How PCOS can affect pregnancy

Polycystic ovary syndrome (PCOS), a common hormone imbalance that impacts 1 in 10 menstruating people, is often associated with infertility (1). And while PCOS can lead to more difficult conception journeys due to irregular ovulation, many people with PCOS are absolutely capable of getting pregnant, especially if they learn how to more effectively manage their condition. Something that is not talked about too often, though, is what happens once you do get pregnant with PCOS. 

Trying to conceive may be a bit more nuanced with PCOS, and the same goes for pregnancy as well. In this article, we will focus on these potential complications for PCOS pregnancies. Read on to learn: 

• What are pregnancy complications associated with PCOS?
• ‍Why does PCOS put me at an increased risk for these complications?
• How do I optimize the health of myself and my baby during pregnancy if I have PCOS? 
  

Pregnancy complications associated with PCOS

If you have PCOS, you are at an increased risk of pregnancy complications such as miscarriages, preeclampsia, gestational diabetes, and preterm birth. 

While these risks may sound scary, having knowledge about issues that you are at a heightened chance of developing due to PCOS can be empowering. While many PCOS pregnancies progress with no complications at all, being aware of warning signs of the below risks can help you be a better advocate for yourself should something go awry.  

Pregnancy loss (miscarriage)

Researchers have reported that PCOS increases the risk of pregnancy loss, with as many as 30% to 50% of PCOS pregnancies ending in miscarriage (2). 

Pregnancy loss rates can be impacted by a number of PCOS-related factors. These include insulin resistance or raised insulin levels, higher luteinizing hormone (LH) levels that are induced by elevated insulin, elevated testosterone levels, obesity, infertility treatments, and genetic abnormalities (2). Low levels of progesterone, which can lead to implantation issues and early miscarriage, have also been linked to PCOS. 

Gestational diabetes

Pregnancy-related gestational diabetes is a type of diabetes that develops in people who did not have diabetes prior to their pregnancy. In the United States, gestational diabetes affects approximately 2% to 10% of pregnancies each year. The condition occurs when your body is not able to make enough insulin during pregnancy (3). 

When pregnant, people need two to three times more insulin to properly convert blood sugar into energy for their body’s functions. A person with insulin resistance may be unable to deal with this additional demand for insulin. If this occurs, their blood glucose levels may be too high, leading to diabetes (4).

The risk of gestational diabetes increases with PCOS according to many studies. During pregnancy, gestational diabetes can also cause high blood pressure, or preeclampsia. This may increase your risk of having a large baby that must be delivered through a c-section. Furthermore, gestational diabetes increases your risk of developing type 2 diabetes. In fact, more than half of pregnant people who develop gestational diabetes develop type 2 diabetes in the future (3).

Preeclampsia

Preeclampsia is a sudden rise in blood pressure during pregnancy. With preeclampsia, your high blood pressure prevents the fetus from getting enough oxygen and nutrients due to reduced blood flow. Additionally, preeclampsia can harm the mothers kidneys, liver, and brain (5). 

Preeclampsia is usually diagnosed during the second trimester. During a prenatal visit, blood pressure and urine are checked. If your blood pressure is considered elevated, which is usually a reading of 140/90 or higher, further testing will be done by the healthcare provider such as a urine culture to identify protein in the urine, which is another possible indicator of preeclampsia (6). People with preeclampsia can also experience eclampsia, which is an onset of seizures. In this case, immediate treatment is necessary. In some cases, early delivery is necessary to relieve the symptoms of preeclampsia and eclampsia and protect the mother’s health (6).

Preterm birth

A premature baby is born before 37 weeks of gestation. Both after birth as well as later in life, preterm infants may suffer from a variety of health problems  (6). Research has shown that people with PCOS are at a higher risk of having a premature birth. The most common reason for preterm birth is preeclampsia. The risk of preterm birth may also be increased by underlying maternal comorbidities such as older age, obesity, prediabetes, chronic hypertension, and fertility treatments (7).

Having a healthy pregnancy with PCOS

Although there are many risks associated with both PCOS and pregnancy, the risk can be reduced through the proper treatment and by having a healthcare provider monitor you continuously.

Some lifestyle changes to consider are incorporating exercise, stress management, improving food choices, and receiving appropriate prenatal care. There are also medicatIons that can help reduce risk of pregnancy complications.

A few examples of ways to optimize your PCOS pregnancy are below.

Nutrition

Nutrition is key when it comes to a healthy pregnancy. When pregnant, you need more of certain nutrients such as protein, iron, folic acid, and iodine. It may be best to eat an anti-inflammatory diet for those with PCOS, but nutrition is not a one-size-fits-all solution. In general, you want to make sure you consume sufficient calories during your pregnancy. Include a variety of fruits and vegetables in your diet, as well as good quality proteins and healthy fats. Working with a nutrition specialist like a certified nutrition specialist (CNS) or registered dietitian (RD) who specializes in maternal health is a helpful way to make sure you are fueling yourself properly and minimizing risks of pregnancy complications. 

Stress management

The adrenal glands produce cortisol, a hormone that regulates stress. Although some cortisol may be good, chronic stress can lead to abnormal levels. The presence of high cortisol levels can result in pregnancy complications; therefore, practicing stress management techniques such as meditation, deep breathing, journaling, or yoga can be beneficial.

If it is financially feasible for you, working with a therapist 1-1 also may be a helpful tool for minimizing stress and working through difficult emotions during your pregnancy. 

Movement

Incorporating exercise in your routine has been shown to help with weight management, sleep, mood and energy levels, gut troubles like constipation and bloating, swelling, and back aches. In addition, following a regular exercise program can reduce the risk of developing gestational diabetes, preterm birth, and a c-section. 

It is important to not overdo it when exercising while pregnant. Generally, 30 minutes of mild to moderate exercise daily is considered safe. Be sure to consult your healthcare provider about different types of movement that may be right for you. 

Prenatal supplements

Be sure to talk with your physician about what supplements may be right for you during pregnancy. Often-used supplements that you can bring up to start the conversation include folic acid, which protects against birth defects of the brain and spine,  iron, and iodine.

If you show signs of developing a more serious pregnancy risk such as gestational diabetes or preeclampsia, there are a variety of more-targeted supplements that may help. For example, preeclampsia has also been shown to be treated and prevented with magnesium sulfate (which can be purchased over the counter, but do not self-administer this while pregnant without speaking with your doctor) (8). Studies have also shown that commonly-recommended PCOS supplements that help control blood sugar such as myo-inositol are tolerated during pregnancy, but make sure to speak with your doctor before adding anything new to your routine (9).

It is also essential to have regular checkups with your doctor, midwife, or nurse throughout your pregnancy to ensure that you are not exhibiting any symptoms of a deficiency that could cause bothersome symptoms or put you or your baby at risk.

Medication

In addition to lifestyle changes, your doctor may recommend you start metformin or insulin injections if you develop gestational diabetes. In addition to magnesium sulfate, your doctor also may recommend a blood pressure-related medication for preeclampsia (8). If low progesterone is the suspected cause of early miscarriage, supplementing with vaginally-administered progesterone has also been shown to be helpful.

Minimizing PCOS pregnancy risks is possible

In conclusion, while PCOS may increase your chances of pregnancy complications, they can be prevented. 

Being aware of the various complications you are at risk for can be an empowering tool to advocate for yourself if you feel like something is “off” as well as having early conversations with your doctor about issues your hormones predispose you to. Finding a healthcare provider you trust is of the utmost importance during your pregnancy journey.  

If you are a Pollie member and need additional support during your pregnancy, you can reach out to your nutritionist or health coach for guidance.

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Sources

1. Polycystic ovary syndrome. Polycystic ovary syndrome | Office on Women's Health. (2019, April 1). Retrieved March 3, 2022, from https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome 
2. Nicole Galan, R. N. (2020, July 6). Does your PCOS diagnosis mean you are at higher risk for miscarriage? Verywell Health. Retrieved March 3, 2022, from https://www.verywellhealth.com/pcos-miscarriage-rate-what-are-the-risks-factors-2616653 
3. Gestational Diabetes. (2021, August 10). Gestational diabetes. Centers for Disease Control and Prevention. Retrieved March 3, 2022, from https://www.cdc.gov/diabetes/basics/gestational.html 
4. Gestational diabetes. Pregnancy, Birth and Baby. (2021, October). Retrieved March 3, 2022, from https://www.pregnancybirthbaby.org.au/gestational-diabetes 
5. U.S. Department of Health and Human Services. (2017, January 21). Preeclampsia and Eclampsia. National Institute of Child Health and Human Development. Retrieved March 3, 2022, from https://www.nichd.nih.gov/health/topics/preeclampsia 
6. U.S. Department of Health and Human Services. (2017, January 31). How do health care providers diagnose preeclampsia, eclampsia, and Hellp syndrome? National Institute of Child Health and Human Development. Retrieved March 3, 2022, from https://www.nichd.nih.gov/health/topics/preeclampsia/conditioninfo/diagnosed 
7. Signs of Premature Labor. Pregnancy, Birth and Baby. (2021, May). Retrieved March 3, 2022, from https://www.pregnancybirthbaby.org.au/signs-of-premature-labour 
8. Tahir F, Majid Z (September 16, 2019) Inositol Supplementation in the Prevention of Gestational Diabetes Mellitus. Cureus 11(9): e5671. doi:10.7759/cureus.5671

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