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PCOS in Pregnancy

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March 20, 2020

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:

  1. Delayed ovulation or irregular menstrual cycles (oligomenorrhea)
  2. High androgenic hormones like testosterone
  3. Polycystic ovaries on ultrasound

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

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. Studies show that women with PCOS have a 3x higher chance of gestational diabetes, 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
  • Polycystic ovary syndrome, and acanthosis nigricans (a skin condition causing hyperpigmentation of skin, especially in the folds)
  • Corticosteroid use
  • Previous diagnosis of gestational diabetes
  • 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.

Pre-eclampsia

Pre-eclampsia is pregnancy-induced high blood pressure (formally known as hypertension) 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 pre-eclampsia 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 pre-eclampsia
  • Pre-existing diabetes
  • Family history of pre-eclampsia
  • Raised pre-pregnancy BMI

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 and possibly decrease it.

  • Complete blood count
  • Blood lipids
  • Fasting insulin and fasting glucose
  • Free testosterone, total testosterone, Sex hormone binding globulin (SHBG)

Final Thoughts

Unfortunately there isn’t much treatment for people who have PCOS during pregnancy, although adopting a healthy diet and physical activity is recommended – check with your health care provider to see what’s right for you.

References

Christ, J., Gunning, M., Meun, C., Eijkemans, M., van Rijn, B., & Bonsel, G. et al. (2018). Pre-Conception Characteristics Predict Obstetrical and Neonatal Outcomes in Women With Polycystic Ovary Syndrome. The Journal Of Clinical Endocrinology & Metabolism104(3), 809-818. doi: 10.1210/jc.2018-01787

GESTATIONAL DIABETES MELLITUS: A review for midwives. Retrieved 20 March 2020, from https://www.ontariomidwives.ca/sites/default/files/Gestational-diabetes-mellitus-backgrounder-PUB_0.pdf

Hart, R. (2019). Generational Health Impact of PCOS on Women and their Children. Medical Sciences7(3), 49. doi: 10.3390/medsci7030049

Hypertensive Disorders of Pregnancy. Retrieved 19 March 2020, from https://www.ontariomidwives.ca/sites/default/files/CPG%20supplemental%20resources/HDP%20Summary.pdf

Palomba, S., de Wilde, M., Falbo, A., Koster, M., La Sala, G., & Fauser, B. (2015). Pregnancy complications in women with polycystic ovary syndrome. Human Reproduction Update21(5), 575-592. doi: 10.1093/humupd/dmv029

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