Miscarriage is the loss of a pregnancy during the first 23 weeks. Around one in eight pregnancies, with women knowing they are pregnant, will tragically 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 difficult. Although PCOS is well-known as a common cause of infertility, it can also increase the risk of miscarriage. The positive news is that if you have PCOS you can gain control, taking steps to improve your diet and lifestyle to support healthy pregnancies.
Does PCOS increase your chance of miscarriage?
PCOS and pregnancy can be fraught with challenges, including a greater risk of miscarriage. It is thought that hormonal imbalances due to PCOS can sometimes trigger miscarriages. PCOS might also be associated with miscarriage due to the fact that many women with PCOS struggle with weight gain, with obesity linked to a greater chance of miscarriage. Another potential cause is elevated levels of insulin in the blood. In fact, research has suggested that women with PCOS are more likely to have a miscarriage with 30-50% of PCOS women likely to miscarry compared to 10-15% of women without PCOS. 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 very limited and there is no proof that abnormal ovarian morphology (as seen in polycystic ovaries) is a direct cause of miscarriage or that pregnancy loss is a result of higher levels of testosterone or luteinising hormone due to PCOS. The problem is that it is difficult to study evidence after the miscarriage, so results can remain vague or inconclusive, with a number of varying factors from case to case.
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 miscarriage. Exercise can reduce excess weight gain and it also minimises stress levels by releasing happy hormones called endorphins. When you’re pregnant, check your exercise plan with your doctor. You should avoid strenuous physical activities, but make sure you stay active.
Minimise medication intake
As with any pregnancy, it is advisable to minimise your medication intake. Ensure that you talk through any medication with your doctor. If you’re seeing a new doctor or talking to a new pharmacist, make sure that they know you’re pregnant. Ensure that you read all information provided with medication, many medicines will be unsuitable for pregnant women. However, some medicines are considered to be safe and your doctor will advise you on dosage.
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. IIf you have PCOS, doctors and fertility specialists may recommend taking Inofolic Alpha.
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).
Reduce intake of caffeinated beverages
The NHS advises no more than 200mg of caffeine per day due to caffeine increasing the risk of miscarriage (bear in mind that chocolate and some fizzy drinks contain caffeine — it’s not just tea and coffee). 200 mg of caffeine a day is the equivalent of two mugs of instant coffee (perhaps one chocolate bar with a cup of coffee? You’ll have to decide what’s more important to you!) For the safest pregnancy, ideally, swap all your caffeinated drinks for caffeine-free versions.
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 (potentially due to obesity). 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. 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. If you do have pre-eclampsia, you may be advised to have your baby earlier by being induced or via a caesarean section. The NHS advice says this should happen around 37 to 38 weeks of pregnancy, or earlier in severe cases.
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). But often women give birth prematurely for no obvious reason and nothing could get prevented it. However, to give yourself the best possible chance of a full-term pregnancy, avoid caffeine and alcohol, eat healthily, 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 lifestyle changes. A healthy diet, appropriate supplements, regular exercise and stress management will increase your 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.
