Pregnancy with PCOS
Does having PCOS make pregnancy high risk?
The answer to this may depend a little on the definition of high risk. Most PCOS patients
can see a regular OBGYN, or perinatologist. Anyone who is severely insulin resistant,
diabetic, or has high blood pressure may need to see a high-risk OBGYN. This is an issue
to be decided by doctor and patient together.
Does a pregnant woman with PCOS require special monitoring?
Some special monitoring may make sense such as earlier gestational diabetes screening
or home glucose monitoring. Beyond that it depends on the PCOS symptoms experienced by the
patient before pregnancy. Anyone taking medication may require additional monitoring.
Many of the issues one needs to watch for are included in routine pregnancy care. For
example, a woman with borderline hypertension before is more likely to have increased blood
pressure in pregnancy, but most doctors check all patients for blood pressure issues.
Is low-carbohydrate dieting healthy in pregnancy?
A diet that is very low in carbohydrates is not safe during pregnancy. If the body is too
low on resources, it will burn fat for calories. A byproduct of this is ketones, and these
may not be healthy for the growing fetus. It is best to follow a meal plan that allows
consumption of vegetables and complex carbohydrates at each meal and snack. A couple of the
plans listed in the weight section are safe during pregnancy, and consultation with a
nutritionist familiar with gestational diabetes may help.
Can insulin-sensitizing medications such as metformin and the glitazones be taken during
pregnancy?
It has been recognized for years that high glucose levels can have a detrimental effect on
the growing fetus and most doctors would suggest diet and/or insulin injections to control
this, but recently there has been discussion that high insulin levels may be just as damaging.
Continuing metformin in pregnancy is an area of controversy some doctors won't prescribe
it to women who are trying to conceive, some tell patients to discontinue metformin after a
positive pregnancy test, some wait for a heartbeat, some treat through the first trimester,
and others continue the medication throughout the pregnancy. There are some studies that
indicate continuing the medication may reduce the risk of miscarriage. The long-term risks
to the baby are not known, but many apparently healthy babies have been born to women who
used metformin while pregnant. Metformin is a Pregnancy Category B drug, meaning that it has
not been known to cause birth defects in rats, but there are no adequate studies in pregnant
women and the choice to continue metformin should be based on whether one considers the
potential benefits to outweigh the risks. This is an area where a woman and her doctor have
to weigh the risks and benefits together.
As for the glitazones, Avandia and Actos are considered safe to the patient using them, but
both are listed as Pregnancy Category C medications. Most doctors will ask patients to
discontinue use of these medications during pregnancy.
Is someone with PCOS more likely to have gestational diabetes?
Many women with PCOS are insulin resistant, and pregnancy tends to be a time of increased
glucose intolerance as well. When one combines the two, there is an increased incidence of
gestational diabetes.
What is gestational diabetes and how is it diagnosed?
Gestational diabetes occurs when a woman has impaired glucose/carbohydrate tolerance during
pregnancy (usually temporarily, or a temporary worsening). The main concerns are having the
baby get too much sugar since the mother is not processing it herself leading to a large
baby, but perhaps with immature lungs, and some birthing difficulties and the ketone byproduct
that may be produced when the body turns to other sources, such as fat-stores, for energy.
It is usually diagnosed based on a reading of 200 mg/dl or higher on a 1-hour oral glucose
challenge test where 50 grams of sugar are consumed, or based on having two parameters out of
normal range on a 3-hour GTT after consuming 100 grams of glucose.
Oral Glucose Tolerance Test for Gestational Diabetes
Time Normal Values Gestational diabetes is diagnosed if 2 or
more levels are above the normal range.
Fasting < 105 mg/dl
1 hour < 190 mg/dl
2 hours < 165 mg/dl
3 hours < 145 mg/dl
Does PCOS cause problems breastfeeding?
There are no adequate studies on the topic, but the hormone imbalances that go along with PCOS
appear to reduce ones ability to breastfeed exclusively. Most PCOS women have no trouble, and
breastfeeding may improve glucose tolerance a short time after giving birth.
Is it safe to use insulin-sensitizing medications while breastfeeding?
Since many medications are excreted in breastmilk, it is usually recommend that insulin-
sensitizing medication not be used while breastfeeding. The effect such medications may have on
the nursing baby or toddler is not known.
Will pregnancy cure PCOS?
There is no cure for PCOS, but some women do have a normalization of cycles after a pregnancy.
Those who had fertility problems may find it easier to get pregnant again
