Pcos and early pregnancy

Pregnant with PCOS - Here's Everything You Need to Know

For many women with PCOS, getting pregnant is a major step and a reason to celebrate! While the challenges of PCOS persist with pregnancy, there are measures you can take to increase your chances of a normal pregnancy. Especially during pregnancy, it’s essential to stay in close contact with your doctors and PCOS care team. Here are some first points about PCOS and pregnancy you may be interested in learning about, however your doctor and care team will know what will work best for you and your situation, so make sure you note down any questions you may have for the next visit. 

Now let’s dive right in:

Pregnant women with PCOS need to be more alert than women without PCOS for possible complications. It is well-known that PCOS puts women at higher risk for complications during pregnancy and delivery.¹ The two main complications that are associated with PCOS are increased risk for a miscarriage in early pregnancy and gestational diabetes.

Women with PCOS are three times more likely to experience a miscarriage in the first trimester of pregnancy than women without PCOS.² Some women with PCOS may already have diabetes prior to pregnancy and many are vulnerable to gestational diabetes. The rate of C-section deliveries is also higher in women with PCOS.

However, the risk for some pregnancy complications can be prevented by maintaining a healthy weight and limiting the amount of weight gain before and during pregnancy.

A meta-analysis in 2006 found that PCOS can increase the risk of gestational diabetes, pregnancy-induced hypertension (PIH), preeclampsia, and preterm birth.⁴ This may also be connected to the fact that women with PCOS will most likely have other pre-existing medical conditions, such as hyperandrogenemia, hyperinsulinemia, and obesity. 

Several studies show an increase in the chance for miscarriage in women with PCOS, but other researchers attribute the increase to other factors such as obesity, increased age, and use of fertility treatments. ^5,6 

In addition, women treated with ovulation-inducing medications may have a higher risk of spontaneous miscarriage compared with normally ovulating women.⁷ Metformin can be used to reduce miscarriage risk in pregnant women with PCOS. It is classified as a Category B drug, which means that it does not cause fetal abnormalities in animal studies. Make sure to check your treatment plan and all the medications and supplements you are taking with your doctor and care team.

Gestational diabetes mellitus (GDM) is an increase in the mother’s blood sugar levels during pregnancy, which typically resolves after the birth of the baby.⁸ However, there is a good chance that you will develop it again in future pregnancies. This type of diabetes usually occurs during the last half of pregnancy. Gestational diabetes is different from diabetes mellitus as the latter is more severe and does not go away after pregnancy.  

In healthy women, blood insulin levels typically increase up to three times during pregnancy. The increase is about sevenfold in women with PCOS. Increased blood sugar in the mother can cause fetal anomalies and even miscarriage. 

Infants of mothers with GDM are often larger than other babies, resulting in the need for cesarean delivery. Taking metformin before and after a pregnancy reduces the rate of GDM to 7 percent. 

Pre-eclampsia is described as a dangerous rise in blood pressure during pregnancy, accompanied by swelling of the legs and the presence of protein in the urine. When left untreated it can turn into eclampsia, causing kidney and liver damage, seizures, and in rare cases, even death. Maintaining normal blood pressure is the most important preventive measure you can take. If you notice any change in your well-being during pregnancy, make sure to check in with your doctor and care team. 

This type of hypertension usually develops about halfway through the pregnancy. Unlike pre-eclampsia and eclampsia, there are no proteins excreted in the urine. Blood pressure often normalizes two to three months after delivery. 

Lowering your high blood pressure, losing at least 10 percent of your weight if you are overweight or obese, and regular exercise can reduce your risk of developing gestational hypertension. 

The rate of preterm delivery is increased in women with PCOS, particularly those with high androgen levels in the blood.⁹  The rate is higher by 67% for multiple pregnancies. Causes of preterm delivery are preterm labor, incompetent cervix, and hypertensive complications, among others.

The risk for pregnancy and neonatal complications are high in women with PCOS, which often leads to cesarean or C-section delivery. In an observational study involving 9,068 women with PCOS, 27.7% of PCOS births were delivered by cesarean section compared with 23. 7% of controls.¹⁰ Birth through C-section has its own risks for both the mother and the baby. 

Before becoming pregnant it’s important to prepare your body and keep it in a healthy condition. It may be difficult to take extra steps to improve your health, but it will greatly benefit the outcome of your pregnancy and your child’s well-being. 

Recent findings suggest that following a healthy lifestyle reduces pregnancy-related complications in PCOS.¹¹ It is advisable to stop drinking alcoholic beverages and, of course, to stop smoking if you are planning to conceive. 

When you are pregnant, make sure to work closely with your doctors and PCOS care team, presumably, your obstetrician or fertility specialist, endocrinologist, and dietitian. Your healthcare providers will guide your medical care before, during and after your pregnancy journey. Check in with them any time you feel changes in your well-being, or have any questions or concerns, as they know you and your situation best.  

Sources:

1. Kjerulff LE, Sanchez-Ramos L, Duffy D. Pregnancy outcomes in women with polycystic ovary syndrome: a meta-analysis. Am J Obstet Gynecol 2011;204:558.e1-6.
2. Jakubowicz, D. J., Iuorno, M. J., Jakubowicz, S., Roberts, K. A., & Nestler, J. E. (2002). Effects of metformin on early pregnancy loss in polycystic ovary syndrome. Journal of Clinical Endocrinology and Metabolism, 87(2), 524–529.
3. Sivalingam VN, Myers J, Nicholas S, Balen AH, Crosbie EJ. Metformin in reproductive health, pregnancy and gynaecological cancer: established and emerging indications. Hum Reprod Update. 2014;20:853–68.)
4. Boomsma CM, Eijkemans MJC, Huges EG, et al. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Hum Reprod Update 2006;12:673-83. for the European society of human reproduction and embryology(Eshre). Hum Reprod. 2018;33(9):1586-1601. doi:10.1093/humrep/dey242
5. Joham AE, Boyle JA, Ranasinha S, Zoungas S, Teede HJ. Contraception use and pregnancy outcome in women with polycystic ovary syndrome: data from the Australian Longitudinal Study on Women’s Health. Hum Reprod. 2014;29(4):802-8.
6. Hudecova M, Olovsson JH, Poromaa IS. Long-term follow-up of patients with polycystic ovary syndrome: reproductive outcome and ovarian reserve. Hum Reprod. 2009;24(5):1176-83.
7. Schindler AE. REVIEW – Pregnancy failure after spontaneous conception or ovulation induction: endocrine causes and treatment. Published online December 31, 2004. Accessed June 23, 2020. https://tspace.library.utoronto.ca/handle/1807/7415
8. WHO recommendation on the diagnosis of gestational diabetes in pregnancy | RHL. Accessed June 23, 2020. https://extranet.who.int/rhl/topics/preconception-pregnancy-childbirth-and-postpartum-care/antenatal-care/who-recommendation-diagnosis-gestational-diabetes-pregnancy-0
9. Joham AE, Palomba S and Hart R. Polycystic ovary syndrome, obesity, and pregnancy. Semin Reprod Med 2016 34(2): 93–101.
10. Rees DA, Jenkins-Jones S, Morgan CL. Contemporary Reproductive Outcomes for Patients With Polycystic Ovary Syndrome: A Retrospective Observational Study. J Clin Endocrinol Metab. 2016;101(4):1664-1672. doi:10.1210/jc.2015-2682
11. Bahri Khomami M, Moran LJ, Kenny L, et al. Lifestyle and pregnancy complications in polycystic ovary syndrome: The SCOPE cohort study. Clin Endocrinol. 2019;90(6):814-821. doi:10.1111/cen.13954

Polycystic ovarian syndrome (PCOS) and pregnancy – symptoms and treatments

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What is PCOS?

Polycystic ovarian syndrome, or PCOS, is a common condition.

People with PCOS can have:

• higher than normal levels of androgens (male-type hormones)
• problems with ovulation (the release of eggs from the ovaries)
• multiple cysts on the ovaries

This can affect your menstrual cycle, fertility and appearance.

If you have PCOS you may struggle to become pregnant and may be at higher risk of developing some pregnancy complications.

What are the symptoms of PCOS?

There are many signs and symptoms that are associated with PCOS. These can include:

• irregular menstrual periods
• cysts on the ovaries
• infertility
• weight gain
• acne
• depression
• excessive face and body hair
• thinning or balding head hair
• insulin resistance (where your cells don't respond to insulin and your blood sugar levels rise)

Some of these symptoms (such as acne, excess face and body hair, and scalp hair loss) are due to increased levels of the hormones called androgens. These hormones are found in all females, but those with PCOS have slightly higher amounts.

CHECK YOUR SYMPTOMS — If you are feeling unwell and not sure what to do next, check your symptoms using the healthdirect Symptom Checker tool.

How is PCOS diagnosed?

It often takes a while to get a PCOS diagnosis. This is because the condition can mimic other problems. Sometimes, people only find out that they have PCOS when they have tests to find out why they are having trouble getting pregnant.

If you think you might have PCOS, see your doctor. Early diagnosis means that your symptoms can be treated early.

At your appointment, your doctor will:

• ask about your symptoms
• ask for your medical history
• examine you

Your doctor may also recommend blood tests and an ultrasound scan to look for any cysts in the ovaries.

In general, to be diagnosed with PCOS, you need to have 2 out of 3 of the following;

• irregular periods, or no periods
• symptoms due to increased levels of androgen hormones, or a blood test showing you have increased levels of androgen hormones
• an ultrasound scan showing multiple cysts on your ovary or ovaries

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Will PCOS affect my fertility?

If you have PCOS, you might struggle to get pregnant.

Fortunately, with lifestyle changes or infertility treatment, most people with PCOS can become pregnant. Talk to your doctor or fertility specialist for individual advice for your situation.

Can PCOS increase my risk of complications during pregnancy?

Having PCOS can increase your risk of some complications during pregnancy, such as:

• high blood pressure
• gestational diabetes
• premature birth

If you have PCOS, you are also at increased risk of having a baby larger than expected for their gestational age. This comes with a higher risk of needing a caesarean delivery.

Babies born to people with PCOS have a higher chance of being admitted to a newborn intensive care unit.

Pregnant women with PCOS may have a higher risk of miscarriage and stillbirth. However, more research is needed in this area.

If you have PCOS and are pregnant, it is important you talk with your doctor. The risk of these complications can be reduced by monitoring your PCOS symptoms and taking extra care during your pregnancy.

What steps can I take to look after my health?

You can make lifestyle changes to manage your PCOS and look after your health. These include:

• maintaining a healthy weight
• eating healthily
• exercising
• managing stress
• getting enough sleep

These lifestyle changes can reduce the symptoms of PCOS and improve your chance of falling pregnant.

If you are overweight, a 5% to 10% loss in weight can increase your fertility.

Speak to your doctor for guidance on how to make effective lifestyle changes.

How is PCOS treated?

Treatment for PCOS depends on each person. Speak to your doctor about the best treatment for you.

If you are trying to fall pregnant, your PCOS treatment will focus on:

• restoring regular ovulation
• weight loss
• improving your general health and wellbeing

If you have made lifestyle changes and are still struggling to fall pregnant, your doctor may order fertility tests. They may also prescribe fertility medicines to help you ovulate. In some cases, they may recommend surgery.

Another possibility is in vitro fertilisation (IVF), which offers the best chance of conception. However, this can be expensive and is usually only considered when all other options have been unsuccessful.

If you are not trying to fall pregnant, your PCOS treatment will focus on:

• reducing your symptoms
• reducing your risk of long-term health issues, including heart disease and type 2 diabetes

Speak to your doctor. They can help you manage your PCOS symptoms by providing:

• weight loss management strategies
• treatment for sleeping problems
• acne treatment
• medicines, including hormonal contraception (birth control) to manage irregular menstruation

Dealing with infertility and PCOS symptoms can be difficult. You may experience feelings of depression and anxiety. Your doctor can refer you to a counsellor or psychologist for your mental health.

Resources and support

Visit the Jean Hailes website for more information on PCOS and its complications.

Hormones Australia also supplies information on PCOS, including questions to ask your doctor.

Speak to a maternal child health nurse

Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available 7am to midnight (AET), 7 days a week.

Sources:

Learn more here about the development and quality assurance of healthdirect content.

Last reviewed: July 2022

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Polycystic Ovary Syndrome (PCOS) | Your Fertility

PCOS can be associated with a range of symptoms including irregular periods and difficulties getting pregnant

Read more on Your Fertility website