PCOS in Pregnancy
UPDATED: SEPTEMBER 2025
When people with PCOS become pregnant, this may lead to some pregnancy complications. Complications are dependent on which PCOS criteria the pregnant person fulfilled prior to pregnancy.
Polycystic ovary syndrome (PCOS) is the most common hormonal disorder in reproductive-aged women. To be diagnosed with PCOS, you need at least 2 of the 3 following criteria:
Delayed ovulation or irregular menstrual cycles (oligomenorrhea)
High androgenic hormones like testosterone, or the presence of hirsutism (male-pattern hair growth)
Polycystic ovaries on ultrasound, or serum anti-Müllerian hormone (AMH) in adults.
Although not a criteria of PCOS, insulin resistance is also a hallmark of PCOS. High insulin (known as hyperinsulinemia) is more prevalent when features of high androgens (like testosterone) are present.
PCOS and Pregnancy Complications
Studies show that women with PCOS often have increased odds of pregnancy complications including:
Miscarriage
During pregnancy, miscarriage is more frequent in those with PCOS. It's specifically influenced by BMI. High androgens as well as high insulin levels cause inflammation within the body that may lead to difficulties in embryo implantation, miscarriage and adverse pregnancy outcomes, some of which are outlined below.
Gestational Diabetes
Gestational diabetes is pregnancy-induced diabetes, that usually resolves in the postpartum (but leads to an increased risk of developing type 2 diabetes as early as 3 years after that index pregnancy). Studies show that women with PCOS have a 3x higher chance of gestational diabetes, often from high androgen levels.
Risk Factors for developing gestational diabetes are:
Over 35 years old
Pre-pregnancy BMI is over 30 kg/m2
Ethnicity (Aboriginal, African, Asian, Hispanic, South Asian)
Family history of diabetes - this is one of the strongest risk factors
Polycystic ovary syndrome, and acanthosis nigricans (a skin condition causing hyperpigmentation of skin, especially in the folds)
Corticosteroid use
Previous diagnosis of gestational diabetes - this is one of the strongest risk factors
Previous 'big' baby
Around 24-28 weeks, pregnant people are offered screening for gestational diabetes. However, if there's a high risk of gestational diabetes based on the above risk factors, screening or testing may be offered earlier and then repeated at 24-28 weeks if it was normal.
Gestational Hypertension
Gestational hypertension is the development of increased blood pressure in pregnancy, without the presence of protein in the urine or other organ complications. Studies show that the odds of developing gestational hypertension were higher in women with PCOS compared with women without PCOS.
Preeclampsia
Preeclampsia is pregnancy-induced high blood pressure and protein in the urine, or other adverse symptoms; at or after 20 weeks gestation. Studies show that women with PCOS have a 3x higher chance of preeclampsia due to high androgen levels.
Symptoms of pre-eclampsia include:
Persistent headache
Visual disturbances
Abdominal pain at the upper right quadrant
Nausea and/or vomiting
Chest pain/shortness of breath
Risk factors in developing preeclampsia are:
Antiphospholipid antibodies
Previous preeclampsia
Pre-existing diabetes
Family history of preeclampsia
Increased pre-pregnancy BMI
If you are early in your pregnancy (ex. before 16 weeks), talk to your obstetrical care provider to determine if aspirin prophylaxis is suitable for you.
C-Section
The odds of cesarean section were higher in women with PCOS compared with women without PCOS. I’ve had many clients who have had a c-section mention that they never considered that their labour would result in one. I believe that while most people strive for vaginal births, it’s important to recognize that sometimes labour doesn’t go how we expect, and preparing for the possibility of a c-section may be helpful.
Blood Work to Consider
If you're planning on becoming pregnant or are in the early stages of pregnancy, it may be worthwhile to do some blood work to assess your risk of some of the above complications and possibly decrease them. These include:
Complete blood count
Blood lipids
Fasting insulin and fasting glucose, HbA1c
Free testosterone, total testosterone, Sex hormone binding globulin (SHBG)
Final Thoughts
If you’re heading into pregnancy with a PCOS diagnosis, lifestyle modifications are the first-line treatment for everyone. This includes being counselled on weight management including diet and exercise recommendations. A naturopathic doctor is well-positioned to support you throughout your pregnancy, to help reduce your risk of developing pregnancy complications.