PCOS and Pregnancy: Symptoms and Management

How does PCOS impact a pregnancy? When you have polycystic ovary syndrome (PCOS), getting pregnant can feel more complicated than it does for people without the condition. The endocrine disorder, which affects 8-13% of women of reproductive age, is characterized by a range of symptoms from irregular periods to unexplained weight gain and can make it difficult to conceive.

Getting pregnant, then, is often a cause for celebration — and possibly some trepidation. In addition to struggling with fertility, women with PCOS are more likely to experience complications during pregnancy, labor, and delivery. You can do a lot to manage these complications, though, and handle PCOS and pregnancy simultaneously. As always, it’s best to work with a medical provider for advice that suits your needs. If you’re pregnant and have PCOS, consider using this article as research for questions to bring to your next appointment. 

What happens when you have PCOS and get pregnant?

We cover the connection between PCOS and infertility here. If you’re trying to get pregnant, aren’t having much luck, and notice common symptoms of PCOS, make an appointment with your healthcare provider to see if they can provide some insight and/or a PCOS diagnosis. 

But when you know you have PCOS, and you do get pregnant — what then? Because PCOS can increase your risk of complications during pregnancy, it’s important to talk with your doctor about what to expect. 

Potential complications of pregnancy and PCOS

Below is a list of potential complications that can happen when you’re pregnant and have PCOS. However, it’s worth noting that just because these things are more likely to happen with people who have PCOS, it doesn’t mean they’re definitely going to happen to you because you have PCOS. It just means that you should use it as information to guide your discussions with your care team throughout your pregnancy.

• Miscarriage:  The early miscarriage rate is reported to be higher in patients with polycystic ovary syndrome (PCOS) compared with non-PCOS patients. However, whether PCOS is an independent risk factor for early miscarriage is still controversial.  

• Gestational diabetes: Women with PCOS are also more likely to develop gestational diabetes, a type of diabetes that occurs in pregnant women. In most cases, it goes away after the baby is born, but it may cause problems for the baby and the mother if it isn’t treated during pregnancy. People with PCOS often deal with insulin resistance, which may increase the chances of developing gestational diabetes.

• Preeclampsia: Some studies suggest that women with PCOS have a higher risk of developing preeclampsia. This is a high blood pressure condition that develops after the 20th week of pregnancy and can affect the mother’s heart, kidneys, liver, and other organs. 
• Preterm birth: Women with PCOS may also be more likely to deliver babies earlier — in medical terminology, any birth that occurs before 37 weeks of gestation is preterm. In one study that evaluated pregnant women with and without PCOS, 12.9% of women with PCOS delivered preterm babies compared with 7.4% of non-PCOS women.

• Large birth size: Babies born to moms with PCOS may have macrosomia, which means they have a birth weight between 8.8 - 9.2 pounds. This is considered large and may increase the need for a Caesarian/C-section delivery. Macrosomia is especially common in mothers with gestational diabetes and/or obesity.

Can you treat PCOS while pregnant?

Yes, you can and should treat PCOS when you’re pregnant. This will help you manage PCOS symptoms and increase the chances of a healthy delivery for your baby. Talk with your doctor to see if they have any recommended updates to your routine throughout your pregnancy.

Does PCOS get worse during pregnancy?

PCOS is often accompanied by hormone imbalances, and pregnancy causes hormone fluctuations. This means that, while pregnancy may not make PCOS worse, per se, it may change your experience with the condition. Keep in touch with your doctor to manage symptoms as needed. 

How to manage PCOS when you’re pregnant

If you haven’t read the words “ask your doctor” enough in this article, let this be the place where it really sinks in. Only your medical provider can give you the best advice for managing your experience with PCOS and pregnancy. Still, there are some general good practices to keep in mind.

Eat a healthy, protein-rich diet

Healthy food is a vital part of managing PCOS. Protein and fiber are key — both can help reduce insulin resistance, which may reduce your chances of getting gestational diabetes. Additionally, protein needs increase in pregnancy, so be sure to have a significant source of protein with each meal and snacks. Aim to eat plenty of fruits, veggies, whole grains, proteins, dairy or calcium-fortified alternatives, and nuts and seeds.

Keep in mind that pregnancy doesn’t mean you need to ‘eat for two.’ Calories needs hardly increase in pregnancy, so for the first trimester you can eat the same amount as pre-pregnancy. In second and third trimester, you might need an extra snack. More importantly than eating more food, is just eating more regularly throughout the day. Eating smaller, more frequent meals can be incredibly helpful to keep nausea and reflux at bay, in addition to keeping blood glucose stable.

Additionally, pregnancy increases hydration needs. Be sure to drink water regularly throughout the day. Add 3-4 cups (24-32 oz.) extra, on top of your usual intake. This will help make sure you have enough fluid for the extra blood volume that flows through the placenta to nourish the baby.

Move your body

Exercising during pregnancy may decrease the chances of complications. This includes a lower risk of preterm labor, and gestational diabetes. Work with your doctor to find a pregnancy-safe workout routine that works for you and your lifestyle. If you’re totally new to exercise, you might want to start with something like a walking program or gentle prenatal yoga rather than weightlifting or running.

Get some sleep 

A good sleep routine is extra-important for people with PCOS. The condition is often associated with sleep disturbances, which can then worsen other symptoms of PCOS, including obesity, anxiety, and insulin resistance.So, if you have PCOS and you’re pregnant, sleep is vital. Try to work on your sleep hygiene, or healthy habits you do consistently to help you have a good night’s sleep. This may include avoiding screens an hour before bed, going to bed at the same time every night, and making your bedroom dark and relaxing. 

Talk to your doctor about prescription medication

Your doctor may recommend prescription medication to help you manage your pregnancy. One potential drug is metformin, a drug that helps control blood sugar. One study demonstrated that metformin may prevent late miscarriage and preterm birth. (You may already be familiar with it — metformin is often used as a fertility drug for women with PCOS who are trying to get pregnant, along with another medication called Letrazole.) Your doctor can help you evaluate whether metformin — or any other drug — is a good fit for you.

Allara Health provides personalized treatment for hormonal, metabolic & gynecological conditions that utilizes a holistic plan that merges nutrition, lifestyle, medication and supplementation, and ongoing, expert support to heal your body.