What Precautions To Take During Pregnancy With Pcos?

What Precautions To Take During Pregnancy With Pcos
Precautions to take during pregnancy with PCOS – Pregnant women with PCOS should exercise regularly and monitor their weight and blood sugar levels. Eating protein-rich foods can help to stabilize blood sugar levels. In addition, it’s essential to eat a healthy diet consisting of high fiber, whole grains and reduced carbohydrates and avoid caffeine, nicotine and alcoholic beverages.
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Is being pregnant with PCOS high risk?

Women with polycystic ovary syndrome (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.

  • 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.2, 3 Some research shows that metformin may reduce the risk of miscarriage in pregnant women with PCOS. However, other studies have not confirmed that metformin reduces miscarriage risk, so more research needs to be done.2, 4, 5
  • Gestational (pronounced je-STEY-shuhn-uhl) 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, 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 (pronounced pree-i-KLAMP-see-uh ). 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.5
  • 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.4, 6 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 such as metformin can prevent or reduce the risk of pregnancy problems in women with PCOS.3, 7, 8 If you have PCOS and get pregnant, work with your health care provider to promote a healthy pregnancy and delivery.
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How can I reduce my risk of miscarriage with PCOS?

Tips for a Healthy Pregnancy – The best way to make sure you have a healthy baby is to look after your own body. This holds true when you are trying to conceive and during pregnancy. Lifestyle changes such as diet and exercise significantly improve pregnancy outcomes in women affected by PCOS.

For women with PCOS who are overweight or obese, a weight reduction of 5-10% is advised and has shown to improve ovulation and future pregnancies. Losing weight before conception is recommended to reduce complications. However, some experts believe that if you are older than 35 and have been trying to get pregnant for more than a year, time is more important than losing weight.

Although weight loss increases your chance of getting pregnant and reduces the risk of metabolic complications, you may not want to delay fertility treatments while you are trying to lose weight. Below are some tips for a healthy pregnancy:

A 30-minute exercise five times per week is recommended for weight control. Exercising helps even when weight is not lost.15 However, you should avoid strenuous physical activities. Check with your fertility specialist before exercising as some fertility treatments will require you to limit your activity.

Medicines should be kept to a minimum. If you’re consulting a doctor for another problem, tell them that you are pregnant. Some medications are considered safe in pregnancy, others are not. Make sure to discuss all of your medications and supplements with your doctor, and ask if they are safe for pregnancy.

Take prenatal vitamins prescribed by your obstetrician. Your doctor may recommend a multivitamin with folic acid a month before you start trying to get pregnant. Folic acid reduces the risk of brain and spinal cord defects in developing babies if you start taking it before pregnancy.

A diet tailored to your physical requirements should be carefully planned with your doctor and dietitian. It should be high in complex, low glycemic carbohydrates such as whole grains, leafy green vegetables, and beans, low in cholesterol and fats, and moderate in proteins. Lots of dietary fiber is important since it can reduce insulin requirements in diabetic pregnancies.

Maintain a healthy blood glucose level before and during pregnancy. Effective treatment for preventing gestational diabetes include frequent blood sugar monitoring, healthy eating plan, insulin injections (if required), and regular physical activity.

Limit your intake of caffeinated beverages such as coffee, tea, soda, and hot chocolate. High doses of caffeine can increase miscarriage risk or result in babies having low birth weight. Pregnant women can have up to 200 mg of caffeine a day; that’s equivalent to 2 mugs of instant coffee.

Talk to your OB-GYN/gynecologist or care team about all of your concerns and open questions, and ask for their advice for your specific situation, as they can support you best on your journey. Listen to their advice carefully, so you know of the risks and can plan ahead, and get in touch with them immediately if the situation requires it. Sources:

  1. Gray RH, Wu LY. Subfertility and risk of spontaneous abortion. Am J Public Health.2000;90:1452–4
  2. Kjerulff LE, Sanchez-Ramos L, Duffy D. Pregnancy outcomes in women with polycystic ovary syndrome: a meta-analysis. Am J Obstet Gynecol 2011;204:558.e1-6.
  3. Kamalanathan S, Sahoo JP, Sathyapalan T. Pregnancy in polycystic ovary syndrome. Indian J Endocrinol Metab.2013;17(1):37-43. doi:10.4103/2230-8210.107830
  4. Wang JX, Davies MJ, Norman RJ. Obesity increases the risk of spontaneous abortion during infertility treatment. Obesity Research.2002;10(6):551-554. doi:10.1038/oby.2002.74
  5. Tummers P, De Sutter P, Dhont M. Risk of spontaneous abortion in singleton and twin pregnancies after IVF/ICSI. Human Reproduction.2003;18(8):1720-1723. doi:10.1093/humrep/deg308
  6. Essah P, Cheang K, Nestler J. The pathophysiology of miscarriage in women with polycystic ovary syndrome. Review and proposed hypothesis of mechanisms involved. HJ.2004;3(4):221-227. doi:10.14310/horm.2002.11130
  7. Fawn BC. Observation in favour of normal early follicle development and disturbed dominant follicle selection in polycystic ovary syndrome. Gynecol Endocrinol.1994 Jan;8(2):75-82.
  8. Shanmugham D, Vidhyalakshmi RK, M. SH. The effect of baseline serum luteinizing hormone levels on follicular development, ovulation, conception and pregnancy outcome in infertile patients with polycystic ovarian syndrome. Int J Reprod Contracept Obstet Gynecol.2017;7(1):318. doi:10.18203/2320-1770.ijrcog20175869\
  9. Jakubowicz DJ, Seppälä M, Jakubowicz S, et al. Insulin reduction with metformin increases luteal phase serum glycodelin and insulin-like growth factor-binding protein 1 concentrations and enhances uterine vascularity and blood flow in the polycystic ovary syndrome 1. The Journal of Clinical Endocrinology & Metabolism.2001;86(3):1126-1133. doi:10.1210/jcem.86.3.7295
  10. Roos N, Kieler H, Sahlin L, Ekman-Ordeberg G, Falconer H, Stephansson O. Risk of adverse pregnancy outcomes in women with polycystic ovary syndrome: population based cohort study. BMJ.2011;343(oct13 1):d6309-d6309. doi:10.1136/bmj.d6309
  11. Boomsma CM, Eijkemans MJC, Huges EG, et al. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Hum Reprod Update 2006;12:673-83. for the european society of human reproduction and embryology(Eshre). Hum Reprod.2018;33(9):1586-1601. doi:10.1093/humrep/dey242
  12. Løvvik TS, Carlsen SM, Salvesen Ø, et al. Use of metformin to treat pregnant women with polycystic ovary syndrome (Pregmet2): a randomised, double-blind, placebo-controlled trial. The Lancet Diabetes & Endocrinology.2019;7(4):256-266. doi:10.1016/S2213-8587(19)30002-6
  13. Morin-Papunen, L., Rantala, A.S., Unkila-Kallio, L., Tiitinen, A., Hippeläinen, M., Perheentupa, A., et al. (2012). Metformin improves pregnancy and live-birth rates in women with polycystic ovary syndrome (PCOS): A multicenter, double-blind, placebo-controlled randomized trial.
  14. Journal of Clinical Endocrinology and Metabolism, 97(5), 1492–1500. American College of Obstetricians and Gynecologists. (2014). Preeclampsia and high blood pressure during pregnancy. Retrieved May 23, 2016, from http://www.acog.org/~/media/For%20Patients/faq034.pdfexternal link (PDF 452 KB)
  15. Balen AH, Morley LC, Misso M, et al. The management of anovulatory infertility in women with polycystic ovary syndrome: an analysis of the evidence to support the development of global WHO guidance. Hum Reprod Update 2016; 22(6): 687–708.

: Is Miscarriage More Common for Women with PCOS?
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Can PCOS have normal delivery?

Can PCOS increase my risk of complications during pregnancy? – Having PCOS can increase your risk of some complications during pregnancy, such as:

high blood pressure gestational diabetes premature birth

If you have PCOS, you are also at increased risk of having a baby larger than expected for their gestational age. This comes with a higher risk of needing a caesarean delivery, Babies born to people with PCOS have a higher chance of being admitted to a newborn intensive care unit,
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Can I drink milk in PCOS pregnancy?

Q: Is Dairy bad for PCOS? – As a general rule, dairy should be avoided if possible for women who suffer from PCOS. There is a hormone called insulin-like growth factor, IGF-I, which will increase androgen production in women with PCOS when they consume foods containing dairy like milk or ice cream.

Many dairy products are also high in secret sugars and, as discussed above, women with PCOS should also avoid foods that have added sugar to them such as frozen yogurt and ice cream because some of their impact on insulin levels. When foods high in sugar are consumed, the hormone insulin will spike and then drop shortly after.

This causes a cycle of highs and lows that women with PCOS are more likely to experience because their bodies have difficulty regulating blood glucose levels which is what leads to inflammation.
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How successful is pregnancy with PCOS?

PCOS Pregnancy Statistics – Pregnancy success rates with induction of ovulation vary considerably and depend on:

  1. The age of the woman
  2. The type of PCOS meds used
  3. Whether the medication used is effective at stimulating ovulation in that woman
  4. Whether there are other infertility factors present in the couple

In general, successful treatment resulting in pregnancy is more likely to occur in the first 3 to 4 months of treatment. After that, the monthly success rate drops off considerably. The approximate average monthly pregnancy success rate (female age under 35, normal sperm) for the major types of treatment used for PCOS are:

Table: Treatment for PCOS Expected “Monthly” Success Rate

Treatment for PCOS Expected “Monthly” Success Rate
Metformin alone About 1-2%
Clomid 15% – if ovulating
Femara 15% – if ovulating
Injectable gonadotropins 20%
IVF, In vitro fertilization 60% – at our IVF clinic

A brief overview of each PCOS treatment option is below For details see the pages that discuss each treatment option
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Can PCOS affect baby gender?

– PubMed

Aim: The aim of this paper was to investigate the sex ratio in the offspring of pregnant patients with polycystic ovary syndrome (PCOS). Methods: Analysis of 70 pregnant patients with PCOS who achieve a pregnancy without any kind of treatment, and having as controls 63 healthy pregnant women without any feature of PCOS. Results: No significant difference in sex ratio was detected between PCOS and controls, even if it resulted significantly different in the full-blown and non-PCO phenotypes. Conclusion: The PCOS phenotypes influenced the sex ratio in the offspring, suggesting that environmental factors could play a role in determination of the offspring gender.

: – PubMed
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Can PCOS cause birth defects?

3. Influence of Polycystic Ovary Syndrome on the Health of the Offspring – In line with the Barker hypothesis, whereby adverse early life influences may lead to disease later in life, six publications reviewed by Yu et al. as part of their meta-analysis describe an adverse association of a mother’s diagnosis of PCOS on the health of her offspring,

  1. The study reports an almost threefold risk of neonatal hypoglycemia and a doubling of the rate of perinatal death, but no increased risk of fetal macrosomia, respiratory distress syndrome or fetal malformations,
  2. The difficulty in the interpretation of the literature is that often the studies are heterogeneous and many have not been controlled for pre-pregnancy BMI, maternal age, multiple pregnancy and the use of IVF.

Furthermore, it is also difficult to determine whether the increased risk of a premature delivery is due to the PCOS per se, or whether it is iatrogenic due to the need to expedite delivery for an obstetric indication. Such a situation could also lead to an incorrect assumption of an increase in low birth weight infants, as often the outcome was not corrected for gestational age.

Such a situation may have a further flow-on effect in the analysis of the risk of congenital abnormalities in the offspring; an iatrogenic premature delivery potentially could lead to an artificial increase in the findings of undescended testicles and a patent ductus arteriosus in the infant, as these congenital abnormalities are more commonly found in premature infants, as they are a normal process of development that has not had time to be completed.

We performed a large study using whole population data within Western Australia of over 2500 pregnant women with PCOS and compared them to 26,000 pregnant women without a PCOS diagnosis. The data was controlled for the use of IVF, ethnicity, maternal age, multiple gestation, maternal smoking and pre-existing co-morbidities.

The main findings were that offspring of women with PCOS were twice as likely to be born prematurely, three times as likely to die in the perinatal period and twice as likely to require a postnatal hospitalisation, Furthermore, offspring of women with PCOS were at an increased risk of a congenital anomaly (6.3% compared with 4.9%, OR 1.20, 95% CI 1.03–1.40),

This data was additionally corrected for all obstetric risk factors, including gestational diabetes and large/small for gestational age. When the congenital abnormalities were analysed by the type of malformation, cardiovascular and urogenital malformations were more common in the offspring of women with PCOS; cardiovascular (1.5% compared with 1.0%, OR 1.37, 95% CI 1.01–1.87) and urogenital defects (2.0% compared with 1.4% OR 1.36, 95% CI 1.03–1.81).
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Does PCOS disappear during pregnancy?

Can pregnancy cure PCOS? – No, unfortunately, PCOS is a chronic condition. However, it is not uncommon for women with PCOS to experience a cessation of their symptoms while they are pregnant. Moreover, many women with the condition have reported an improvement to their regular menstrual cycle after they have been pregnant.
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What happens to PCOS after pregnancy?

PCOS and breast-feeding – If you’re diagnosed with PCOS, you may need to continue to manage symptoms even after pregnancy. But symptoms and severity can vary. Sometimes the hormonal fluctuations after pregnancy and breast-feeding can change the symptoms, so it may be awhile before you settle into your new “normal.” It’s safe to breast-feed with PCOS, even if you’re on insulin medication to help control your blood sugar.
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How many PCOS pregnancies end in miscarriage?

Why polycystic ovarian syndrome pregnancy lead to the Risk of Early Pregnancy Loss? – Women with polycystic ovarian syndrome pregnancy symptoms are at risk of EPL. It is clinically tested that a first-trimester miscarriage can occur in 50% of pregnant women with PCOS, a rate which is three times higher than that in women without PCOS. What Precautions To Take During Pregnancy With Pcos
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How can I prevent a miscarriage with PCOS naturally?

There appears to be a higher rate of miscarriage in women with polycystic ovarian syndrome (PCOS). The reason for this is being studied. Increased levels of luteinizing hormone, which aids in secretion of progesterone, may play a role. Increased levels of insulin and glucose may cause problems with development of the embryo.

Insulin resistance and late ovulation (after day 16 of the menstrual cycle) also may reduce egg quality, which can lead to miscarriage. The best way to prevent miscarriage in women with polycystic ovarian syndrome (PCOS) is to normalize hormone levels to improve ovulation, and normalize blood glucose and androgen levels.

Recently, more doctors are prescribing the drug metformin to help with this.
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Can PCOS affect my son?

Discussion – In the present study, we analysed the pubertal period of sons born to PCOS women, a stage of profound changes in the body composition, insulin sensitivity and sex steroid production. We are, thus, completing our previous observations in PCOSs during infancy, childhood and adulthood.

  • We found an increased WHR along with higher cholesterol and LDL levels during Tanner stages II–III.
  • PCOSs also showed higher FSH and androstenedione levels during this stage.
  • The cholesterol alterations were also observed during the Tanner stage IV–V but with no anthropometric differences.
  • Despite being comparable in age, BMI and Tanner stage, PCOSs seem to develop early derangements in cholesterol levels.

We have previously reported this observation in children and adult PCOSs ( 12 ). Nevertheless, in that case, PCOSs BMI was also significantly higher and the differences disappeared when controlled by BMI. In the present study, BMIs were comparable and propensity score analysis showed that this difference was attributable to the PCOSs condition.

Thus, cholesterol alterations in this group seem to represent an intrinsic independent feature probably associated with an incipient state of insulin resistance. Although insulin and glucose levels were comparable during all Tanner stages, during Tanner stages II–III, LDL was positively correlated with basal glucose, 30, 60 and average insulin levels and negatively correlated with ISI composite.

Thus, indirectly LDL levels might be reflecting insulin resistance at this stage. The increase in WHR and a trend to higher waist circumference (WC) in Tanner II–III boys may also represent a latent insulin resistance that is expressed later on during adulthood.

  1. In a larger study, waist was associated with insulin resistance during adolescence.
  2. In this regard, associations between adiposity measures, such as WC, and insulin resistance have been shown to be stronger in children during puberty compared with those who had completed pubertal development ( 28 ).
  3. In this regard, in the current study, WC was correlated with different surrogates of insulin resistance during Tanner stages II–V.

Thus, this might be a good marker for metabolic disruption in pubertal boys. Daughters of women with PCOS show increased insulin and triglyceride levels from an early stage ( 15 ). On the other hand, boys show comparable insulin and triglyceride levels but significantly higher LDL and total cholesterol levels.

This feature is still present during adulthood but is accompanied by increased insulin levels ( 12 ). Thus, we can suggest that there is a sexual dimorphism regarding the expression and onset of insulin resistance in the offspring of PCOS women, with an early appearance of hypertriglyceridemia and hyperinsulinemia in girls and an early increased LDL and late hyperinsulinaemia in boys.

This sexual dimorphism has also been found in normal Chilean girls, showing higher triglyceride levels in adolescent girls compared to boys ( 29 ). Thus, the expression of insulin resistance in daughters and sons of PCOS women seems to be determined in part by these naturally occurring gender differences.

Later, during adult life, this insulin resistance is expressed as increased insulin levels and higher BMI in PCOS women and adult PCOSs as we have previously reported ( 12 ). Opposite to what we found in younger PCOSs, in whom we observed increased AMH levels, pubertal PCOSs show normal AMH levels, same as the adult PCOSs group in our previous report ( 14 ).

Thus, it seems like, despite having a period of possible delayed maturation during infancy and childhood, Sertoli cells seem to have an appropriate function during puberty. Starting puberty, we observed increased FSH levels and higher androstenedione levels that then normalize during the next stage of puberty.

  • Higher androstenedione may come from the testis or the adrenal gland.
  • A possible explanation is that there is an increased secretion of androgens from the adrenal gland as has been suggested in PCOS women ( 30, 31 ), and then as the testis takes over androgen secretion, this difference disappears.
  • Higher FSH levels are harder to interpret and may reflect a slightly earlier maturation of the gonadal axis.

In conclusion, sons of women with PCOS show increased total cholesterol and LDL levels during puberty, which may represent latent insulin resistance that is later on translated into higher insulin levels and a higher BMI. Thus, this is a group that should be followed and studied looking for further features of insulin resistance and cardiovascular risk markers.
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What fruits are good for PCOS?

Foods to include in your diet – Women with PCOS need to follow a diet where their nutritional needs are met while maintaining a healthy weight. Here is a look at the most important points while planning your daily diet in PCOS: A low glycemic index (GI) diet : Foods with low GI get digested slowly and blood sugar rises gradually and slowly, thus insulin levels rise at a much slower rate.

  1. The improvement in insulin levels seems to be beneficial for PCOS.
  2. Any unprocessed low carbohydrate food, whole grains, nuts, seeds, fruits, starchy vegetables, and legumes all come under this category.
  3. An anti-inflammatory diet : A diet that reduces fatigue and inflammation-related symptoms is helpful too.

Here consuming berries, leafy greens, and extra virgin oil is recommended by experts. The DASH diet : Or what is known as the Dietary Approach to Stop Hypertension- also helps to manage PCOS. Foods that are high in saturated fat and sugar are a big NO.

A Dash diet is rich in whole grains, seasonal fruits and vegetables, low-fat dairy products, fish, and poultry. Basically, whatever harms your heart, increases weight, and dysregulates insulin levels are to be avoided. Instead, what should be included in your daily food are the following- 1. Natural unprocessed foods enable vitamin absorption, and healthy nutrient intake and lead to weight loss.2.

High-fibre foods like oats and millets can lower cholesterol and inflammation in the body as well as stabilise blood sugar levels.3. Fish –salmon, tuna, sardines, and foods rich in vitamins can aid in improving insulin resistance and decrease the severity of symptoms associated with PCOS.4.

Leafy greens like spinach, kale, and mustard leaves which are low in the glycaemic index but rich in phytochemicals, vitamins, and antioxidants can be eaten raw as in salads or pureed and made into exotic dishes.5. Coloured fruits– red grapes, blueberries, blackberries, cherries, papaya, melon, are all rich in antioxidants and fibre but low in glycemic index and as such can prove helpful for PCOS patients.

They also satisfy the sweet cravings. But going on an only fruit diet or consuming only fruits is not recommended. It’s better to eat most fruits with their skin and avoid drinking juices as the latter don’t have fibres and usually increase the sugar level faster than when we eat them.6.

Vegetables- broccoli, cauliflower, avocados, green beans, and carrots which are a rich source of magnesium, help to boost immunity and prevent obesity so are good for people suffering from PCOS. At least try to eat 25 gms of such veggies daily.7. Legumes- dried beans like rajma, lentils, moong, and split peas all work to lower inflammation and insulin levels so ladies should include them in their diet.8.

Healthy fats- olive oil, coconuts, and vegetable oils with low omega 6 fatty acids help to increase hormone production, and fat is a biological necessity that aids in vitamin absorption and improving brain and heart function.9. Nuts – pine nuts, walnuts, almonds, and pistachios all have the right balance of mono-saturated fats to help balance female hormones and should be consumed in moderation.10.

Chocolate- dark ones in moderation work as antioxidants, and hence curtail the effects of PCOS.11. Spices- turmeric, cinnamon, black pepper, ginger, cumin, and saffron have proven to be very effective in dealing with PCOS, and including them in your daily diet is very beneficial for anyone’s health. Include most of the above-mentioned food in your daily diet in different combinations- the result should be to maintain a stable weight with controlled insulin levels.

Eat small meals but at regular intervals.
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Can I breastfeed with PCOS?

Breastfeeding with Polycystic Ovary Syndrome (PCOS)

Photo: First published June 2016PCOS is a leading cause of infertility in women. Symptoms include:

Raised levels of insulin (that can lead to excessive weight gain). Raised levels of male hormones (that can lead to acne and growth of unwanted hair). Irregular menses, ovarian cysts. Raised risk of diabetes. Underdevelopment of breast tissue.

Because PCOS is a syndrome and not a disease, the combination of symptoms is unique in each case, making identification more challenging for health providers. As a result, many women never receive a formal diagnosis. Mothers with PCOS may struggle to produce enough milk or some may make an overabundance of it.
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Why is it hard to stay pregnant with PCOS?

Polycystic ovary syndrome What Precautions To Take During Pregnancy With Pcos ovary syndrome (PCOS), also known as polycystic ovarian syndrome, is a common health problem caused by an imbalance of reproductive, The hormonal imbalance creates problems in the, The ovaries make the egg that is released each month as part of a healthy menstrual cycle.

  • Infertility (inability to get pregnant). In fact, PCOS is one of the most common causes of infertility in women.
  • Development of (small fluid-filled sacs) in the ovaries

Between 5% and 10% of women between 15 and 44, or during the years you can have children, have PCOS. Most women find out they have PCOS in their 20s and 30s, when they have problems getting pregnant and see their doctor. But PCOS can happen at any age after puberty.

  • Irregular menstrual cycle, Women with PCOS may miss periods or have fewer periods (fewer than eight in a year). Or, their periods may come every 21 days or more often. Some women with PCOS stop having menstrual periods.
  • Too much hair on the face, chin, or parts of the body where men usually have hair. This is called “hirsutism.” Hirsutism affects up to 70% of women with PCOS.
  • Acne on the face, chest, and upper back
  • Thinning hair or hair loss on the scalp; male-pattern baldness
  • Weight gain or difficulty losing weight
  • Darkening of skin, particularly along neck creases, in the groin, and underneath breasts
  • Skin tags, which are small excess flaps of skin in the armpits or neck area

The exact cause of PCOS is not known. Most experts think that several factors, including genetics, play a role:

  • High levels of, Androgens are sometimes called “male hormones,” although all women make small amounts of androgens. Androgens control the development of male traits, such as male-pattern baldness. Women with PCOS have more androgens than normal. Higher than normal androgen levels in women can prevent the ovaries from releasing an egg (ovulation) during each menstrual cycle, and can cause extra hair growth and acne, two signs of PCOS.
  • High levels of insulin. Insulin is a hormone that controls how the food you eat is changed into energy. Insulin resistance is when the body’s cells do not respond normally to insulin. As a result, your insulin blood levels become higher than normal. Many women with PCOS have insulin resistance, especially those who have overweight or obesity, have unhealthy eating habits, do not get enough physical activity, and have a family history of (usually type 2 diabetes). Over time, insulin resistance can lead to type 2 diabetes.

Yes. Having PCOS does not mean you can’t get pregnant. PCOS is one of the most common, but treatable, causes of infertility in women. In women with PCOS, the hormonal imbalance interferes with the growth and release of eggs from the ovaries (ovulation).

  • Diabetes. More than half of women with PCOS will have diabetes or prediabetes (glucose intolerance) before the age of 40. Learn more about diabetes on our,
  • High blood pressure. Women with PCOS are at greater risk of having high blood pressure compared with women of the same age without PCOS. High blood pressure is a leading cause of heart disease and stroke. Learn more about,
  • Unhealthy cholesterol. Women with PCOS often have higher levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol. High cholesterol raises your risk of heart disease and stroke.
  • Sleep apnea. This is when momentary and repeated stops in breathing interrupt sleep. Many women with PCOS have overweight or obesity, which can cause sleep apnea. Sleep apnea raises your risk of heart disease and diabetes.
  • Depression and anxiety. and are common among women with PCOS.
  • Endometrial cancer. Problems with ovulation, obesity, insulin resistance, and diabetes (all common in women with PCOS) increase the risk of developing cancer of the endometrium (lining of the uterus or womb).

Researchers do not know if PCOS causes some of these problems, if these problems cause PCOS, or if there are other conditions that cause PCOS and other health problems. Yes and no. PCOS affects many systems in the body. Many women with PCOS find that their menstrual cycles become more regular as they get closer to,

However, their PCOS hormonal imbalance does not change with age, so they may continue to have symptoms of PCOS. Also, the risks of PCOS-related health problems, such as diabetes, stroke, and heart attack, increase with age. These risks may be higher in women with PCOS than those without. There is no single test to diagnose PCOS.

To help diagnose PCOS and rule out other causes of your symptoms, your doctor may talk to you about your medical history and do a physical exam and different tests:

  • Physical exam. Your doctor will measure your blood pressure,, and waist size. They will also look at your skin for extra hair on your face, chest or back, acne, or skin discoloration. Your doctor may look for any hair loss or signs of other health conditions (such as an enlarged thyroid gland).
  • Pelvic exam. Your doctor may do a pelvic exam for signs of extra male hormones (for example, an enlarged clitoris) and check to see if your ovaries are enlarged or swollen.
  • Pelvic ultrasound (sonogram). This test uses sound waves to examine your ovaries for cysts and check the endometrium (lining of the uterus or womb).
  • Blood tests. Blood tests check your androgen hormone levels, sometimes called “male hormones.” Your doctor will also check for other hormones related to other common health problems that can be mistaken for PCOS, such as, Your doctor may also test your cholesterol levels and test you for diabetes.

Once other conditions are ruled out, you may be diagnosed with PCOS if you have at least two of the following symptoms:

  • Irregular periods, including periods that come too often, not often enough, or not at all
  • Signs that you have high levels of androgens:
    • Extra hair growth on your face, chin, and body (hirsutism)
    • Acne
    • Thinning of scalp hair
  • Higher than normal blood levels of androgens
  • Multiple cysts on one or both ovaries

There is no cure for PCOS, but you can manage the symptoms of PCOS. You and your doctor will work on a treatment plan based on your symptoms, your plans for having children, and your risk of long-term health problems such as diabetes and heart disease. Many women will need a combination of treatments, including:

  • to help relieve your symptoms

You can take steps at home to help your PCOS symptoms, including:

  • Losing weight. Healthy eating habits and regular physical activity can help relieve PCOS-related symptoms. Losing weight may help to lower your blood glucose levels, improve the way your body uses insulin, and help your hormones reach normal levels. Even a 10% loss in body weight (for example, a 150-pound woman losing 15 pounds) can help make your menstrual cycle more regular and improve your chances of getting pregnant. Learn more about,
  • Removing hair. You can try facial hair removal creams, laser hair removal, or electrolysis to remove excess hair. You can find hair removal creams and products at drugstores. Procedures like laser hair removal or electrolysis must be done by a doctor and may not be covered by health insurance.
  • Slowing hair growth. A prescription skin treatment (eflornithine HCl cream) can help slow down the growth rate of new hair in unwanted places.

The types of medicines that treat PCOS and its symptoms include:

  • Hormonal birth control, including the pill, patch, shot, vaginal ring, and hormone intrauterine device (IUD). For women who don’t want to get pregnant, hormonal can:
    • Make your menstrual cycle more regular
    • Lower your risk of
    • Help improve acne and reduce extra hair on the face and body (Ask your doctor about birth control with both estrogen and progesterone.)
  • Anti-androgen medicines. These medicines block the effect of androgens and can help reduce scalp hair loss, facial and body hair growth, and acne. They are not approved by the Food and Drug Administration (FDA) to treat PCOS symptoms. These medicines can also cause problems during pregnancy.
  • Metformin. Metformin is often used to treat type 2 diabetes and may help some women with PCOS symptoms. It is not approved by the FDA to treat PCOS symptoms. Metformin improves insulin’s ability to lower your blood sugar and can lower both insulin and androgen levels. After a few months of use, metformin may help restart ovulation, but it usually has little effect on acne and extra hair on the face or body. Recent research shows that metformin may have other positive effects, including lowering body mass and improving cholesterol levels.

You have several options to help your chances of getting pregnant if you have PCOS:

  • Losing weight. If you have overweight or obesity, losing weight through healthy eating and regular physical activity can help make your menstrual cycle more regular and improve your fertility. Find a personalized healthy eating plan using the tool.
  • Medicine. After ruling out other causes of infertility in you and your partner, your doctor might prescribe medicine to help you ovulate, such as clomiphene (Clomid).
  • In vitro fertilization (IVF). IVF may be an option if medicine does not work. In IVF, your egg is fertilized with your partner’s sperm in a laboratory and then placed in your uterus to implant and develop. Compared to medicine alone, IVF has higher pregnancy rates and better control over your risk of having twins and triplets (by allowing your doctor to transfer a single fertilized egg into your uterus).
  • Surgery. Surgery is also an option, usually only if the other options do not work. The outer shell (called the cortex ) of ovaries is thickened in women with PCOS and thought to play a role in preventing spontaneous ovulation. Ovarian drilling is a surgery in which the doctor makes a few holes in the surface of your ovary using lasers or a fine needle heated with electricity. Surgery usually restores ovulation, but only for 6 to 8 months.

Read more about, PCOS can cause problems during pregnancy for you and for your baby. Women with PCOS have higher rates of:

  • Miscarriage
  • Cesarean section (C-section)

Your baby also has a higher risk of being heavy (macrosomia) and of spending more time in a neonatal intensive care unit (NICU). You can lower your risk of problems during pregnancy by:

  • Reaching a healthy weight before you get pregnant. Use this to see your healthy weight before pregnancy and what to gain during pregnancy.
  • Reaching healthy blood sugar levels before you get pregnant. You can do this through a combination of healthy eating habits, regular physical activity, weight loss, and medicines such as metformin.
  • Taking, Talk to your doctor about how much folic acid you need.

Researchers continue to search for new ways to treat PCOS. Some current studies focus on:

  • Genetics and PCOS
  • Environmental exposure and PCOS risk
  • Ethnic and racial differences in PCOS symptoms
  • Medicines and supplements to restart ovulation
  • Obesity and its link to PCOS
  • Health risks for children of women with PCOS

To learn more about current PCOS treatment studies, visit,

  1. Trivax, B., & Azziz, R. (2007)., Clinical Obstetrics and Gynecology, 50 (1), 168–177.
  2. Bremer, A.A. (2010)., Metabolic Syndrome and Related Disorders, 8 (5), 375–394.
  3. American College of Obstetricians and Gynecologists. (2015).,
  4. Lorenz, L.B., & Wild, R.A. (2007)., Clinical Obstetrics and Gynecology, 50, 226–243.
  5. Goodman, N.F., Cobin, R.H., Futterweit, W., Glueck, J.S., Legro, R.S., & Carmina, E. (2015)., Endocrine Practice, 11, 1291–300.
  6. Boomsma, C.M., Fauser, B.C., & Macklon, N.S. (2008)., Seminars in Reproductive Medicine, 26, 72–84.

The Office on Women’s Health is grateful for the medical review by:

  • Violanda Grigorescu, M.D., M.S.P.H., Chief, Partnerships and Evaluation Branch, Division of Health Informatics and Surveillance, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention
  • Torie Comeaux Plowden, M.D., M.P.H., Fellow, Reproductive Endocrinology and Infertility, Eunice Kennedy Shriver National Institute of Child Health and Human Development
  • Lubna Pal, M.B.B.S., M.R.C.O.G., M.S., F.A.C.O.G., Associate Professor, Director of the Polycystic Ovary Syndrome (PCOS) Program, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine

All material contained on these pages are free of copyright restrictions and maybe copied, reproduced, or duplicated without permission of the Office on Women’s Health in the U.S. Department of Health and Human Services. Citation of the source is appreciated. Page last updated: February 22, 2021 : Polycystic ovary syndrome
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How successful is pregnancy with PCOS?

Discussion – In the present study, we found that women with PCOS had higher live birth rate, clinical pregnancy rate and implantation rate, as well as an increased risk of pregnancy complications (miscarriage, preterm delivery and PIH) in their first IVF treatment when compared with non-PCOS controls. Among all these outcomes, higher clinical pregnancy rate, implantation rate, miscarriage rate, and very preterm delivery rate (<32weeks) were still maintained in the PCOS population after adjusting for the following risk factors: maternal age, BMI, infertility duration, total dose of gonadotropin, serum E 2 level and endometrial thickness on the day of hCG trigger, number of fertilized occytes, number of embryos transferred, embryo type and quality. We found women with PCOS had significantly greater numbers of oocytes retrieved and fertilized. We postulated that by retrieving more oocytes and achieving higher fertilization number, there could be more embryo selection, and therefore higher subsequent pregnancy rate. Moreover, a significantly increased live birth rate was observed in women with PCOS even after correcting for maternal age and BMI, however, this effect faded when adjusted for all the above-mentioned risk factors. It is still under debate whether women with PCOS have an increased risk of miscarriage compared with controls. Although available data show conflicting results, miscarriage rate was suggested to be comparable based on the PCOS consensus of 2012 ( 1 ). One meta-analysis showed no difference in miscarriage rate between women with PCOS and those without undergoing IVF ( 12 ). Our data showed a significantly increased risk of miscarriage among PCOS subjects compared with controls, which is consistent to a large Australian study also demonstrating that the miscarriage rate was more frequent in women with PCOS than in controls (20% vs.15%; P =0.003) ( 13 ). Furthermore, in our study, the difference was still statistically significant after adjusting for important confounders. On subgroup analysis, the association between PCOS and miscarriage was only seen among the lean population after adjusting for age and BMI (aOR 1.599, 95% CI 1.173–2.181, P =0.003). Our results indicate that there may be other intrinsic "PCOS factors" which may contribute to miscarriage except BMI. A recent study shows that PCOS-induced miscarriage may be associated with hyperandrogenism and insulin resistance, which could disrupt normal mitochondrial function and homeostasis and a resulting imbalance between oxidative and antioxidative stress responses in the gravid uterus ( 14 ). However, this is an in vivo animal study, and the relevance of the results for humans remains to be established. Two meta-analyses demonstrated that women with PCOS have a 2-fold increased risk of preterm delivery ( 6, 7 ), whereas another meta-analysis demonstrated no effect ( 8 ). In a large Swedish study, infants born to mothers with PCOS were more frequently delivered prematurely (OR 2.21, 95% CI 1.69–2.90) ( 15 ). Another cohort study confirmed an increased risk of preterm delivery (OR 2.02, 95% CI 1.13–3.61) ( 16 ). Here, we observed an increased rate of preterm delivery before 32 weeks among PCOS subjects, but no difference in the rate of preterm delivery before 37 weeks after adjusting for the confounders. However, we found that the development of PIH was associated with preterm delivery both before 37 weeks and before 32 weeks, suggesting that preterm delivery may occur through development of PIH. On subgroup analysis, there was a strong correlation between PCOS and preterm delivery before 37 weeks (aOR 1.360, 95% CI 1.035–1.787, P =0.027) among lean population. This finding was consistent with the previous study, which also showed that a significantly increased risk in preterm delivery was only found among the lean PCOS subjects ( 17 ). Hyperandrogenism, disturbed glucose metabolism and higher levels of inflammatory markers have been regarded as potential causes of preterm delivery in women with PCOS ( 16, 18 ). Hyperandrogenism and insulin resistance characteristic of PCOS are associated with disturbances in the coagulation and fibrinolytic system, resulting in endothelial dysfunction, atherothrombosis and chronic low grade inflammation, which may lead to micro-vasculopathy and placental dysfunction ( 16 ). Several studies have reported that the inflammatory cytokine levels were higher in amniotic fluid of women in premature labor ( 19, 20 ). Thus, underlying inflammatory mediators associated with PCOS may also contribute to predisposition for preterm delivery. Additionally, a recent study showed that higher antimüllerian hormone (AMH) levels were a risk factor for preterm delivery in women with PCOS ( 21 ). This result may be explained by the higher AMH level observed in PCOS women during pregnancy was considered to have an impact on the endocrine system of the fetus and offspring ( 22 ). Taken together, we demonstrate an increased risk of preterm delivery in women with PCOS compared with women without PCOS. Thus, PCOS women during pregnancy might need increased attention and closer follow-up to improve the outcome. The higher rate of PIH (3.9%) in women with PCOS in our study is similar with those in the literature (3%–32%) ( 7 ). However, this may be an underestimate as patients may have unreported or underreported symptoms, or they may have been admitted to a different hospital. The mechanisms responsible for hypertension in women with PCOS may be explained as follows: first, insulin resistance could cause secondary hyperinsulinemia, which may produce enhanced sodium retention and play a role in the development of hypertension ( 23, 24 ); second, insulin could stimulate the release of insulin-like growth factor (IGF-1), which may determine the vascular smooth muscle hypertrophy and thus contribute to the hypertension ( 25 ); third, hyperandrogenemia also seems to be related to blood pressure ( 15 ). There have been three meta-analyses reported a three to four times increased risk of PIH in women with PCOS ( 6 – 8 ). Similarly, we observed increased rate of PIH in the PCOS population. However, after adjusting for the confounders, the prevalence of PIH among women with PCOS was somewhat higher but only borderline significant (aOR 1.764, 95% CI 0.981–3.171, P =0.058), suggesting that there may be other risk factors contributing to PIH. On subgroup analysis, no significant different on the morbidity of PIH was seen among both lean and overweight/obese PCOS women. GDM is the most commonly described pregnancy complication in women with PCOS. The early diagnosis and treatment could significantly reduce the incidence and severity of related maternal and neonatal complications ( 26 ). Higher GDM rate in PCOS women was thought to be due to insufficient pancreatic β-cell function to overcome the placental hormone-mediated exacerbation of pre-existing insulin resistance during pregnancy ( 27 ). Three meta-analyses reported a three times higher risk of GDM in women with PCOS ( 6 – 8 ). Among all the studies included, one Swedish population-based cohort study compared 3787 women with PCOS and 1191336 women without PCOS and showed than GDM was more than 2-fold higher in women with PCOS after adjusting data for confounders (OR 2.32, 95% CI 1.88–2.88) ( 15 ). However, the women they included had more severe disease as exposed, and the findings may consequently not be generalizable to all women with PCOS. In this study, we observed the prevalence of GDM was 9.7% among PCOS subjects, which is consistent with the reported rates (3%–40%) ( 28 ). However, we failed to find a statistically significant difference in the risk of GDM between women with PCOS and controls. This result may be partially explained by the relatively young population in our study, as many studies have indicated that advanced maternal age is an important risk factor for GDM ( 29, 30 ). Insulin resistance appears to be a crucial aetiological characteristic in most women with PCOS ( 31 ). Insulin resistance and compensatory hyperinsulinaemia could increase ovarian androgen production and reduce hepatic sex-hormone binding globulin (SHBG) production, resulting in androgen excess ( 31 ). Both androgen excess and insulin resistance underpin the features of PCOS. In this study, we used QUICKI as a surrogate marker for insulin resistance and found that it was significantly correlated with miscarriage and live birth after controlling for maternal age. It suggests that insulin resistance is an important factor behind the increased risk of adverse pregnancy outcomes in women with PCOS. However, QUICKI was not associated with GDM in our study. The results may be explained by the administration of metformin among PCOS women, which appears to be an inhibition of hepatic glucose production and an increase in peripheral insulin sensitivity ( 32 ). Multiple pregnancies are considered to be one of the most important adverse outcomes in patients following assisted reproductive technologies. Negative pregnancy complications associated with multiple gestations have been well documented, including increased risk of PIH, pre-eclampsia, preterm delivery, neonatal mortality and cesarean delivery ( 33, 34 ). The higher incidence of multiple pregnancies among PCOS patients in our study may therefore underlie the poorer observed outcomes. Moreover, although several studies have suggested that women with PCOS showed a higher rate of cesarean section, this was not observed in our study ( 6 – 8, 35 ). Increasing evidences have showed a higher rate of pregnancy complications in women with PCOS. The increased incidence can partially be explained by higher BMI in women with PCOS. However, after adjusted for BMI, there seems to be an intrinsic "PCOS factors" which may contribute to pregnancy complications. The pathophysiology and intrinsic mechanisms underlying PCOS are complex and considerably intertwined. The interplay between these mechanisms results in the clinical features of PCOS, including hyperandrogenism, PCOM and ovulatory dysfunction. Insulin resistance in PCOS is an intrinsic characteristic, which is aggravated by obesity but not simply a consequence of obesity. Insulin resistance and compensatory hyperinsulinemia adversely effects ovarian androgen production in PCOS ( 36 ). Studies have shown that adipocytes and adipocyte function are aberrant in PCOS, favoring insulin resistance and subclinical inflammation ( 37 ). Inflammatory cytokines could suppress insulin-mediated glucose transport to a greater degree in adipocytes derived from patients with PCOS ( 38 ). Overall, primary defects in adipocyte functioning, including insulin-mediated glucose transport ( 39 ), GLUT4 production ( 40 ), and insulin-stimulated inhibition of lipolysis ( 41 ) have been reported in PCOS. In addition to decreased hepatic synthesis of SHBG caused by hyperinsulinaemia, hyperandrogenism could also be resulted from increased expression of several genes encoding steroidogenic enzymes in follicular theca cells, like DENND1A and CYP17A1 ( 42 ). Hyperandrogenism and insulin resistance characteristic of PCOS may also play a crucial role during trophoblast invasion and placentation, and thus increase the long-term risk for mothers and children ( 16 ). In our study, women with PCOS were younger, and had higher BMI compared with women without PCOS which could be perceived as nonideal controls. Although matching does not offer advantage over independent control selection with regard to study validity under case-control design, it could improve study precision ( 43 ). Thus, we also performed a stratified analysis for the adverse pregnancy outcomes among women overweight/obese or lean. Regarding the difference in maternal age, it is minimal (30.0 vs.31.0 years; P <0.001) and the difference is probably due to the large number of subjects involved. An important strength of this study is the large size of the cohort, which enabled us to include more relevant confounders to provide a more precise estimation of the risks of pregnancy complications in women with PCOS than in former studies. Additionally, we were able to distinguish between preterm and very preterm delivery, which is important as the relationship between PCOS and preterm delivery might differ according to gestational age. Moreover, subgroup analysis was performed to stratify risk for the pregnancy complications by lean vs. overweight/obese PCOS, which makes it possible to analyze the relationship between PCOS and adverse pregnancy outcomes under different subgroups. Our study also has a number of limitations. First, potential selection bias could have occurred since the infertility factors were different between PCOS and non-PCOS patients. Second, our study relied on self-reported data of pregnancy complications, which may lead to an underestimation of the prevalence of PIH and GDM. Third, the retrospective nature made it difficult to study several pregnancy and neonatal outcomes, such as antepartum hemorrhage, pre-eclampsia, birthweight, small or large for gestational age neonates. Furthermore, we were unable to stratify preterm delivery for cause (e.g. premature ruptures of membranes, cervical insufficiency) or spontaneous versus induced preterm delivery, or analyze between PIH and pre-eclampsia. Finally, the results of this study cannot be generalized to all IVF cases since we only analyzed fresh embryo transfer cycles. View complete answer

Can PCOS cause birth defects?

3. Influence of Polycystic Ovary Syndrome on the Health of the Offspring – In line with the Barker hypothesis, whereby adverse early life influences may lead to disease later in life, six publications reviewed by Yu et al. as part of their meta-analysis describe an adverse association of a mother’s diagnosis of PCOS on the health of her offspring,

The study reports an almost threefold risk of neonatal hypoglycemia and a doubling of the rate of perinatal death, but no increased risk of fetal macrosomia, respiratory distress syndrome or fetal malformations, The difficulty in the interpretation of the literature is that often the studies are heterogeneous and many have not been controlled for pre-pregnancy BMI, maternal age, multiple pregnancy and the use of IVF.

Furthermore, it is also difficult to determine whether the increased risk of a premature delivery is due to the PCOS per se, or whether it is iatrogenic due to the need to expedite delivery for an obstetric indication. Such a situation could also lead to an incorrect assumption of an increase in low birth weight infants, as often the outcome was not corrected for gestational age.

Such a situation may have a further flow-on effect in the analysis of the risk of congenital abnormalities in the offspring; an iatrogenic premature delivery potentially could lead to an artificial increase in the findings of undescended testicles and a patent ductus arteriosus in the infant, as these congenital abnormalities are more commonly found in premature infants, as they are a normal process of development that has not had time to be completed.

We performed a large study using whole population data within Western Australia of over 2500 pregnant women with PCOS and compared them to 26,000 pregnant women without a PCOS diagnosis. The data was controlled for the use of IVF, ethnicity, maternal age, multiple gestation, maternal smoking and pre-existing co-morbidities.

The main findings were that offspring of women with PCOS were twice as likely to be born prematurely, three times as likely to die in the perinatal period and twice as likely to require a postnatal hospitalisation, Furthermore, offspring of women with PCOS were at an increased risk of a congenital anomaly (6.3% compared with 4.9%, OR 1.20, 95% CI 1.03–1.40),

This data was additionally corrected for all obstetric risk factors, including gestational diabetes and large/small for gestational age. When the congenital abnormalities were analysed by the type of malformation, cardiovascular and urogenital malformations were more common in the offspring of women with PCOS; cardiovascular (1.5% compared with 1.0%, OR 1.37, 95% CI 1.01–1.87) and urogenital defects (2.0% compared with 1.4% OR 1.36, 95% CI 1.03–1.81).
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