Pregnancy Complications in PCOSDr Chaithra S.K
PCOS is the most common endocrinological disorder affecting 4-12% of women. PCOS refers to a condition with a combination of reproductive and metabolic characteristics. Women with PCOS have difficulty in conceiving due to various issues like anovulation, obesity, menstrual irregularities and hyperandrogenism. Ovulation induction along with metformin and myoinositol improve the fertility rates in PCOS women.
Once they conceive again, there is a challenge of taking care of the pregnancy. Most women with PCOS have hormonal imbalances and are overweight or obese. They are at higher risk during pregnancy. Various hazards during pregnancy include pregnancy miscarriages, gestation diabetes mellitus, hypertensive disorders of pregnancy—macrosomia, preterm pre-labour rupture of membranes, preterm delivery, and increased risk of cesarean section.
Miscarriages (or) Early Loss of Pregnancy PCOS women have a much higher risk of miscarriage compared with non- PCOS women. The threat has been estimated at 30-50% due to the androgenic milieu.
Gestational Diabetes Mellitus Women with PCOS have a higher risk of gestational diabetes mellitus. They may be due to hormonal variation, insulin resistance, and obesity.
Hypertensive Disorders of pregnancy are at two times increased risk for hypertension & preeclampsia compared to the average population.
Macrosomia Uncontrolled gestational diabetes can lead to macrosomia. Fetal macrosomia is large for gestational age babies. Diabetic mothers are also at increased risk of polyhydramnios. Due to macrosomia & polyhydramnios, the risk of preterm delivery increases.
Preterm Delivery In the case of preterm delivery, neonatal risks such as respiratory distress syndrome, intraventricular hemorrhage, hypothermia, necrotizing enterocolitis, jaundice and hypoglycemia have to be tackled.
Management of PCOS in pregnant women
As we are all aware of the risks mentioned above associated with PCOS pregnancy, adequate and proper care with individualized treatment is necessary for managing pregnancy. For early miscarriages
• Adequate luteal phase support
• T. Metformin may play a role in reducing early miscarriages & gestational diabetes mellitus.
• Proper diet advice
• To avoid excessive weight gain.
As this population is at increased risk OGCT 75gms glucose challenge test is Preferably done at 12 wks, then repeated at 24 wks.
Once they are diagnosed with GDM with strict sugar control.
• Medical nutrition therapy
• Insulin if required
Close monitoring of mother & fetus is mandatory
In the case of gestational diabetes mellitus with macrosomia & polyhydramnios, there is a risk of preterm delivery & PPROM. Maintaining strict diabetic control, follow-up of interval growth of fetus & Amniotic fluid index play an essential role.
In such cases, the goal should be to continue pregnancy till 37 weeks with constant monitoring of the mother & instances of macrosomia, increased chances of C-section, or operative vaginal deliveries have to be considered.
The patient to be counselled regarding the above risks and the need for continuous monitoring & supervision of pregnancy. With proper, individualized care, PCOS women Can enjoy happy pregnancy & motherhood.