosis of PCOS or CAH and pregnancy were identified. Each subject had a delivery or maternal death to be included once per pregnancy. Participants/materials, setting, methods Descriptive analyses were performed to compare the demographic features among both groups, for which chi-squared tests were used. Multivariate logistic regression analysis was performed to calculate unadjusted and adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CI) and correct for any difference in baseline demographics (P &amp;lt; 0.05) between the groups. According to the Tri-Council Policy statement (2018), institutional review board (IRB) approval was not required, given that data was anonymous and publicly available. Main results and the role of chance A total of 15,179 women with either PCOS or CAH were included. Approximately 98% of those women (14,881) were diagnosed with PCOS, while the rest 2% (298) had CAH. The adjusted analysis for race, obesity, previous CS, multiple gestation and IVF yielded the following results. For pregnancy outcomes PIH (aOR=1.76; 95% CI: 1.12-2.77; p = 0.015) and GDM (aOR=1.68; 95% CI: 1.12-2.52; p = 0.012) were more common among women with PCOS, whereas no statistically significant results were detected for rates of placenta previa, preeclampsia or eclampsia superimposed on pre-existing hypertension or eclampsia. After additional adjusting for PIH and GDM, the delivery outcomes showed CS to be significantly less common in the PCOS group (aOR=0.59; 95% CI 0.44-0.80; p &amp;lt; 0.001), with no significant differences concerning preterm premature rupture of membranes, preterm delivery, abruptio placenta, chorioamnionitis, operative vaginal delivery, hysterectomy, postpartum hemorrhage, wound complications, maternal death and need for transfusion. In neonatal outcomes, women with CAH had higher percentages of SGA neonates (aOR=0.32; 95% CI 0.20-0.52; p &amp;lt; 0.001) and no difference in intrauterine fetal demise and congenital anomalies. Limitations, reasons for caution The limitations of our study are its retrospective nature and the fact that it relies on an administrative database. Furthermore, CAH type was not specified. Information on medication use and compliance was also lacking information about certain potential confounders such as parity, and duration of labor. Wider implications of the findings This is the first study to investigate the differences in obstetrical and neonatal outcomes between these two hyperandrogenic disorders and we noted that the majority of risks were similar, despite the difference in the pathophysiology of these conditions. Rates of certain complications differ and studies are needed to elucidate why. Trial registration number N/A

O-009 The Role of Ethnicity and Polycystic Ovary Syndrome on Pregnancy Complications. An Analysis of a Population Database

Abstract Study question The goal of this study was to determine the independent effect of ethnicity on adverse obstetrical outcomes in women with Polycystic Ovary Syndrome (PCOS). Summary answer Among women with PCOS, African Americans, Hispanic and Asians are at an increased risk of certain adverse obstetrics outcomes, whereas Caucasians have fewer pregnancy complications. What is known already Polycystic ovarian syndrome is associated with an increased risk of pregnancy complications possibly due to the insulin resistance inherent in this syndrome. Variable ethnicities demonstrate different magnitudes of insulin resistance and in non-PCOS populations are known to be at modified pregnancy complication risks. Different ethnicities may have different phenotypes of PCOS, possibly further modifying outcomes. The role of ethnicity in women with PCOS and its effect on pregnancy complications has not been well studied. Study design, size, duration This retrospective population-based study utilized data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS), over 11 years from 2004 to 2014. The data are representative of 20% of admissions to US hospitals and geographically represent over 96% of the American population. Clinical modification ICD9-CM codes were used to identify women with PCOS and group them according to maternal ethnicity. In 2015 codes were changed to ICD-10 which are not comparable. Participants/materials, setting, methods All women with PCOS(n = 12782) were grouped according to maternal ethnicity: Caucasian(9107), African American(1098), Hispanic(1288), Asian(741), and other. Pregnancy, delivery, and neonatal outcomes were collected per group and compared to the rest. Chi-square tests were used to compare the baseline characteristics between the cohorts. Logistic regression analyses were conducted to explore associations between ethnicity and pregnancy outcomes through the estimation of odds ratio (OR) and 95% confidence intervals (CI) while controlling for confounding effects. Main results and the role of chance PCOS was found in 12,782 patients with included ethnicity results. Asian women had a higher prevalence of gestational diabetes(GDM) (aOR1.96, 95%CI 1.49-2.58, p &amp;lt; 0.001), chorioamnionitis (aOR3.41, 95%CI 2.12-5.47, p &amp;lt; 0.0001), operative vaginal delivery (aOR2.42, 95%CI 1.65-3.56, p &amp;lt; 0.001), postpartum hemorrhage(PPH) (aOR2.07, 95%CI 1.25-3.43, p = 0.004) and maternal infection (aOR2.84, 95%CI 1.80-4.49, p &amp;lt; 0.001). African Americans had a higher risk of pregnancy-induced hypertension (aOR1.38, 95% CI 1.06-1.80, p = 0.02), preeclampsia (aOR1.68, 95% CI 1.15-2.45, p = 0.007), preterm premature rupture of membrane (aOR2.75, 95%CI 1.58-4.78, p &amp;lt; 0.001), chorioamnionitis (aOR1.83, 95%CI 1.12-2.98, p = 0.016) and cesarean sections (aOR1.69, 95%CI 1.32-2.15, p &amp;lt; 0.001) and lower risk of operative vaginal delivery (aOR0.53, 95%CI 0.31-0.93, p = 0.03), spontaneous vaginal delivery (aOR0.67, 95%CI 0.52-0.85, p &amp;lt; 0.001), and maternal infection (aOR1.91, 95%CI 1.21-3.00, p = 0.005). The risk of GDM (aOR1.36, 95%CI 1.06-1.73, p &amp;lt; 0.014) and PPH (aOR1.58, 95%CI 1.01-2.47, p = 0.045) was increased among Hispanic patients. Caucasian patients were at lower risk of GDM(aOR0.67, 95%CI 0.57-0.79, p &amp;lt; 0.0001), chorioamnionitis (aOR0.39, 95%CI 0.28-0.55, p &amp;lt; 0.0001), casarean section (aOR0.83, 95%CI 0.73-0.95, p &amp;lt; 0.008), spontaneous vaginal deliveries (aOR1.25, 95% CI1.10-1.43, p &amp;lt; 0.001), PPH (aOR0.70, 95% CI0.50-0.98, p &amp;lt; 0.035), blood transfusion (aOR0.49, 95%CI 0.29-0.83, p &amp;lt; 0.007), maternal infection (aOR0.34, 95% CI 0.27-0.51, p &amp;lt; 0.0001) and small for gestational age infants (aOR0.64, 95%CI 0.44-0.93, p &amp;lt; 0.018). Rates of other pregnancy outcomes were similar for the groups. Limitations, reasons for caution This is a retrospective analysis utilizing an administrative database that relied on the accuracy and consistency of the individuals coding the data. There are known limitations to how accurately hospital coding is able to capture perinatal conditions and complications. Wider implications of the findings Our study demonstrated that among women with PCOS, specific ethnicities are at an increased risk of adverse obstetric outcomes. This underlines the importance of screening for certain pregnancy complications in PCOS women of African American, Hispanic, and Asian ethnicity. Studies should evaluate the role of insulin resistance in these outcomes. Trial registration number not applicable - This study used publicly accessible, anonymized data; therefore, according to articles 2.2, 2.4 of Tri-Council Policy Statement (2010), institutional review board approval was not required.

P-601 Comparison of adverse obstetric outcomes in women with the hyperandrogenic syndromes, polycystic ovary syndrome and Cushing’s syndrome: an evaluation of a population database

Abstract Study question How does the risk for adverse obstetric outcomes differ among women with polycystic ovary syndrome (PCOS) and women with Cushing’s syndrome (CUS)? Summary answer PCOS increased the risk of gestational diabetes and cesarean section relative to CUS, whereas CUS increased the prevalence of operative vaginal delivery and blood transfusions. What is known already PCOS and CUS are hyperandrogenic disorders that have previously been associated with unique adverse obstetric outcomes. Despite there being similarities in the hyperandrogenism and insulin resistance of these disorders, there is a lack of knowledge when comparing their specific risks of pregnancy complications. Study design, size, duration A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS), was performed. A dataset of all deliveries between 2004 and 2014 inclusively, was created. 14 881 deliveries to women with PCOS and 134 deliveries to women with CUS were identified. The HCUP-NIS presents information on approximately 20% of admissions to US hospitals. Data was not continued into 2015 when ICD-10 codes were used, which are not comparable. Participants/materials, setting, methods Descriptive analyses were performed to compare the demographic features among both groups using chi-squared tests. Multivariate logistic regression analysis was performed to calculate unadjusted and adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CI). According to Tri-Council Policy statement (2018), IRB approval was not required, given data was anonymous and publicly available. Main results and the role of chance At baseline, CUS was associated with a higher risk of chronic hypertension (P &amp;lt; 0.001), pregestational diabetes mellitus (P = 0.01), thyroid disease (P = 0.004), and higher rates of smoking during pregnancy (P = 0.02) whereas PCOS was associated with higher rates of obesity (P = 0.01). In terms of obstetric outcomes, PCOS increased the prevalence of gestational diabetes mellitus (P = 0.002, adjusted[a] OR 2.73; 95% CI 1.46 to 5.12), and cesarean section (P &amp;lt; 0.001, aOR 2.63; 95% CI 1.81-3.83) in comparison to CUS. CUS increased the prevalence of operative vaginal delivery (P &amp;lt; 0.001, aOR 0.10; 95% CI 0.06-0.14), and transfusion (P = 0.002, aOR 0.25; 95% CI 0.11-0.59) in comparison to deliveries to women with PCOS. No significant differences were found in terms of pregnancy-induced hypertension (P = 0.78), gestational hypertension (P = 0.86), preeclampsia (P = 0.25), preeclampsia or eclampsia superimposed on pre-existing hypertension (P = 0.13), premature rupture of membranes (P = 0.99), preterm delivery (P = 0.17), placental abruption (P = 0.82), chorioamnionitis (P = 0.16), spontaneous vaginal delivery (P = 0.35), postpartum hemorrhage (P = 0.29), and maternal infection (P = 0.11). In terms of neonatal outcomes, both deliveries to women with PCOS and women with CUS had similar outcomes for small for gestational age infants (P = 0.52), intrauterine fetal demise (P = 0.94), and congenital anomalies (P = 0.53). Limitations, reasons for caution The data within this retrospective cohort study relies on the accuracy of the individuals collecting the data. Data on medication use and compliance was unavailable. Wider implications of the findings Pregnant women with PCOS and CUS are at risk for certain specific obstetric complications, with most risks being similar. The magnitude of the insulin resistance in PCOS may be greater than in CUS due to the increased risk of gestational diabetes in PCOS when controlling for obesity and confounding effects. Trial registration number Not applicable

P-589 How Does Hypothyroidism Alter Perinatal Outcomes in Patients with Polycystic Ovary Syndrome? - An Evaluation of a Population Database

Abstract Study question Does concomitant hypothyroidism in polycystic ovary syndrome (PCOS) patients have an additive effect on the risk for adverse pregnancy, delivery and neonatal outcomes? Summary answer In patients with PCOS, hypothyroidism significantly increases the risk for preeclampsia, however risks of other adverse perinatal outcomes are unaltered. What is known already PCOS and hypothyroidism are common endocrinopathies during reproductive age, and each has been shown to be associated with pregnancy complications. While PCOS has been associated with gestational diabetes, gestational hypertension, and preeclampsia, overt hypothyroidism has been associated with pregnancy loss, intrauterine growth restriction, preeclampsia, and preterm birth. Furthermore, PCOS and thyroid abnormalities are known to be linked, with a higher prevalence of thyroid dysfunction in pregnant PCOS patients compared to controls. However, information on obstetric and neonatal outcomes in women with both PCOS and hypothyroidism is lacking. Study design, size, duration A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS), was performed. A dataset of all deliveries between 2004 and 2014 inclusively, was created. This population-based cohort study included 14,882 women with an International Classification of Diseases (ICD)-9 diagnosis of PCOS in the United States. IN 2015 data was converted to ICD-10 codes which are not comparable to ICD-9 codes. Participants/materials, setting, methods All pregnancy admissions that resulted in delivery or maternal death were included so that patients were counted only once per pregnancy. We compared PCOS women with a concurrent diagnosis of hypothyroidism to those without. Women with hyperthyroidism were excluded. Pregnancy, delivery, and neonatal outcomes were compared between the two groups. Multivariate logistic regression analysis was used to adjust for confounding effects. Main results and the role of chance Overall, 14,882 women met the inclusion criteria. Amongst them, 1,882 (12.65%) had a concomitant diagnosis of hypothyroidism, and 13,000 (87.35%) did not. Women with concomitant hypothyroidism, compared to those without, were characterized by increased maternal age (25.5% ≥35 years vs. 18%, p &amp;lt; 0.001, respectively), and had a higher rate of multiple gestations (7.1% vs. 5.7%, p = 0.023). Interestingly, pregnancy, delivery, and neonatal outcomes were comparable between the groups, except for a higher rate of small-for-gestational-age (SGA) neonates in the group with hypothyroidism (4.1% vs. 3.2%, p = 0.033), when not accounting for confounding effects. In a multivariate logistic regression adjusting for potential confounders, hypothyroidism was no longer found to be associated with SGA (adjusted odds ratio [aOR] 1.32, 95% confidence interval [CI] 0.99-1.75, p = 0.057), but was found to increase the odds for preeclampsia (aOR 1.30, 95% CI 1.06-1.59, p = 0.012). Of note when controlling for confounding effects, all other pregnancy, delivery, and neonatal outcomes were comparable between the groups, including pregnancy-induced hypertension; eclampsia; gestational diabetes mellitus; preterm premature rupture of membranes; preterm delivery; placental abruption; cesarean delivery; hysterectomy; post-partum hemorrhage; wound complications; maternal death; blood transfusions; maternal infection; venous thromboembolism; disseminated intravascular coagulation; SGA; intrauterine fetal death; and congenital anomalies. Limitations, reasons for caution Due to our study’s retrospective nature, some data is missing such as TSH levels, TPO antibody status, the time period in which hypothyroidism was diagnosed (pre-gestationally or during the 1st, 2nd or 3rd trimesters), and Levothyroxine treatment dose and compliance. Wider implications of the findings Patients with PCOS and hypothyroidism during pregnancy should be managed with consideration of instituting both preventive measures for preeclampsia development and heightened blood pressure, proteinuria, and symptom monitoring. Interestingly, hypothyroidism did little to affect the already increased rates of pregnancy complications in PCOS. This should be further studied. Trial registration number not applicable

What type of uterine anomalies had an additional effect on pregnancy outcomes, compared to other uterine anomalies? An evaluation of a large population database

Objective To compare pregnancy risks between different congenital uterine anomalies utilizing other congenital anomalies as a control group in a large population database. Design, setting, and sample A retrospective population-based cohort study from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) included 3,846,342 births (2010–2014). Of them, 6195 deliveries were to women with bicornuate uteri, 798 with arcuate uteri, 2255 with didelphys uteri, 802 with unicornuate uteri and 1404 with septate uteri. Main outcome measures and results After adjustment for confounders, women with bicornuate uteri were more likely to deliver vaginally (aOR 1.4, 95%CI: 1.1–1.9), p = .01), less likely to deliver by cesarean (CD) and had lower risk of small for gestational age (SGA) (aOR 0.8, 95%CI: 0.7–0.9, p = .03) when compared to the other anomalies (aOR 0.6, 95%CI: 0.5–0.6, p = .0001). Pregnant women with arcuate uterus had lower risks of preterm delivery (PTD) (aOR 0.6, 95%CI: 0.5–0.8, p = .0001), less chance of operative vaginal delivery (aOR 0.5, 95%CI: 0.2–0.9, p = .04), and higher risk for CD (aOR 1.6, 95%CI: 1.4–2, p = .0001). Pregnant women with didelphys uteri had higher risk of preterm premature rupture of membranes (PPROM) (aOR 1.6, 95%CI: 1.3–1.9, p = .0001), PTD (aOR 1.5, 95%CI: 1.3–1.6, p = .0001), CD (aOR 1.4, 95%CI: 1.2–1.5, p = .0001) and wound complications (aOR 1.6, 95%CI: 1.1–2.4, p = .02). Pregnant unicornuate uteri had increased risks of PTD (aOR 1.4, 95%CI: 1.1–1.6, p = .0001), CD (aOR 2, 95%CI: 1.6–2.5, p = .0001) and of SGA (aOR 1.8, 95%CI: 1.4–2.3, p = .0001). Pregnant septate uteri had higher risk of chorioamnionitis (aOR 1.5, 95%CI: 1.1–2.1, p = .048) and CD (aOR 1.4, 95%CI: 1.2–1.6, p = .0001). Conclusions We demonstrated that there are different risks for certain adverse pregnancy and neonatal outcomes in diverse uterine anomalies as compared to the other anomalies.

S239 The Association of Obstructive Sleep Apnea and Clostridium difficile: A Nationwide Inpatient Sample Analysis

Introduction: Obstructive sleep apnea (OSA) is a sleep disorder involving repeated apneic episodes during sleep due to an obstruction of the airflow. OSA predisposes individuals to community-acquired pneumonia due to upper airway microaspiration. Furthermore, hypoxia due to intermittent pharyngeal collapses is shown to cause a pro-inflammatory state and reduced NK cell cytotoxicity and maturation, which can increase the risks of infections due to suppression of immune response. Increased incidence of infections in the OSA subgroup leads to increased use of antibiotics. Antibiotic exposure is the primary risk factor for developing Clostridium difficile (C. diff) infection. In synchrony with this notion, the primary purpose of this study was to determine the association between OSA and C. diff infection. Methods: A retrospective analysis was conducted using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS). Patients without C. diff were analyzed (control) and were randomly selected and matched to each patient who did have C. diff. Weighted logistic regression models were used to calculate the association between OSA and C. diff for different comorbidities. Results: A total of 7,135,090 patients were included in our analysis. The prevalence of C. diff was significantly higher in patients with OSA (1.19% vs. 1.00%, p< 0.0001). In addition, multiple comorbidities were significantly elevated in the OSA group compared to those without OSA, including alcohol and obesity (p< 0.0001). Conclusion: This study uses ICD-10-CM codes with a specific search code for OSA. Our large population database shows a significant association between OSA and C. diff. One of the hypotheses describing this increased association could be more antibiotic exposure in OSA subgroup leading to C. diff. Additional studies are needed to confirm or refute this association.