Does having PCOS make pregnancy riskier?

Being pregnant with polycystic ovary syndrome (PCOS) can raise understandable worries about miscarriage, pregnancy complications, and whether extra monitoring will be needed. Many people worry that PCOS automatically means a high-risk pregnancy.

In reality, most people with PCOS go on to have healthy pregnancies and healthy babies. While PCOS is linked to a slightly higher risk of some complications, these risks are usually influenced by factors such as insulin resistance, weight, age, and metabolic health – rather than PCOS alone. With good preparation, early support, and routine antenatal care, outcomes are often far more positive than people expect.

In this article, I explain which pregnancy risks are more common in PCOS, why they occur, how they are monitored, and what reassurance is important to keep in mind.

Does PCOS increase the risk of miscarriage?

PCOS is associated with a slightly higher risk of miscarriage, but this risk is influenced by several factors rather than PCOS itself.

Key contributors include:

• Female age, which is one of the strongest predictors
• Insulin resistance
• Weight
• Hormonal imbalance

These factors can be more common in PCOS and often explain the increased risk.

The reassuring message is that good pre-pregnancy care and the right support can reduce this risk. Many people with PCOS go on to have successful pregnancies, and having PCOS does not mean miscarriage is inevitable.

Does PCOS increase the risk of high blood pressure or pre-eclampsia?

Yes, PCOS is associated with a slightly higher risk of high blood pressure and pre-eclampsia during pregnancy, but this is not the case for everyone.

The increased risk is usually linked to:

• Insulin resistance
• Higher body weight
• Metabolic health
• Female age
• Whether it is a first pregnancy

With good pre-pregnancy planning and careful monitoring during pregnancy, most people with PCOS have healthy pregnancies. The key is early support, regular checks, and proactive management of risk factors.

Am I more likely to develop gestational diabetes if I have PCOS?

Yes, having PCOS does increase the chance of developing gestational diabetes.

This higher risk is mainly related to:

• Insulin resistance, which is common in PCOS
• Factors such as age and weight

The reassuring part is that gestational diabetes is something pregnancy care teams monitor closely. With early screening, obstetric support around food and movement, and regular checks, it can be picked up early and managed very well, helping both you and your baby stay healthy.

What other pregnancy complications are more common with PCOS?

Most people with PCOS have straightforward pregnancies, but a few complications are slightly more common and worth being aware of. These can include:

• Gestational diabetes
• High blood pressure or pre-eclampsia
• Preterm birth
• A higher chance of induction or caesarean delivery

Many of these risks are influenced by insulin resistance, weight, and age, rather than PCOS alone.

The positive message is that PCOS is very well recognised in pregnancy care. With good preparation, early screening, and regular antenatal support, most pregnancies progress smoothly, and many people find the experience far more reassuring than they initially expected.

Can PCOS affect the baby’s growth or the risk of preterm birth?

PCOS can be linked to a slightly higher chance of preterm birth or differences in baby’s growth, but for most people this does not become a problem.

Many pregnancies in people with PCOS progress completely normally, with babies growing well and being born at term. Pregnancy care teams are very experienced in monitoring growth and wellbeing, and any concerns are usually picked up early.

With regular scans, routine antenatal care, and timely support if needed, the vast majority of babies born to people with PCOS are healthy and do very well.

Do I need extra monitoring during pregnancy if I have PCOS?

Not necessarily.

Most people with PCOS follow standard pregnancy care, with a few additional checks as a precaution. These may include monitoring growth, blood pressure, or blood sugar more closely.

This approach is not because a problem is expected, but because being proactive helps ensure that anything that does arise is caught early and managed promptly.

Can PCOS symptoms change during pregnancy or after birth?

PCOS symptoms can change during pregnancy and after giving birth, and this varies from person to person.

During pregnancy:

• Some people notice improvements in symptoms such as acne or excess hair growth
• Others see little change
• Period-related symptoms usually settle during pregnancy

After birth, particularly once periods return, PCOS symptoms can reappear or feel more noticeable for a time. The positive part is that this phase is manageable.

With the right postnatal support, lifestyle adjustments, and medical care if needed, symptoms often settle again. Many people find that understanding their PCOS better after pregnancy helps them feel more informed and in control going forward.

About the author

Dr Yusuf Beebeejaun is a London-based Consultant in Reproductive Medicine and Fertility Specialist at London Pregnancy Clinic, providing research-led fertility care across private and NHS settings. He specialises in fertility assessment, IVF, ovarian stimulation, recurrent implantation failure, and PGT-A, and sees patients privately at King’s Fertility and Spital Clinic.