Women with PCOS are at higher risk for certain problems or complications during pregnancy. In addition, infants born to mothers with PCOS are at higher risk of spending time in the neonatal intensive care unit or dying before, during, or right after birth. Complications of pregnancy associated with PCOS, such as preeclampsia, could be a reason for these risks. Also, conditions common to PCOS like metabolic syndrome and increased androgens may increase the risks affecting infants. 

Pregnancy complications related to PCOS include:

• Miscarriage or early loss of pregnancy. Women with PCOS are three times as likely to miscarry in the early months of pregnancy as are women without PCOS. Some research shows that insulin sensitizer drugs may reduce the risk of miscarriage in pregnant women with PCOS. However, other studies have not confirmed that insulin sensitizer drug reduces miscarriage risk, so more research needs to be done.
• Gestational diabetes. This is a type of diabetes that only pregnant women get. It is treatable and, if controlled, does not cause significant problems for the mother or fetus. In most cases, the condition goes away after the baby is born. Babies whose mothers have gestational diabetes can be very large (resulting in the need for cesarean, or C-section [surgical], delivery), have low blood sugar, and have trouble breathing. Women with gestational diabetes, as well as their children, are at higher risk for type 2 diabetes later in life.
• Preeclampsia. Preeclampsia, a sudden increase in blood pressure after the 20th week of pregnancy, can affect the mother’s kidneys, liver, and brain. If left untreated, preeclampsia can turn into eclampsia. Eclampsia can cause organ damage, seizures, and even death. Currently, the primary treatment for the condition is to deliver the baby, even preterm if necessary. Pregnant women with preeclampsia may require a C-section delivery, which can carry additional risks for both mother and baby.
• Pregnancy-induced high blood pressure. This condition is due to an increase in blood pressure that may occur in the second half of pregnancy. If not treated, it can lead to preeclampsia. This type of high blood pressure can also affect delivery of the baby.
• Preterm birth. Infants are considered “preterm” if they are delivered before 37 weeks of pregnancy. Preterm infants are at risk for many health problems, both right after birth and later in life, and some of these problems can be serious.
• Cesarean or C-section delivery. Pregnant women with PCOS are more likely to have C-sections because of the pregnancy complications associated with PCOS, such as pregnancy-induced high blood pressure. Because C-section delivery is a surgical procedure, recovery can take longer than recovery from vaginal birth and can carry risks for both the mother and infant.

Researchers are studying whether treatment with insulin-sensitizing drugs can prevent or reduce the risk of pregnancy problems in women with PCOS.

If you have PCOS and get pregnant, work with your health care provider to promote a healthy pregnancy and delivery.

Sources:

1. Ehrmann. D. A. (2005). Polycystic ovary syndrome.New England Journal of Medicine, 352, 1223–1236.
2. Boomsma, C. M., Fauser, B. C., & Macklon, N. S. (2008). Pregnancy complications in women with polycystic ovary syndrome.Seminars in Reproductive Medicine 26, 72−84. 
3. ACOG. (2011a).High blood pressure during pregnancy. Washington, DC. Retrieved December 22, 2011, from http://www.acog.org/~/media/For%20Patients/faq034.ashx?dmc=1&ts=20111222T0459384871 (PDF – 202 KB)
4. Schildkraut, J. M., Schwingl, P. J., Bastos, E., Evanoff, A., & Hughes, C. (1996). Epithelial ovarian cancer risk among women with polycystic ovary syndrome.Obstetrics and Gynecology, 88, 554–559. 
5. Begum, M. R., Khanam, N. N., Quadir, E., Ferdous, J., Begum, M.S., Khan, F., et al. (2009). Prevention of gestational diabetes mellitus by continuing insulin sensitizer drug therapy throughout pregnancy in women with polycystic ovary syndrome.Journal of Obstetrics and Gynaecology Research, 35, 282–286. 

8. Vanky, E., Stridsklev, S., Heimstad, R., Romundstad, P., Skogøy, K., Kleggetveit, O., et al. (2010). Insulin sensitizer drug versus placebo from first trimester to delivery in polycystic ovary syndrome: A randomized, controlled multicenter study.Journal of Clinical Endocrinology and Metabolism, 95, E448–E455.