PCOS Pregnancy and Delivery Complications

PCOS and Pregnant? Questions Answered

Women with polycystic ovary syndrome (PCOS) are at higher risk for certain problems or complications during pregnancy. Some women may not realize they have PCOS until they try to conceive. PCOS often goes unnoticed until pregnancy. But if you’ve been trying to conceive naturally for over a year, you should speak to your doctor about getting tested.

Your doctor can help you develop a plan for getting pregnant. Some strategies, such as losing weight, healthy eating, and in certain cases, medications, can increase your chances of getting pregnant.

Women with PCOS are at higher risk for pregnancy and delivery complications. These include a three-fold increase in miscarriage risk in early PCOS pregnancy compared to women without PCOS, gestational diabetes (diabetes during pregnancy) which can lead to large babies, preeclampsia which is characterized by sudden elevated blood pressure and body swelling after the 20th week of pregnancy, preterm birth, and C-section delivery. 

If you develop preeclampsia during your pregnancy, you will have to be monitored extremely closely because it can affect the mother's kidneys, liver, and brain.

Diabetes during pregnancy is a concern many women with PCOS must face. If you develop gestational diabetes, insulin may be required to keep your blood sugar levels stable. Gestational diabetes could result in problems during delivery. For example, larger babies are more at risk for shoulder dystocia (when the baby’s shoulder gets stuck during labor).

The following information is published with permission from the Hormone Health Network, the public education arm of the Endocrine Society. It has been extracted from the Diabetes and Pregnancy patient guide.

What care do you need during pregnancy?

Blood glucose. While pregnant, you will probably need to check your blood sugar more often than before pregnancy. Check your blood sugar as often as your doctor recommends. You should probably test it before meals, one or two hours after a meal, at bedtime, and during the night.

Ask your doctor what your blood glucose numbers should be. Most pregnant women with diabetes should aim for these blood sugar levels as long as they do not cause low blood sugar:

Before meals (fasting blood glucose)

One hour after the start of a meal: 140 mg/dL or less

Two hours after the start of a meal: 120 mg/dL or less

Insulin. If you were already using an insulin pump before pregnancy, you should keep using it. You probably should not start using an insulin pump for the first time during pregnancy. But if other types of insulin treatment do not control your blood sugar, your doctor may want you to switch to an insulin pump.

Medical nutrition therapy. You should see a dietitian for nutrition therapy. This healthy eating plan, tailored to you, helps make sure you get the nutrients you need and gain the right amount of weight while controlling your blood sugar. 

The dietitian may suggest you limit the level of carbohydrates, or “carbs” (for instance, potatoes, bread, and fruit) that you eat. It is a good idea to eat three small meals and two to four snacks a day. Your dietitian also will advise how often to eat and how many calories to eat a day. 

The most important thing is to make sure your diet is full of nutrient-rich foods and adequate protein, and low on high-sugar foods. Avoiding junk food and processed foods is your best bet.

Proper medical management and medical nutrition therapy are imperative to prevent the onset of medical complications and optimize fetal growth and development. 

Exercise. Postmeal physical activity, such as walking for 10 to 20 minutes, can help manage blood pressure and insulin resistance by controlling postprandial hyperglycemia. 

Yoga has also been shown to be especially effective in improving fertility and PCOS. It’s important to understand that yoga will not cure your PCOS, but will help you feel more connected to your body, restore hormone balance, and can help increase blood circulation to the pelvic region.

Vitamins. Your doctor likely will decrease the dose of folic acid you take once you finish your first trimester of pregnancy (week 12). Most often, the recommended dose of folic acid is 0.4 mg (400 micrograms) to 1 mg per day through the rest of pregnancy and until you stop breastfeeding. Ask your doctor what other prenatal vitamins you need.

Will you be able to breastfeed?

If you’re diagnosed with PCOS, you may need to continue to manage symptoms even after pregnancy. But symptoms and severity can vary. Sometimes the hormonal fluctuations after pregnancy and breastfeeding can change the symptoms, so it may be a while before you settle into your new “normal.”

Women with diabetes are encouraged to breastfeed their babies. Breastfeeding lowers your baby’s risk for childhood obesity and for type 2 diabetes later in life. Women with gestational diabetes have an increased risk of developing type 2 diabetes, but breastfeeding seems to lower that risk. It also may help you lose the weight you gained during pregnancy!

Insulin is safe for breastfeeding women. If you take metformin or glyburide pills to treat type 2 diabetes, you can safely continue taking these medications while breastfeeding.

Trouble with Milk Supply?

Lactation consultants recommend that all women with PCOS pump after feedings for at least 10 to 15 minutes on each breast to help establish an adequate milk supply in the first two weeks of initiating nursing. 

Frequent feedings with full drainage can also help maximize milk production, as can consuming an adequate amount of food and fluid each day.

Milk supply problems may be prevented by establishing early intervention strategies during pregnancy. This may include obtaining resources for local breastfeeding support groups and preparing to work with a board-certified lactation consultant. Good breastfeeding management, including proper latch and positioning, are imperative to successful milk production and proper infant growth and development.

What Can You Do to Help Have a Healthy Baby?

There are some risks for your baby, including premature birth, growing unusually large for the gestational age, miscarriage, or lower Apgar score. If your baby is a girl, there is also a greater chance that she will develop PCOS.

You can help ensure your baby’s health and your own health. Work with your obstetrician and your diabetes specialist to get proper medical care before, during, and after pregnancy. Take your diabetes medicine as prescribed and keep your blood sugar under control. Follow the healthy eating plan that you made with your health care team. Also, be physically active. Ask your doctor what type of activity is best for you.

The good news is that with careful planning, proper medical care, and good self-care, you can have a safe PCOS pregnancy and healthy baby.