Does PCOS increase your chances of miscarriage?

Miscarriage is the loss of a pregnancy during the first 23 weeks. This happens frequently, as around one in four pregnancies will sadly end in miscarriage.

If you have polycystic ovary syndrome (PCOS), your initial focus may be on successfully conceiving because getting pregnant with PCOS can be slow if you do not get proper guidance. Although PCOS is well-known as a common cause of anovulation, it can also increase the risk of a pregnancy loss. The positive news is that if you have PCOS you can gain control, taking steps to improve your diet and lifestyle to improve your fertility and to increase the chances of having healthy pregnancies. 

Does PCOS increase your chance of pregnancy loss?

PCOS and pregnancy can sometimes be challenging, including a greater risk of pregnancy loss. Insufficient levels of progesterone and sometimes higher levels of androgens can increase the chances of losing a pregnancy. PCOS carries a higher chance of miscarriage especially when there is excessive weight or obesity, as the excess weight alone increases the risk of a pregnancy loss.

Added to this, there are reports of a higher rate of miscarriage for those with PCOS who go through IVF. However, research in this area is still ongoing and more studies are needed, as it seems that there are more than one factors that increase the chance of a pregnancy loss in PCOS.  

If you have PCOS, what can you do to minimise the risk of miscarriage?

Exercise

Managing PCOS and exercise go hand-in-hand and gentle, regular exercise has a multitude of benefits that help to minimise the risk of pregnancy loss. Exercise can reduce excess weight gain and it also minimises stress levels by releasing happy hormones called endorphins. Reaching a healthy weight and engaging in regular light exercise well before falling pregnant will give you the best chances of a healthy pregnancy. Once you’re pregnant, check your exercise plan with your doctor. You should avoid strenuous physical activities, but make sure you stay active every day. 

Take prenatal vitamins

The NHS advises that it is important to take 400 micrograms of folic acid every day before you’re pregnant and until you’re 12 weeks pregnant. Folic acid can help prevent neural tube defects, such as spina bifida. The NHS also advises taking a supplement of 10 micrograms of vitamin D each day as it is difficult to get enough from foods alone. Vitamin D is needed to keep muscles, teeth and bones healthy.

Maintain a healthy blood glucose level

High blood glucose also can increase the chance that you’ll have a miscarriage, so it is important to maintain a healthy blood glucose level, both when trying for a baby and during pregnancy. Frequent blood sugar monitoring will also help spot/prevent gestational diabetes. A treatment plan will also include regular exercise, a healthy diet and sometimes insulin injections.

Stress management

There’s no evidence that stress can cause miscarriage, but stress isn’t good for your overall health. Stress can manifest itself physically and make your PCOS symptoms feel worse. Make sure that you rest during your pregnancy when you need to, keep active and eat well. Spas often do pregnancy-specific packages, including pregnancy-safe massages and treatments (make sure that you tell the spa that you’re pregnant as they’ll need to ensure your safety).

Avoid intake of caffeinated beverages

Caffeine increases the chances of miscarriage, low birth-weight and fetal growth restriction. Bear in mind that matcha, green tea, chocolate and some fizzy drinks contain caffeine — it’s not just tea and coffee. For the safest pregnancy, ideally, swap all of your caffeinated drinks for naturally caffeine-free versions such as barley coffee, or try rooibos, fennel and mint tea.

What other pregnancy complications should you be aware of if you have PCOS?

Gestational diabetes

As mentioned, high blood sugar in pregnancy can lead to gestational diabetes. This can lead to a larger baby, with related birth complications. Research has found that those with PCOS have an increased risk of gestational diabetes, especially if they are overweight or obese. However, with careful management, there is no reason why you can’t have an otherwise healthy pregnancy with a healthy baby. Management will include gentle exercise to lower your blood sugar and a diet focused on foods with a low glycaemic index (GI) such as green vegetables, wholemeal bread, quinoa, sweet potato and oats.

Pre-eclampsia

Although any pregnancy can be affected by pre-eclampsia, many studies have found that women with PCOS are at an increased risk of pre-eclampsia. Pre-eclampsia is a serious health condition that can put both the baby’s and your health at serious risk. 

Early signs of pre-eclampsia include having protein in your urine (proteinuria) and high blood pressure (hypertension) which should both be picked up during your routine antenatal appointments. To lower your risk of developing pre-eclampsia, keep your weight healthy through diet and exercise. 

Premature delivery

As having PCOS means that there is a higher chance of pregnancy complications, you may have a higher chance of having a premature delivery (usually related to pre-eclampsia). However, to give yourself the best possible chance of a full-term pregnancy, avoid caffeine and alcohol, eat healthily, get enough sleep, keep active and give up smoking if you’re a smoker.

In Summary

Reading a list of heightened pregnancy risks for those with PCOS can feel overwhelming. But the important thing to remember is that many of these risks can be lowered simply by making positive lifestyle changes. A healthy diet, regular exercise and stress management are all key to a healthy baby. Hopping on this new regime before you start seeking a pregnancy and reaching a healthy weight before you get a positive pregnancy test will significantly increase the chances of getting pregnant and having a healthy pregnancy.

References:

Kamalanathan, S., Sahoo, J.P., Sathyapalan, T. Pregnancy in polycystic ovary syndrome. Indian J Endocrinol Metab. 2013.

Mikola, M., Hiilesmaa, V., Halttunen, M., Suhonen, L., Tiitinen, A. Obstetric outcome in women with polycystic ovarian syndrome. Human Reproduction. 2001.

Palomba, Stefano et al. Pregnancy complications in women with polycystic ovary syndrome. Human Reproduction Update, Volume 21, Issue 5, Sept/Oct 2015.

Turhan, N.O., Seçkin, N.C., Aybar, F., Inegö, I. Assessment of glucose tolerance and pregnancy outcome of polycystic ovary patients. Int J Gynaecol Obstet. 2003.