PCOS Pregnancy and Delivery Complications

Women with PCOS are at higher risk for pregnancy and delivery complications. These include a three-fold increase in miscarriage risk in early pregnancy compared to women without PCOS, gestational diabetes (diabetes during pregnancy) which can lead to large babies, preeclampsia which is characterized by sudden elevated blood pressure and body swelling after the 20th week of pregnancy, preterm birth, and C-section delivery.

Diabetes during pregnancy is a concern many women with PCOS must face. The following information is published with permission from the Hormone Health Network, the public education arm of the Endocrine Society. It has been extracted from the Diabetes and Pregnancy patient guide.

What care do you need during pregnancy?

Blood glucose. While pregnant, you will probably need to check your blood sugar more often than before pregnancy. Check your blood sugar as often as your doctor recommends. You should probably test it before meals, one or two hours after a meal, at bedtime, and during the night.

Ask your doctor what your blood glucose numbers should be. Most pregnant women with diabetes should aim for these blood sugar levels as long as they do not cause low blood sugar:

Before meals (fasting blood glucose)
One hour after the start of a meal: 140 mg/dL or less Two hours after the start of a meal: 120 mg/dL or less

Insulin. If you were already using an insulin pump before pregnancy, you should keep using it. You probably should not start using an insulin pump for the first time during pregnancy. But if other types of insulin treatment do not control your blood sugar, your doctor may want you to switch to an insulin pump.

Medical nutrition therapy. You should see a dietitian for nutrition therapy. This healthy eating plan, tailored to you, helps make sure you get the nutrients you need and gain the right amount of weight, while controlling your blood sugar. The dietitian may suggest you limit the amount of carbohydrates, or “carbs” (for instance, potatoes, bread, and fruit), that you eat. It is a good idea to eat three small meals and two to four snacks a day. Your dietitian also will advise how often to eat and how many calories to eat a day.

Vitamins. Your doctor likely will decrease the dose of folic acid you take once you finish your first trimester of pregnancy (week 12). Most often, the recommended dose of folic acid is 0.4 mg (400 micrograms) to 1 mg per day through the rest of pregnancy and until you stop breastfeeding. Ask your doctor what other prenatal vitamins you need.

Will you be able to breastfeed?

Women with diabetes are encouraged to breastfeed their baby. Breastfeeding lowers your baby’s risk for childhood obesity and for type 2 diabetes later in life. Women with gestational diabetes have an increased risk of developing type 2 diabetes; breastfeeding seems to lower that risk. It also may help you lose the weight you gained during pregnancy!

Insulin is safe for breastfeeding women. If you take metformin or glyburide pills to treat type 2 diabetes, you can safely continue taking these medications while breastfeeding.

What can you do to help have a healthy baby?

You can help ensure your baby’s health and your own health. Work with your obstetrician and your diabetes specialist to get proper medical care before, during, and after pregnancy. Take your diabetes medicine as prescribed and keep your blood sugar in control. Follow the healthy eating plan that you made with your health care team. Also, be physically active. Ask your doctor what type of activity is best for you.

The good news is that with careful planning, proper medical care, and good self-care, you can have a safe pregnancy and a healthy baby.