Can PCOS Increase Your Risk Of Miscarriage?

If you have polycystic ovary syndrome (PCOS), you may know that fertility problems are a common adverse effect. Many people don’t find out they have the condition until they have difficulty conceiving.

Pregnancy is possible with treatment for many people with PCOS. But how does the condition affect you during pregnancy? And does it increase your chance of having a miscarriage?

What is PCOS?

PCOS is a common endocrine disorder that affects people assigned female at birth.

It is typically characterized by elevated androgen levels (male sex hormones), irregular or absent periods, and multiple small cysts on the ovaries. You must have two out of three of these characteristics to be diagnosed with PCOS according to the criteria doctors typically use.

PCOS can cause several symptoms, including excess hair growth (hirsutism), oily skin, and unexplained weight gain. However, symptoms and their severity differ from person to person.

Understanding the impact of PCOS on pregnancy

PCOS impacts fertility due to the hormonal imbalances it causes. People with PCOS have increased androgen levels, which can interfere with ovulation and reduce the quality of any eggs released.

The condition can also cause an imbalance between luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones are crucial for stimulating eggs to mature and be released from the ovaries. Normal ovulation doesn’t occur when they are imbalanced.¹

Insulin resistance also plays a role in reducing fertility. It causes delayed egg maturation, and any released eggs tend to be smaller and of lower quality. Typically, insulin resistance also shifts your hormonal balance toward producing more androgens. However, most people with PCOS can successfully conceive and give birth with treatment.²

When conception does occur, people with PCOS have a higher risk of both early pregnancy loss and later pregnancy complications, including gestational diabetes, preeclampsia, premature birth, and low birth weight. So, yes — PCOS does increase your risk of miscarriage.³

The rate of early pregnancy loss in people with PCOS is 30–50%. Meanwhile, this rate is 10–15% in the general population of pregnant people. There are several reasons for this difference.

Some cases of early pregnancy loss in people with PCOS may occur due to ovulation-inducing drugs commonly used to help PCOS patients conceive. Elevated LH levels may also play a role, although using medical treatments to reduce LH levels does not seem to reduce miscarriage risk.

Higher testosterone levels are also associated with recurrent miscarriages in people with PCOS and those with high androgen levels. Elevated testosterone reduces uterine receptivity, making it harder for an embryo to implant successfully into the uterus. This increases the rate of early miscarriage.

All of this means that patients with PCOS are more likely to miscarry in the first trimester, sadly after they have likely had difficulty conceiving.

The role of insulin resistance in causing PCOS-related pregnancy complications

Insulin resistance appears to play an important role in PCOS-related pregnancy complications.

Hormonal changes cause insulin resistance in a normal pregnancy. By reducing the mother’s glucose uptake, nutrients are diverted to the growing fetus. This then results in compensatory hyperinsulinemia (increased insulin levels in the blood) in the second and third trimesters.

People with PCOS almost always have insulin resistance. When the normal insulin resistance of pregnancy is added to this preexisting resistance, it can result in gestational diabetes. This condition generally develops in the second half of pregnancy. It occurs in 40–50% of pregnancies in people with PCOS.⁴

It’s very clear that overweight people with PCOS have an increased risk of developing gestational diabetes. However, researchers are still uncertain whether people with PCOS with a normal body weight also have an increased risk.

In any case, experts know that pregnant people with gestational diabetes are at an increased risk for pregnancy complications, including miscarriage.

What factors increase the risk of miscarriage?

Higher androgen levels and insulin resistance are both associated with an increased risk of miscarriage.

However, obesity is the most common factor that increases the risk of miscarriage in people with PCOS. Excess body weight makes it harder to conceive and successfully carry a pregnancy. It also increases your risk of pregnancy complications, like gestational diabetes.

To minimize your chances of miscarriage, you should attempt to lose as much excess weight as you can before trying to get pregnant.

Other factors associated with miscarriage include the following:

• Chromosome problems

• Older age

• Smoking and drug use, including consumption of alcohol and large quantities of caffeine

• Uncontrolled diabetes or high blood pressure

• Thyroid problems

• Lupus

• Kidney disease

• Certain infections, including rubella, malaria, cytomegalovirus, and some sexually transmitted diseases

• Food poisoning

• Certain medications, including non-steroidal anti-inflammatory drugs (NSAIDs)

• Uterine fibroids

• A weakened cervix

It is possible to have PCOS and other medical issues at the same time, such as high blood pressure and thyroid problems.

How can people with PCOS reduce their risk?

Losing a pregnancy after experiencing fertility problems can be extremely distressing. It can be even more challenging if you spent a lot of money on fertility treatments in order to get pregnant. It’s understandable that you would want to take as many steps as possible to reduce your risk of miscarriage.

Below are some ways to reduce the risk of miscarriage:

Losing weight 

Obesity both reduces your chance of conceiving and increases your risk of miscarriage and other complications. Gestational diabetes can also increase you and your baby’s chances of developing type 2 diabetes later in life.⁵ ⁶

Losing excess weight before trying to get pregnant is the healthiest choice for both you and your child.

While some weight gain during pregnancy is normal and desirable, excessive weight gain can be a cause or indicator of problems with your pregnancy. Your doctor will monitor your weight throughout your pregnancy, and if you gain more than the expected amount, they will talk to you about healthy ways to control your weight gain.

Taking metformin

Metformin is commonly prescribed to patients with PCOS who wish to get pregnant. This drug increases the body’s sensitivity to insulin, which helps reduce insulin resistance.⁷

In a study in Scandinavia, metformin reduced the risk of early miscarriage by about 80%. In addition, there was a significantly lower rate of pregnancy complications like premature birth among people who took metformin throughout pregnancy.⁸

Your medical team will decide whether metformin is a good option for you. They will prescribe it if they believe it’s appropriate. If you’re prescribed metformin, ensure you take it diligently as directed.

Quit smoking

If you smoke, you should quit before trying to get pregnant. In addition to the serious dangers it poses to your overall health, smoking can reduce your chances of conception and increase your risk of miscarriage.

If quitting is difficult for you, talk to your doctor about a smoking cessation program. There’s help available that can allow you to finally kick the smoking habit.

Avoid alcohol

Alcohol can increase your risk of miscarriage and result in birth defects like fetal alcohol spectrum disorder. This condition can impact your child’s coordination, memory, math ability, and much more.⁹

To avoid this, you should stop drinking when you start trying to conceive and continue to avoid alcohol until your child is weaned from breastfeeding.

Eat a healthy diet

Anyone who is pregnant should strive to eat a healthy, balanced diet.

“Eating for two” doesn’t mean you should eat twice as much as you normally would. However, if you’re not overweight, you will need to consume about 340–450 extra calories per day during the second and third trimesters.¹⁰

You may need fewer additional calories than this if you are overweight. Talk to your doctor or a nutritionist to determine the best plan for you.

Various nutrients are important during pregnancy, including folic acid, iron, calcium, vitamin D, choline, omega-3 fatty acids, B vitamins, and vitamin C.¹¹

Supplements

The Centers for Disease Control and Prevention (CDC) recommends taking a daily supplement containing 400mcg of folic acid for anyone who might become pregnant.¹²

Folic acid is essential for neural tube development at the very beginning of pregnancy. Deficiency can cause severe birth defects. You should start taking folic acid right away if you are trying to conceive.

Taking a high-quality daily prenatal vitamin and mineral supplement during pregnancy is recommended. It should include nutrients like folic acid, iron, iodine, and vitamin D. This is not a substitute for eating a healthy diet — you should take a prenatal supplement in addition to making healthy dietary choices. Your medical team can help you determine whether your prenatal vitamin contains all the recommended nutrients.¹³

These steps are valuable for anyone who is pregnant, particularly for people with conditions that raise their risk of miscarriage, like PCOS. By setting yourself up for a healthy pregnancy, you reduce your risk of miscarriage and complications and give your child the best chance in life.

The lowdown

Having PCOS increases your risk of miscarriage and premature birth. However, most people with PCOS can have successful pregnancies and give birth to healthy babies.

You should talk to your doctor before trying to get pregnant.

Taking metformin is extremely helpful throughout the entire process, from trying to conceive all the way through the pregnancy. It increases your chances of conception and reduces your risk of miscarriage and premature birth.

It’s also a good idea to talk to a nutritionist, especially if you are overweight and/or using fertility treatment.

Your doctor can guide you through your pregnancy and advise you on steps you can take to help keep you and your child healthy.