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Polycystic Ovary Syndrome (PCOS) is condition of the ovaries, organs of the female reproductive system responsible for producing ova (eggs) and hormone secretion. This is an article about the risks of pregnancy when having PCOS. The ovaries release an egg from one side each month. Fertilization may or may not occur. Ovarian hormones control the menstrual periods and gestation as well as female characteristics such as distribution of hair and the shape of the body.

In PCOS, not only are the ovaries themselves enlarged, but the out surface has an abnormally large number of follicles. Follicles are sacs of fluid that grow around the eggs. They appear as small ‘bubbles’ on the surface of the ovary, or, on ultrasound, like black holes in the middle of the organs. The cause of the condition remains uncertain. About a quarter of all women show ovarian follicles on ultrasound but will not have symptoms. About ten per cent of all women are affected.

Women with the condition ovulate infrequently and have irregular menstrual periods. They may experience weight gain and have an atypical distribution of body hair, with concentrations on the face, upper arm and abdomen.

Pregnant women with polycystic ovary syndrome have a higher risk of gestational diabetes, or high blood glucose levels during pregnancy, even if they have never been diabetic before. This can lead to a condition called macrosomia, or high birth weight, in the newborn.

Women with polycystic ovary syndrome are more susceptible to miscarriage and early labour. This is because elevated insulin levels may disrupt the balance between blood clotting/clot prevention hormones. There is therefore a risk of blood clots interfering with the ability of the placenta to supply the fetus with nutrients and remove waste products. This can result in miscarriage.

The condition carries with it a 30 to 40 per cent risk of Early Pregnancy Loss (EPL), or miscarriage in months one, two or three of gestation. This is believed to be because of diminished production of a protein instrumental in implantation and maintenance of pregnancy.

There is also an increased incidence of high blood pressure, which is an indication of a serious complication of pregnancy, pre-eclampsia, formerly known as ‘toxemia.’ This condition is also characterized by protein in the urine and edema, or swelling (abnormal fluid accumulation). Pre-eclampsia can lead to maternal convulsions and is a risk to the life of both mother and fetus. The only ‘cure’ is immediate delivery. With careful medical supervision and complete bed rest, gestation can be prolonged and both mother and child can survive and live healthy lives.

Newborns of mothers who have PCOS may spend time in a neonatal intensive care unit. They tend to be born pre-term or following induction of labor or Caesarean section as a result of complications. Many mothers have had fertility treatment, which often results in multiple births (twins, triplets). Some medications for PCOS are not suitable for use while pregnant. Achieving conception with this challenging condition is a blessing. There are risks, but with careful monitoring and supervision with your health care team, there is no reason your pregnancy should not go to term, or near term, and produce a healthy baby.