PCOS and Pregnancy: What You Need to Know

Originally published 09/11/2021. Updated for accuracy and relevancy on 11/17/2023

There are many ways to have a successful pregnancy while having PCOS. This article will review what you need to know about pregnancy and PCOS. 

By OBGYN and fertility expert Dr. Kenosha Gleaton

Polycystic ovary syndrome or polycystic ovarian syndrome (PCOS) is the most common endocrine disorder affecting nearly one in 15 women of reproductive age. Evidence shows that pregnant women with PCOS face significantly higher long-term health risks for both the mother and baby.¹ Pregnant women with PCOS are at a higher risk for gestational diabetes, pregnancy-induced hypertension, and preeclampsia. Their babies are at an increased risk of neonatal complications, including preterm birth and an admission to a neonatal intensive care unit for extra care. That being said, there are many ways to have a successful and healthy pregnancy while having PCOS. This article will review what you need to know about pregnancy and PCOS.

How Long Does It Take to Get Pregnant With PCOS?

Women  often face challenges in getting pregnant with PCOS. If you are under the age of 35 and have a regular menstrual cycle and ovulation schedule, along with a healthy partner, the likelihood of getting pregnant within a year is very high (90%). One thing you can do to increase chances of getting pregnant is begin using ovulation tests to track your ovulation and pinpoint your fertile window. Check out our guide on when to have sex during ovulation to help! However, if you are not ovulating or if you have irregular cycles, talk to your doctor about the best course of action.

Successful Pregnancies With PCOS

While women with PCOS may face challenges, there are ways to improve your chances of a successful and healthy pregnancy. This includes:

• Eating mostly healthy foods (fruits, vegetables, whole grains), and limiting junk food and red meat 
• Establishing a regular exercise routine
• Maintaining a healthy weight (Read How Much Weight Should I Gain During Pregnancy?)
• Checking your blood sugar and blood pressure  to make sure your levels stay in a healthy range
• Adhering to any medication or supplement routine recommended by your OBGYN

It’s important to consult with your doctor about your individual situation and any suggestions they have to mitigate risks. 

Pregnancy Risks Associated With PCOS

Some of the risks associated with PCOS pregnancy include gestational diabetes, hypertension, preterm birth, and preeclampsia. PCOS can affect a woman's insulin resistance, which can lead to obesity. Pregnant women who suffer from obesity are at an increased risk of gestational diabetes, which affects anywhere from 5-40% of women with PCOS.² The risks associated with other obstetric complications are estimated at 10-30% for gestational hypertension, 8-15% for pre-eclampsia and 6-15% for preterm delivery.

PCOS Increases the Risk of Gestational Diabetes

Diabetes during pregnancy is an increased concern for PCOS women. Gestational diabetes occurs when your body doesn’t make enough insulin during your pregnancy.³ Insulin is a hormone made by your pancreas that functions as a key to let blood sugar into the cells for use as energy. Pregnancy changes can cause your body’s cells to use insulin less effectively, which is called insulin resistance. Insulin resistance increases your body’s need for insulin.

All pregnant women have some insulin resistance during late pregnancy. However, some women, especially those who have been diagnosed with PCOS, have insulin resistance even before they get pregnant. Because of the increased need for insulin, they are more likely to have gestational diabetes. In fact, studies show that PCOS patients have a 2.4X increased odds of gestational diabetes, regardless of age, race, and if they are carrying one baby or twins.⁴ This is because PCOS is associated with high blood sugar and insulin resistance. If you become pregnant with PCOS, it is likely that you will be tested for gestational diabetes earlier than at the routine 24-28 weeks.

Studies show that PCOS women have more than 2 fold increased odds of gestational diabetes.

A systematic review of four randomized controlled trials found that taking a myo-inositol supplement was associated with lower rates of gestational diabetes in pregnancy, from 28% in women who did not take the supplement, to between 8% and 18% in the women who took it. However the quality of the evidence was deemed low.⁵

PCOS and Vitamin D Deficiency

In women with PCOS, 67-85% have a vitamin D deficiency which can worsen other symptoms including insulin resistance, ovulation and menstrual cycle irregularities, and infertility among others.⁶ If you are wondering how to calculate ovulation for irregular  periods, we’re here to help. PCOS patients receiving fertility treatment in the form of medications who have a vitamin D deficiency are less likely to ovulate and can have a 40% lower chance of live births compared to women who have regular vitamin D levels.⁷

One study looked at the impact of vitamin D supplementation on AMH levels for women with and without PCOS.⁸AMH (Anti-Müllerian hormone) is an ovarian biomarker that may be used to assess a woman’s egg count. AMH levels can be two to three times higher for women with PCOS.⁹ AMH levels were found to decrease after vitamin D supplementation for women with PCOS. [8]

PCOS and Twins

Women with PCOS may be more likely to have multiples (twins, or more). One study found that while the multiple pregnancy rate is 1.1% in the average population, it is 9.1% for PCOS patients.¹⁰ This is likely partly due to the fact that women with PCOS may need ovulation induction medication to conceive, which increases the chances of having twins.

The risk of preterm birth is higher for both women with PCOS and women carrying twins, therefore most OBGYNs will ensure appropriate monitoring for fetal health.¹¹

Take Aways

Women with PCOS may face challenges when it comes to fertility and pregnancy, but there are steps you can take in order to have a healthy and happy pregnancy. With the help of your OBGYN and a healthy lifestyle, women with PCOS can have successful pregnancies. Check out our wide range of fertility products to help get started with your pregnancy journey!

Sources: 

1. Boomsma C, Fauser B, Macklon N. Pregnancy Complications in Women with Polycystic Ovary Syndrome. Seminars in Reproductive Medicine. 2008;26(1):072-084. doi:https://doi.org/10.1055/s-2007-992927 
2. GHAZEERI GS, NASSAR AH, YOUNES Z, AWWAD JT. Pregnancy outcomes and the effect of metformin treatment in women with polycystic ovary syndrome: an overview. Acta Obstetricia et Gynecologica Scandinavica. 2012;91(6):658-678. doi:https://doi.org/10.1111/j.1600-0412.2012.01385.x 
3. CDC. Gestational Diabetes. Centers for Disease Control and Prevention. Published August 10, 2021. https://www.cdc.gov/diabetes/basics/gestational.html 
4. Lo JC, Feigenbaum SL, Escobar GJ, Yang J, Crites YM, Ferrara A. Increased Prevalence of Gestational Diabetes Mellitus Among Women With Diagnosed Polycystic Ovary Syndrome: A population-based study. Diabetes Care. 2006;29(8):1915-1917. doi:https://doi.org/10.2337/dc06-0877 
5. Motuhifonua SK, Lin L, Alsweiler J, Crawford TJ, Crowther CA. Taking myo-inositol as a dietary supplement during pregnancy to prevent the development of gestational diabetes. www.cochrane.org. Published February 15, 2023. Accessed October 18, 2023. https://www.cochrane.org/CD011507/PREG_taking-myo-inositol-dietary-supplement-during-pregnancy-prevent-development-gestational-diabetes 
6. Wu MH, Lin MW. The role of vitamin D in polycystic ovary syndrome. Indian Journal of Medical Research. 2015;142(3):238. doi:https://doi.org/10.4103/0971-5916.166527 
7. Specialists CF. Vitamin D Deficiency and PCOS. Coastal Fertility Specialists. Published May 19, 2020. Accessed October 18, 2023. https://www.coastalfertilityspecialists.com/resources/blog/vitamin-d-deficiency-and-pcos/ 
8. Moridi I, Chen A, Tal O, Tal R. The Association between Vitamin D and Anti-Müllerian Hormone: A Systematic Review and Meta-Analysis. Nutrients. 2020;12(6):1567. doi:https://doi.org/10.3390/nu12061567
9. Yue C, Lu L, Meng L, Zhang QL, Ying C. Threshold value of anti-Mullerian hormone for the diagnosis of polycystic ovary syndrome in Chinese women. PLOS ONE. 2018;13(8):e0203129-e0203129. doi:https://doi.org/10.1371/journal.pone.0203129
10. Mikola M. Obstetric outcome in women with polycystic ovarian syndrome. Human Reproduction. 2001;16(2):226-229. doi:https://doi.org/10.1093/humrep/16.2.226 
11. Løvvik T, Wikström A-K, Neovius M, Stephansson O, Roos N, Vanky E. Pregnancy and perinatal outcomes in women with polycystic ovary syndrome and twin births: a population-based cohort study. BJOG: An International Journal of Obstetrics & Gynaecology. 2015;122(10):1295-1302. doi:https://doi.org/10.1111/1471-0528.13339