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High-Risk Pregnancy

Pregnancy With PCOS: Extra Monitoring and What to Know

Published 6 April 2026
This content is for informational purposes only and does not replace professional medical advice. Always consult your midwife or GP.
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Medically reviewed content. Last updated: April 2026.

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Pregnancy With PCOS: Extra Monitoring and What to Know

Medically reviewed content. Last updated: April 2026.

Getting pregnant with PCOS can take extra effort, but once you are pregnant, you may wonder what comes next. PCOS does carry some additional risks during pregnancy, but with the right monitoring, most people with PCOS have healthy pregnancies and healthy babies. This guide explains what extra care you can expect and how to look after yourself.

Does PCOS affect pregnancy?

Yes, but the risks are manageable with good antenatal care. Research shows that people with PCOS have a higher chance of certain pregnancy complications compared to those without the condition. This does not mean these complications will happen, just that your care team will monitor you more closely.

What are the additional risks?

Gestational diabetes. This is the most significant additional risk. People with PCOS are two to three times more likely to develop gestational diabetes, largely because of the underlying insulin resistance that is common in PCOS. You will usually be offered a glucose tolerance test (GTT) between 24 and 28 weeks, and possibly earlier if other risk factors are present.

Pre-eclampsia. The risk of pre-eclampsia is slightly higher with PCOS. Your blood pressure and urine will be checked at every antenatal appointment. If you are identified as higher risk, you may be offered low-dose aspirin (150mg daily) from 12 weeks to reduce this risk.

Premature birth. Some studies show a slightly increased risk of preterm delivery, though the absolute risk remains low.

Caesarean delivery. Higher rates of caesarean delivery have been reported in people with PCOS, partly related to the higher rates of gestational diabetes, larger babies, and induction of labour.

Higher birth weight. Babies of parents with PCOS may be slightly larger, particularly if gestational diabetes develops.

What extra monitoring will you have?

Your care will typically include screening for gestational diabetes (GTT at 24 to 28 weeks, sometimes earlier), regular blood pressure and urine checks at every appointment, growth scans in the third trimester if gestational diabetes is diagnosed or if there are concerns about baby size, and consultant-led care rather than midwife-only care, depending on your individual risk profile.

If you were taking metformin to conceive, your consultant will discuss whether to continue it during pregnancy. Some specialists recommend continuing metformin in the first trimester or throughout pregnancy to reduce the risk of gestational diabetes, though this is not standard NHS practice and the evidence is still evolving.

What about PCOS symptoms during pregnancy?

Periods. Obviously absent during pregnancy, which is a welcome change for many people with PCOS who normally have irregular cycles.

Acne. May improve or worsen during pregnancy due to hormonal changes. Avoid retinoid-based acne treatments during pregnancy. Gentle cleansers and pregnancy-safe topical treatments can help.

Hair growth. Excess hair growth (hirsutism) may change during pregnancy. Some people notice improvement, while others find it worsens. Hormonal acne and hair growth treatments are generally stopped during pregnancy.

Weight. If weight management was a challenge before pregnancy, it remains important during pregnancy. Your midwife or a dietitian can provide guidance on healthy eating and appropriate weight gain for your BMI.

How can you look after yourself?

Eat to manage blood sugar. Even before a GD diagnosis, eating in a way that supports stable blood sugar levels is beneficial. Choose low-GI carbohydrates, pair carbs with protein, eat regularly, and avoid sugary drinks and processed foods.

Stay active. Regular moderate exercise improves insulin sensitivity and supports overall health. Walking, swimming, and pregnancy yoga are all excellent options. Aim for 150 minutes per week unless advised otherwise.

Take your supplements. Folic acid (400mcg daily) and vitamin D (10mcg daily) are essential. Continue any prescribed medications unless your doctor advises otherwise.

Monitor your weight. Discuss healthy weight gain targets with your midwife based on your pre-pregnancy BMI. Modest, steady gain is the goal.

Attend all appointments. The additional monitoring offered to people with PCOS is there to catch any issues early. Keep all your appointments, and raise any concerns with your midwife or consultant.

What about after birth?

PCOS does not go away after pregnancy. Your symptoms and hormonal patterns will return to their pre-pregnancy state once your hormones settle. If you were taking metformin or other medications before pregnancy, discuss with your GP when to restart them.

If you developed gestational diabetes, you will need follow-up blood sugar testing after birth and annual screening, as the combination of PCOS and previous GD significantly increases your long-term risk of type 2 diabetes. Maintaining the healthy eating and exercise habits you developed during pregnancy is the best protection.

Breastfeeding may help improve insulin sensitivity and is encouraged for all the usual reasons, plus the potential metabolic benefits.

Key takeaways

  • PCOS increases the risk of gestational diabetes, pre-eclampsia, and caesarean delivery, but most people with PCOS have healthy pregnancies with good care
  • You will typically have additional monitoring including a glucose tolerance test and regular blood pressure checks
  • Eating to manage blood sugar, staying active, and attending all appointments are the most important things you can do
  • PCOS symptoms may change during pregnancy but will return afterwards
  • Follow-up after birth is important, especially if you had gestational diabetes

Sources

  • NHS. Polycystic ovary syndrome. nhs.uk
  • NICE Guideline NG3. Diabetes in pregnancy. 2015, updated 2020
  • RCOG. Polycystic ovary syndrome: what it means for your long-term health. Patient information. 2023
  • Boomsma CM et al. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Human Reproduction Update. 2006
  • Teede HJ et al. International evidence-based guideline for the assessment and management of polycystic ovary syndrome. 2023
Part of our complete guide
Understanding High-Risk Pregnancy: Conditions, Monitoring, and Support

Frequently asked questions

Does PCOS affect pregnancy?

Yes, but the risks are manageable with good antenatal care. Research shows that people with PCOS have a higher chance of certain pregnancy complications compared to those without the condition. This does not mean these complications will happen, just that your care team will monitor you more closely.

What are the additional risks?

Gestational diabetes. This is the most significant additional risk. People with PCOS are two to three times more likely to develop gestational diabetes, largely because of the underlying insulin resistance that is common in PCOS. You will usually be offered a glucose tolerance test (GTT) between 24 and 28 weeks, and possibly earlier if other risk factors are present.

What extra monitoring will you have?

Your care will typically include screening for gestational diabetes (GTT at 24 to 28 weeks, sometimes earlier), regular blood pressure and urine checks at every appointment, growth scans in the third trimester if gestational diabetes is diagnosed or if there are concerns about baby size, and consultant-led care rather than midwife-only care, depending on your individual risk profile.

What about PCOS symptoms during pregnancy?

Periods. Obviously absent during pregnancy, which is a welcome change for many people with PCOS who normally have irregular cycles.

How can you look after yourself?

Eat to manage blood sugar. Even before a GD diagnosis, eating in a way that supports stable blood sugar levels is beneficial. Choose low-GI carbohydrates, pair carbs with protein, eat regularly, and avoid sugary drinks and processed foods.

What about after birth?

PCOS does not go away after pregnancy. Your symptoms and hormonal patterns will return to their pre-pregnancy state once your hormones settle. If you were taking metformin or other medications before pregnancy, discuss with your GP when to restart them.

Sources

  1. NHS. Polycystic ovary syndrome
  2. NICE Guideline NG3. Diabetes in pregnancy. 2015, updated 2020
  3. RCOG. Polycystic ovary syndrome: what it means for your long-term health. Patient information. 2023
  4. Boomsma CM et al. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Human Reproduction Update. 2006
  5. Teede HJ et al. International evidence-based guideline for the assessment and management of polycystic ovary syndrome. 2023

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