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PCOS and Pregnancy: how PCOS affects being pregnant

Polycystic ovary syndrome (PCOS) is a common condition that affects how a person’s ovaries work, with symptoms often including irregular periods or no periods and excessive hair growth. Given the complex nature of PCOS, people diagnosed with this condition may face a unique set of challenges when it comes to pregnancy. It can not only influence the ability to conceive but also impact the course and outcome of pregnancy.

Pregnancy in people with PCOS is usually associated with higher rates of complications such as gestational diabetes, pregnancy-induced hypertension, and preterm birth. Despite these challenges, many individuals with PCOS successfully conceive and have healthy pregnancies. Healthcare providers might suggest lifestyle changes, medications, or other treatments to improve fertility outcomes and reduce the risk of complications. As research advances, the understanding of PCOS and its relationship with pregnancy continues to evolve, bringing new insights into effective management strategies for expecting parents with the condition.

Key Takeaways

  • PCOS is a common hormonal disorder affecting ovarian function, contributing to reproductive and metabolic challenges.
  • Individuals with PCOS may face increased risks of pregnancy complications, which necessitates close monitoring.
  • Proper management strategies can improve fertility outcomes for individuals with PCOS, reducing the risk of pregnancy-related complications.

What is PCOS?

Polycystic ovary syndrome (PCOS) is a health condition characterised by hormonal imbalances and metabolism issues which can affect the overall health and appearance of those diagnosed. It is one of the most common endocrine disorders, impacting various aspects of health, including the menstrual cycle and fertility.

Symptoms of PCOS include:

  • Irregular or anovulatory menstrual cycles, resulting in less frequent or missed periods
  • Higher levels of androgens (male hormones), which may cause physical signs such as excess facial or body hair, alopecia (hair loss on the head), oily skin and acne
  • Polycystic ovaries, where the ovaries may be enlarged and contain many fluid-filled sacs (follicles) which surround the eggs

The cause of PCOS is not completely understood but is believed to involve a combination of genetic and environmental factors. Hormones are intricately involved in the onset of PCOS; individuals may have increased levels of androgens like testosterone or high levels of insulin, contributing to excess insulin production.

The hormonal imbalances typically lead to issues with the regulation of the menstrual cycle, affecting ovulation and the frequency of regular periods. The imbalance of hormones such as follicle-stimulating hormone can prevent the development and release of mature eggs, leading to the condition known as anovulation.

Diagnosis typically involves the Rotterdam criteria, which requires at least two of the following for a diagnosis of PCOS:

  1. Irregular ovulation or anovulation
  2. Clinical or laboratory evidence of high androgens
  3. Polycystic ovaries visible on ultrasound

People with PCOS may also experience insulin resistance, which prompts the pancreas to produce even more insulin. This excess insulin is believed to increase androgen production, further affecting the menstrual cycle and fertility.

The impact of PCOS on fertility

Polycystic ovary syndrome (PCOS) is linked to a variety of factors that can impact fertility in individuals. This condition is characterised by an imbalance of reproductive hormones, which can lead to a variety of symptoms that interfere with the reproductive system’s normal functioning.

Hormonal Imbalance: PCOS commonly involves elevated levels of androgens (often referred to as “male hormones”), which can disrupt the ovarian cycle and prevent regular ovulation.

Irregular Menstruation: Many people with PCOS experience irregular menstrual cycles. As a direct consequence, pinpointing the fertile window becomes challenging, which can delay conception for those seeking to become pregnant.

Insulin Resistance: A significant number of individuals with PCOS have insulin resistance, which can lead to higher insulin levels. This can further exacerbate hormonal imbalance, making it difficult to achieve and maintain a viable pregnancy.

Each individual’s situation is unique, and while PCOS presents challenges to fertility, many have successfully attained pregnancy through various tailored treatment plans following lifestyle adjustments and medical interventions.

>> Read More | PCOS and Fertility: the ultimate guide to conception

PCOS pregnancy complications: what are the risks?

Unfortunately living with PCOS increases the risk of certain health conditions during pregnancy for both parent and baby. Ensure you inform your healthcare provider that you have PCOS so you can be supported during your pregnancy.

High blood pressure

High blood pressure (hypertension) is common during pregnancy, specifically during the mid to later stages. The incidence of high blood pressure in pregnant people with PCOS is much higher than that of those without PCOS.

This is likely to be related to hormonal irregularities and insulin resistance in people with PCOS.

Gestational diabetes

Pregnancy can often lead to gestational diabetes, especially in those with PCOS. Maintaining blood sugar levels is crucial for the health of the parent and foetus.

People with PCOS have a higher risk of developing gestational diabetes during pregnancy. This is because of the higher incidence of insulin resistance seen in people with PCOS.

Before or early in the pregnancy your medical team will invite you for an oral glucose tolerance test (OGTT). You will do another OGTT at 24-28 weeks of pregnancy too.

People usually recover from gestational diabetes post-pregnancy. Monitoring by your doctor and medical team is essential.

Preeclampsia

It does appear that people with PCOS are at an increased risk of developing preeclampsia. Preeclampsia is a sudden increase in blood pressure after the 20th week of pregnancy. This can impact the parent’s kidneys, brain, and liver.

It is not yet understood why people pregnant with PCOS have an increased risk of preeclampsia and an independent correlation between the two has not been found.

Cesarean or C-section delivery

The risk of requiring a cesarean delivery, commonly known as a C-section, is higher in pregnancies complicated by PCOS. This is because of the risk of early birth and high blood pressure in pregnant people with PCOS. This can take more time to recover from and may carry more risks for the parent and baby.

Early birth

PCOS may lead to early birth, which can necessitate care in a neonatal intensive care unit to support the newborn’s development. Babies delivered before 37 weeks are considered early births or preterm deliveries. People with PCOS are at risk of early births and this is likely linked to a variety of factors. These include preeclampsia, insulin resistance, hypertension or fertility treatments.

Miscarriage

Unfortunately, people with PCOS are 3 times more likely to suffer from early miscarriage than those without PCOS. This may be because of a variety of factors including the use of fertility treatments or the higher age of conception commonly seen in people with PCOS.

Hormonal balance may influence the likelihood of miscarriage too. Raised insulin resistance, higher LH levels and elevated testosterone levels plus low progesterone levels are linked to PCOS and miscarriage.

Precautions to take during pregnancy with PCOS

Pregnancy for those with polycystic ovary syndrome (PCOS) calls for specific precautions to optimise health outcomes. Focused attention on supplements, nutrition, physical activity, and emotional support is essential.

Pregnancy supplements

People with PCOS may require additional supplements to support a healthy pregnancy. It’s important to consult with a healthcare provider to determine the right supplements, which could include:

  • Folic Acid: Essential for foetal development, at least 400 micrograms daily for the first 12 weeks of pregnancy.
  • Vitamin D: Enhances bone health and immune function. Aim for 10 micrograms per day.

Nutrition during pregnancy

Nutrition plays a vital role in managing PCOS during pregnancy. Key nutritional strategies involve high-fibre foods to stabilise blood sugar, such as whole grains and legumes plus lean proteins like chicken, fish, or tofu to support muscle growth and repair.

Some foods should be avoided during pregnancy:

  • Certain cheese: Avoid soft cheeses with a white rind, such as brie and camembert, and soft blue cheeses like gorgonzola and Roquefort unless they’re cooked until steaming hot. These can contain listeria, a bacteria that could harm your baby.
  • Pate: All types of pate should be avoided, again because of the listeria risk.
  • Raw or partially cooked eggs: Make sure eggs are thoroughly cooked until the whites and yolks are solid to prevent the risk of salmonella. In the UK, eggs with the Red Lion stamp have a very low risk of salmonella and can be eaten runny or raw in pregnancy.
  • Raw or undercooked meat: Avoid raw or undercooked meat, especially poultry and meats like sausages or minced meat. Be particularly cautious with cured meats like salami, chorizo, and pepperoni. There’s also a risk of toxoplasmosis from undercooked meat.
  • Liver products: Avoid liver and liver products such as liver pâté or liver sausage, as they may contain a lot of vitamin A, which can be harmful to the baby.
  • Game meats: Some game meats like goose, partridge or pheasant may be shot with lead pellets and are best avoided or eaten in limited amounts during pregnancy.
  • High-mercury fish: Fish with high levels of mercury should be avoided. This includes shark, swordfish, and marlin. Also, limit the amount of oily fish you eat to no more than two portions a week.
  • Raw shellfish: Avoid raw shellfish to reduce the risk of food poisoning, which can be particularly unpleasant during pregnancy.
  • Unpasteurized milk: Avoid unpasteurized milk and dairy products made from it to reduce the risk of listeriosis.
  • Excess caffeine: Limit caffeine intake to no more than 200 milligrams per day – the equivalent of two cups of instant coffee. High levels of caffeine may result in babies having a low birth weight.
  • Alcohol: The NHS advises that the safest approach is to avoid alcohol altogether to minimize the risk to the baby. Drinking alcohol, especially in the first three months of pregnancy, increases the risk of miscarriage, premature birth, and your baby having a low birth weight.
  • Certain fish: Besides high-mercury fish, pregnant women should also avoid having more than two portions of oily fish a week (such as salmon, trout, mackerel, and herring) and should avoid eating some types of fish such as swordfish, marlin, and shark completely. Tuna should be limited to no more than two fresh steaks or four medium cans per week because of mercury content.
  • Some supplements and herbal remedies: Some vitamins and supplements are not safe to take while you’re pregnant, including vitamin A, which can harm your baby. Additionally, some herbal remedies can be unsafe during pregnancy, so it’s important to consult a healthcare professional before using them.
  • Foods with soil on them: Ensure all fruits and vegetables are washed thoroughly to remove any soil or dirt, which could contain toxoplasma, a parasite that can cause toxoplasmosis.

Movement during pregnancy

Physical activity is beneficial for people with PCOS during pregnancy, but it’s important to listen to your body and your healthcare team to choose movement that is safe for you and your baby. Recommended activities include swimming as it is gentle on the joints and helps reduce swelling as well as prenatal yoga which improves flexibility and blood circulation, and reduces stress.

Long-term health concerns associated with PCOS

Polycystic ovary syndrome (PCOS) is a hormonal condition that can lead to several long-term health complications. People with PCOS are often at a higher risk of developing type 2 diabetes due to the commonality of insulin resistance associated with this syndrome. This condition impairs the body’s ability to utilise insulin effectively, leading to elevated blood glucose levels.

In terms of reproductive health, there is an associated risk of endometrial cancer. The irregular menstruation often seen in PCOS can result in a thickened endometrium, which may increase cancer risk.

Risk FactorConcern Related to PCOS
Insulin ResistanceThis leads to a higher risk of type 2 diabetes
High Blood PressureMay cause hypertension and related complications
High CholesterolElevates the risk of heart disease
Menstrual IrregularityIncreases the likelihood of endometrial cancer

Management of these long-term health implications involves a multidimensional approach, including lifestyle modifications and possibly medical interventions. Regular screenings, an active lifestyle, a balanced diet, and medication can help mitigate these risks. Careful monitoring of one’s health is crucial for individuals with PCOS to prevent and address these potential long-term concerns.

Frequently Asked Questions: Pregnancy and PCOS

Understanding the intersection between PCOS and pregnancy is crucial for expecting individuals to manage the condition. These FAQs provide targeted information to navigate the complexities of pregnancy with PCOS.

Are there any specific precautions to consider during a pregnancy if I have PCOS?

Individuals with PCOS should be aware of the increased risk of certain pregnancy complications, such as gestational diabetes and hypertensive disorders. Close monitoring and proactive management with healthcare professionals are recommended.

What symptoms might indicate pregnancy in individuals with PCOS?

Symptoms of pregnancy for those with PCOS do not differ greatly from those without the condition. However, due to irregular menstrual cycles associated with PCOS, recognising symptoms such as nausea or fatigue becomes integral in acknowledging the early stages of pregnancy.

Does PCOS categorise as a high-risk factor during pregnancy, and what implications does it have for prenatal care?

PCOS is considered a high-risk factor in pregnancy, necessitating more frequent monitoring during prenatal care to manage and mitigate potential complications such as preterm birth and miscarriage.

Does pregnancy improve PCOS symptoms?

There is a possibility for an improvement in PCOS symptoms during pregnancy for some individuals, yet this is not the case universally. Hormonal fluctuations during pregnancy may temporarily alter how PCOS manifests. However, symptom management should be assessed on a case-by-case basis.

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Alex Okell ANutr Founder and Editor

Founder and Editor | Registered Associate Nutritionist

  Founder of Be The Collective LTD [The PCOS Collective & The Endo Collective] Alex Okell ANutr is a London-based reproductive health nutritionist with experience in research, private practice and digital media. She holds a Master’s degree in Nutrition from King’s College London and has co-authored papers with the University of Cambridge, King’s College London, The Food Foundation and the Food Standards Agency. Alex offers 1:1 PCOS support in our virtual PCOS clinic.

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