PCOS and Pregnancy: What Every Woman Should Know

By Dr. Gueye-Weinstein, MD, MPH, FACOG

As an obstetrician-gynecologist, one of the most common concerns I hear from my patients is about managing PCOS during pregnancy. If you're one of the 10-15% of women of reproductive age living with Polycystic Ovary Syndrome, you may be wondering how this condition will affect your pregnancy journey. Let me share what I've learned through years of practice and help you understand what to expect.

The Reality About PCOS and Fertility

First, let me address the elephant in the room: yes, PCOS can make conception more challenging, but it doesn't make pregnancy impossible. In my practice, I've helped countless women with PCOS achieve healthy pregnancies. The key is understanding how PCOS affects your body and working together to optimize your health.

PCOS primarily affects fertility through irregular or absent ovulation. The hormonal imbalances—elevated androgens, insulin resistance, and disrupted hormone patterns—can disrupt your natural cycle. However, with the right approach, we can often restore ovulation and improve your chances of conception.

What I Tell My Patients About Pregnancy Risks

I believe in being honest with my patients about potential complications while emphasizing that knowledge is power. Women with PCOS do face some increased risks during pregnancy, but understanding these helps us monitor more closely and intervene early when needed.

Gestational Diabetes is probably my biggest concern. The insulin resistance that's often part of PCOS makes you 2-3 times more likely to develop gestational diabetes. That's why I recommend early screening—usually around 12-16 weeks instead of waiting until the standard 24-28 week mark.

High Blood Pressure and Preeclampsia are also more common. I monitor my PCOS patients' blood pressure closely throughout pregnancy, and I teach them the warning signs to watch for at home.

Early Pregnancy Loss rates are higher in the first trimester for women with PCOS. While this can be emotionally challenging, I want you to know that many women with PCOS go on to have successful pregnancies, even after experiencing a loss.

My Pre-Pregnancy Game Plan

When patients ask me about preparing for pregnancy with PCOS, I always start with what I call the "foundation first" approach:

Get Your Metabolic House in Order: I work with patients to optimize their insulin sensitivity through lifestyle changes and sometimes medication like metformin. Even a 5-10% weight loss can make a significant difference in ovulation and pregnancy outcomes.

Start Folic Acid Early: I recommend 400-800 micrograms daily, starting at least a month before you try to conceive. This simple step dramatically reduces the risk of neural tube defects.

Focus on Anti-Inflammatory Nutrition: I often refer patients to our registered dietitian who specializes in PCOS. The goal isn't a restrictive diet but rather a sustainable approach that supports hormonal balance.

Consider Fertility Support: If you're not ovulating regularly, we have excellent options. Medications like letrozole can often restore ovulation. I've found that addressing the underlying insulin resistance often improves the success of these treatments.

How I Manage PCOS During Pregnancy

Once you're pregnant, my approach becomes more intensive but in a good way—I want to catch any issues early when they're most treatable.

Enhanced Monitoring: You'll see me more frequently than my typical pregnancy patients. We'll do early diabetes screening, regular blood pressure checks, and additional ultrasounds to monitor your baby's growth.

The Metformin Question: This is something I discuss individually with each patient. Research suggests that continuing metformin during pregnancy may reduce complications, but the decision depends on your specific situation and comfort level.

Collaborative Care: I often work closely with maternal-fetal medicine specialists and endocrinologists to ensure you're getting comprehensive care.

After Your Baby Arrives

The PCOS journey doesn't end at delivery, and I make sure my patients understand what to expect postpartum.

Breastfeeding Benefits: I encourage breastfeeding when possible, as it can help improve insulin sensitivity and may delay the return of PCOS symptoms. However, some women with PCOS struggle with milk supply, and that's okay too—we have strategies to help.

Ongoing Health Monitoring: I recommend diabetes screening 6-12 weeks after delivery and annually thereafter. PCOS increases your long-term risk of diabetes and heart disease, so staying on top of your health is crucial.

Family Planning: We'll discuss contraception options that work well with PCOS, considering how different methods might affect your insulin sensitivity and hormone levels.

When to Call My Office

I always give my patients clear guidelines about when to seek immediate care. With PCOS, I'm particularly concerned about:

• Severe headaches or vision changes (possible preeclampsia)

• Persistent nausea and vomiting

• Decreased baby movement

• Any vaginal bleeding

• Severe abdominal pain

Don't hesitate to call—I'd rather see you for a false alarm than miss something important.

My Message of Hope

After years of caring for women with PCOS, I want you to know that while this condition requires more attention during pregnancy, it doesn't prevent you from having a healthy baby. Some of my most rewarding moments in practice have been holding the healthy babies of women who were told they might never conceive naturally.

The key is partnership. When we work together—with you being an active participant in your care and me providing the medical expertise and monitoring—we can navigate this journey successfully.

Your Next Steps

If you have PCOS and are thinking about pregnancy, I encourage you to schedule a preconception consultation. We can review your specific situation, optimize your health, and create a personalized plan for your pregnancy journey.

Remember, every woman with PCOS is unique. What works for one patient may not be right for another, which is why individualized care is so important. My job is to provide you with the knowledge, support, and medical care you need to achieve your goal of a healthy pregnancy and baby.

Dr. Gueye-Weinstein is a board-certified obstetrician-gynecologist with specialized training in functional medicine. She holds a Master's in Public Health and is a Fellow of the American College of Obstetricians and Gynecologists. She has extensive experience managing high-risk pregnancies and helping women with PCOS achieve their reproductive goals.

Ready to discuss get your PCOS reversed? Contact our office to schedule a consultation and take the first step toward your healthy pregnancy.