Polycystic ovarian syndrome (PCOS) is a hormonal disorder that can cause abnormally long or infrequent menstrual periods, an excess of male (androgen) hormone levels, and follicles on the ovaries, which can prevent eggs from regularly being released. It’s more common and severe in people who carry extra weight.
The exact causes of PCOS are unknown, but research has uncovered several theories as to why it may occur. It may be triggered by an excess of insulin, which can increase the production of androgen and hinder ovulation. PCOS may also be due to low-grade inflammation, which can trigger androgen production. Additionally, there may be a hereditary component.
PCOS doesn’t just make for an irregular, uncomfortable period. It can have a variety of health complications, including diabetes, sleep apnea, depression, and endometrial cancer. It also raises the risk of fertility problems and adverse birth outcomes, like miscarriage and premature delivery.
Below, we explore the ways PCOS can affect pregnancy, so you can know what to expect.
Getting Pregnant With PCOS Is Harder
Fertility issues are common in people diagnosed with PCOS. Flo Health estimates that up to 70% of women with this condition struggle to become pregnant.
Since PCOS is a hormonal disorder, it directly impacts ovulation and thus the ability to get pregnant. People with PCOS produce higher levels of the hormone androgen, which is typically present in higher quantities in male bodies. But when a female body produces too much androgen, it prevents the ovaries from releasing eggs regularly. If no egg is released during the menstrual cycle, there’s nothing for the sperm to fertilize, thus preventing pregnancy from occurring.
As such, people with PCOS often have to seek external help in order to become pregnant. There are a variety of options available, including the following:
- Regulating your period: some women take birth control of progestin-only pills in order to help regulate their menstrual cycle by reducing androgen production.
- Medications: some women will be prescribed certain medications that can help stimulate ovulation (like Clomiphene, Metformin, or letrozole).
- Lifestyle changes: making certain changes to your diet and fitness routine can help regulate your menstrual cycle, as carrying extra weight can exacerbate the symptoms of PCOS. It also helps to avoid smoking, drinking, and stressful situations when trying to manage PCOS.
- Reproductive assistance: many women who struggle to conceive because of PCOS choose fertility assistance to increase their likelihood of getting pregnant, like IVF and/or hormone treatments.
Many people with PCOS find it helpful to work with a fertility specialist to determine the biggest factors impeding their ability to conceive and the best options available to them.
Higher Risk Of Pregnancy Complications
Even after getting pregnant, the challenges for people with PCOS don’t always stop there. Polycystic ovarian syndrome has been linked to a higher risk of pregnancy complications and adverse birth outcomes, including the following.
Miscarriages are pregnancy losses that happen on or before 20 weeks of gestation. As the NICHD reports, some research has found that the risk of miscarriage is three times higher for women who’ve been diagnosed with PCOS.
This is thought to be because people with PCOS have lower levels of the hormone progesterone, which ensures the endometrium lining is thick enough to support the implantation and development of an embryo. But when the lining is compromised due to low levels of progesterone, it heightens the risk of experiencing an early miscarriage.
While some studies have found that taking a medication known as metformin can reduce this risk, the results aren’t conclusive.
Gestational diabetes refers to diabetes that’s diagnosed during pregnancy and usually goes away post-birth. PCOS is one of many risk factors that can make a woman more susceptible to developing gestational diabetes.
With proper treatment and control, people with gestational diabetes can have healthy pregnancies. But it does pose a series of maternal and fetal health risks, like:
- Large birth weight
- Premature delivery
- Need for a c-section
- Fetal respiratory issues
- Low blood sugar in baby
- Future maternal diabetes
- Higher risk of obesity in offspring
- Maternal high blood pressure and preeclampsia
Preeclampsia is characterized by high blood pressure in pregnancy, which can lead to organ damage (often to the liver and kidney) if not treated and controlled. It’s most common after 20 weeks of gestation and can occur in women who had normal blood pressure prior to and during pregnancy.
Preeclampsia poses a variety of risks to fetal and maternal health, including the following:
- Premature birth
- Placental abruption
- HELLP syndrome
- Fetal growth restriction
- Maternal heart problems
- Maternal organ damage
People with PCOS are more likely to experience high blood pressure in pregnancy, which can result in preeclampsia if it becomes more serious. This can result in eclampsia, a severe complication of preeclampsia that can include the onset of seizures and comas in pregnant women with severe preeclampsia.
Babies that are delivered before 37 weeks of gestation are considered premature. Women with PCOS are more likely to go into labor pre-term, which holds a multitude of risks for the baby, who will be underdeveloped, including:
- Cerebral palsy
- Hearing loss
- Dental problems
- Vision problems
- Issues with metabolism
- Temperature control issues
- Learning disabilities or delays
- Behavioral or psychological problems
- Immune system, breathing, blood, heart, and/or brain problems
Premature births also raise the risk of adverse outcomes for mothers, including traumatic birth experiences, which can heighten the risk for mental health problems, like postpartum depression (PPD).
Need for C-section.
Since PCOS often leads to high blood pressure in pregnancy, this raises the likelihood of requiring a c-section. Not only can this lead a mother’s birth plan to go awry, but it can be harder to recover from than a vaginal delivery.
C-sections also carry risks for both the mother and baby, such as:
- Blood clots
- Maternal infection
- Fetal surgical injury
- Postpartum hemorrhage
- Breathing problems in infant
- Higher risk of needing c-section in future pregnancies
Remember – PCOS may be more common than you think. Women’s Health reports that 10% of all women of childbearing age are diagnosed with polycystic ovarian syndrome, and the majority of these women struggle with fertility as a result.
But there are treatment options and many people with PCOS go on to have healthy pregnancies and babies. Research has found that people with and without PCOS tend to have the same number of children across their life and that the majority of women with PCOS give birth at least once without the need for fertility treatments.
For more information on how PCOS affects fertility and pregnancy, please speak with your doctor.
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