PCOS & Pregnancy Complications: What should be done?

Women with polycystic ovarian syndrome(PCOS) who are pregnant need to be more cautious about potential complications as compared to women without PCOS. It is widely known that women with PCOS are more likely to experience problems during pregnancy and delivery. An increased chance of early pregnancy loss and gestational diabetes are the two main side effects of PCOS in pregnancy.

However, maintaining a healthy weight and controlling weight gain before and throughout pregnancy can reduce the risk for several pregnancy problems.

What are the other pregnancy complications in women with PCOS?

Women with PCOS and their prenatal babies are more likely to face specific complications, such as:

• Miscarriage: Numerous studies indicate that women with PCOS have an increased risk of miscarriage, although some researchers link this risk to other elements such as obesity, advanced age, and the usage of fertility treatments. An increased risk of unexpected miscarriage may also occur in women taking ovulation-inducing medications as compared to those women who ovulate regularly. Some studies have shown that  intake of tablet metformin can lower the risk of miscarriage in pregnant women with PCOS.
• Gestational Diabetes: An increase in the mother’s blood sugar levels during pregnancy is known as gestational diabetes mellitus (GDM). This kind of diabetes typically develops in the second half of pregnancy and blood sugar levels return to normal after 12 weeks of pregnancy. However,if the blood sugar level remains high even after 12 weeks of delivery then the patient has Diabetes mellitus.These patients have increased chances of developing GDM in future pregnancies and also are at higher risk of suffering from diabetes in future. GDM-affected mothers frequently have larger-than-average babies and thus are at higher risk for cesarean delivery. Metformin usage before and during pregnancy lowers the rate of developing gestational diabetes in patients with PCOS.
• Preeclampsia: Pre-eclampsia is defined as a new onset of increase in blood pressure during pregnancy after 20 weeks of gestational age and proteinuria, that is protein in the urine, or a new onset of increase in blood pressure during pregnancy after 20 weeks of gestational age with end organ dysfunction with or without proteinuria. Patients may or may not have any symptoms  like swelling of legs and/or hands, excessive weight gain, headache etc. It is a serious disorder which can develop into eclampsia if untreated, which can lead to kidney and liver damage, seizures, and in rare instances, even death. The most crucial preventive step you can take is to keep your blood pressure within normal limits. Make sure to check in with your doctor if you experience any changes in your health while pregnant.
• Gestational Hypertension: Gestational Hypertension is a pregnancy-related high blood pressure after 20 weeks of gestational age. Unlike preeclampsia there are no proteins excreted in the urine. Twelve weeks following delivery, blood pressure frequently returns to normal. Your chance of developing gestational hypertension can be reduced by lowering your high blood pressure, losing at least 10% of your weight pre-conception  if you are overweight or obese, and engaging in regular exercise.
• Preterm Birth: Women with PCOS are more likely to deliver preterm babies, especially if their blood levels of androgen are high. This risk is increased in cases of multiple pregnancies. Multiple pregnancy, history of previous preterm delivery, incompetent cervix, and hypertensive disorders are a few of the factors that contribute to preterm birth.
• Cesarean Delivery: Women with PCOS have a higher risk of pregnancy and neonatal problems, which frequently requires cesarean or C-section delivery. 

What care do women with PCOS need during pregnancy?

• Regular Exercise: Walking for 10 to 20 minutes after eating can help manage postprandial hyperglycemia, which in turn helps manage blood pressure and insulin resistance. Additionally, yoga has been proven to be particularly useful in enhancing PCOS and fertility. It’s essential to remember that while yoga won’t treat PCOS, it will make you feel closer to your body, help you get your hormones back in check, and possibly even improve blood flow to your pelvis.
• Balanced diet : A nutritionist can be consulted for a balanced diet. This personalised healthy eating plan makes sure you obtain the nutrients you need, put on the proper amount of weight, and keep your blood sugar under control. The most crucial thing is to make sure your diet is full of foods rich in essential nutrients, and has balanced carbohydrates, fat and  protein. Your best bet is to stay away from processed and junk food.
• You may require frequent visits to the doctor during pregnancy so that if needed timely diagnosis and treatment of complications can be made.As discussed above, intake of tablet metformin plays an important role in preventing complications secondary to PCOS in pregnancy. Thus, it is important to take this medicine regularly along with other medication in the prescribed dose by your doctor.
• Blood sugar: Glucose tolerance test is recommended for all pregnant females who are at risk of developing diabetes in pregnancy for example patients with obesity, history of GDM in previous pregnancy or family history of diabetes. Even if the glucose tolerance test comes within normal limits, it is important to check blood sugar values regularly if you are at high risk for developing GDM. Ask your doctor what your blood glucose readings should be. 
• Blood Pressure: Your blood pressure is usually checked at every visit to the hospital. However, it is better if you can monitor your blood pressure if you are at high risk of developing hypertension in pregnancy or preeclampsia for early diagnosis and treatment. Consult your obstetrician if the readings at home are coming higher than normal range.

It’s crucial to prepare your body and maintain its health before getting pregnant. Although it may be challenging, making additional efforts to enhance your health will have a positive impact on both the result of your pregnancy and the wellbeing of your unborn child.

While PCOS may affect your fertility and pregnancy, conception and a healthy pregnancy is still possible with the correct care and treatment!