If you have PCOS and you’re pregnant—or hoping to be soon—you might be feeling a mixture of joy and anxiety. Perhaps you’ve read alarming statistics about pregnancy complications, or a healthcare provider has mentioned increased risks without explaining what that actually means or what you can do about it.
Let me start with what matters most: the majority of people with PCOS have healthy pregnancies and healthy babies.
Yes, PCOS does increase certain pregnancy risks—that’s medically accurate, and I’m not going to minimise it. But here’s what’s equally true: understanding these risks and taking evidence-based steps to manage them dramatically improves your outcomes. You have far more agency than you might realise.
I’ve supported countless people with PCOS through pregnancy over the past decade. What I’ve learned is that knowledge reduces fear, and proactive management creates the best possible environment for both you and your baby.
Let me walk you through what actually matters.
How PCOS Affects Pregnancy: Understanding the Risks
PCOS doesn’t disappear when you conceive. The same metabolic and hormonal factors that affected your fertility continue to influence your pregnancy. Understanding these connections helps you take meaningful action.
Gestational Diabetes
Those with PCOS have a significantly higher risk of developing gestational diabetes—roughly two to three times higher than those without PCOS. This isn’t about blame or poor choices. It’s about the underlying pancreatic b-cell dysfunction or the insulin resistance that’s common in PCOS.
When you’re pregnant, your body naturally becomes somewhat insulin-resistant in the second and third trimesters—this ensures enough glucose reaches your baby. But if you already have insulin resistance from PCOS, this normal pregnancy change can push your blood sugar into the diabetic range.
Gestational diabetes matters. Maternal complications include high blood pressure in pregnancy (preeclampsia) and raised risks of a caesarean delivery and developing type 2 diabetes mellitus. The baby can suffer from being too big (macrosomia) or too small (low birth weight), with low-weight babies more common in people with both PCOS and gestational diabetes. There is also a heightened risk of the baby developing too many red blood cells (polycythaemia), high blood sugar levels (foetal hyperglycaemia) or low blood sugar levels (neonatal hypoglycaemia), lung problems (neonatal respiratory distress syndrome), and increased mortality around birth.
The good news? Gestational diabetes can often be prevented or well-managed through nutrition, movement, and monitoring.
Preeclampsia and High Blood Pressure
PCOS increases the risk of pregnancy-induced hypertension and preeclampsia—a serious condition characterised by high blood pressure and protein in the urine.
In severe cases, it may require hospitalisation and early delivery to protect both you and your baby.
Miscarriage and Preterm Birth
Research shows that PCOS is associated with higher rates of miscarriage, particularly in the first trimester, and increased risk of preterm birth. The mechanisms aren’t fully understood, but insulin resistance, inflammation, and hormonal imbalances all may play a role.
This doesn’t mean miscarriage is inevitable—many people with PCOS have uncomplicated pregnancies that go to full term. But it does mean that early and consistent prenatal care matters.
Birth Weight Concerns
Babies born to parents with PCOS may be larger than average (macrosomia) or, more commonly, smaller than expected. Large babies face higher risks during delivery and may have blood sugar regulation problems after birth. They’re also at increased risk for metabolic syndrome and type 2 diabetes later in life.
Foetal Programming: Your Baby’s Long-Term Health Begins Now
Here’s something fascinating and important: the nutritional and metabolic environment you provide during pregnancy influences your baby’s health trajectory for their entire life. This concept is called developmental programming or foetal origins of adult disease.
Research shows that a developing baby is exquisitely sensitive to the maternal metabolic environment. When a baby develops in an environment of insulin resistance, inflammation, and elevated blood glucose, epigenetic changes occur—meaning the way their genes are expressed is altered. These changes can predispose them to insulin resistance, obesity, cardiovascular disease, and even PCOS (particularly in female babies) decades later.
This isn’t meant to create fear or guilt. It’s meant to empower you. Because you absolutely can influence your metabolic health before and during pregnancy. And the research is clear: when metabolic factors are well-managed during pregnancy, outcomes for babies improve dramatically.
Your body’s environment during these nine months genuinely shapes your child’s metabolic future. That’s not pressure—it’s an incredible opportunity to make a meaningful difference.
I’ve written in detail about how to reduce your baby’s chance of developing PCOS, which covers these developmental programming concepts more thoroughly.
Before Pregnancy: The Power of Preconception Optimisation
If you’re reading this before conceiving, you have a remarkable window of opportunity. The metabolic improvements you make now don’t just support conception—they create the healthiest possible starting point for your pregnancy.
Focus on metabolic health, not just weight. While improving body composition can be beneficial for some people with PCOS, what matters more is insulin sensitivity, inflammation levels, and hormonal balance. You can improve all of these regardless of whether a significant weight change occurs.
Address insulin resistance. This is foundational. A low-glycaemic way of eating, regular movement, adequate sleep, and stress management all improve insulin sensitivity. For some, inositol supplementation or medication (under professional guidance) can be helpful.
Optimise your nutrients. Folate, vitamin D, magnesium, omega-3 fatty acids, and B vitamins all support healthy pregnancy and foetal development. Testing and targeted supplementation before pregnancy ensure your body has what it needs.
Manage inflammation. An anti-inflammatory diet rich in colourful vegetables, omega-3s, and whole foods while limiting processed foods, excess sugar, and inflammatory oils creates a healthier internal environment.
Support your mental health. The stress of infertility and pregnancy anxiety is real. Working with a therapist, practising mindfulness, and building your support network before pregnancy serves you throughout the journey.
During Pregnancy: What You Can Do
Once you’re pregnant, your focus shifts to maintaining metabolic balance and creating optimal conditions for your baby’s development.
Nutrition: A Powerful Tool
What you eat directly affects your blood sugar, inflammation levels, and the nutrients available to your growing baby.
Prioritise low-glycaemic eating. This isn’t about restriction—it’s about choosing foods that provide sustained energy and stable blood sugar. Focus on:
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Non-starchy vegetables (unlimited amounts)
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Moderate portions of complex carbohydrates (quinoa, sweet potato, legumes, oats)
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Adequate protein at each meal (fish, eggs, poultry, legumes, Greek yoghurt)
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Healthy fats (avocado, olive oil, nuts and seeds, fatty fish)
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Leave added sugar to what you receive naturally from fruits and vegetables
Eat regularly. Skipping meals may create blood sugar instability. Using a blood sugar monitor and speaking with a pregnancy nutritionist can help determine your best eating practice.
Include anti-inflammatory foods daily. Berries, leafy greens, turmeric, ginger, and colourful vegetables may all calm inflammation.
Stay hydrated. Water supports every bodily function as well as optimal blood pressure.
Movement: Safe and Beneficial
Exercise during pregnancy is safe for most people and specifically helpful for PCOS. It improves insulin sensitivity, helps prevent excessive weight gain, reduces gestational diabetes risk, and supports mental health.
Aim for 30 minutes of moderate activity most days of the week. This might include:
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Walking
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Swimming or water aerobics
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Prenatal yoga
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Stationary cycling
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Light resistance training
Listen to your body. Pregnancy isn’t the time for intense training, but staying active provides genuine benefits for both you and your baby. Always discuss your exercise plan with your healthcare provider, particularly if you have any pregnancy complications.
Monitoring and Professional Management
Proactive monitoring catches potential problems early when they’re most manageable.
Early and regular prenatal care are essential. Make sure your healthcare provider understands PCOS and its pregnancy implications.
Glucose tolerance testing typically occurs around 24-28 weeks, but your provider may test earlier, given PCOS. Some people with PCOS benefit from early screening in the first trimester and repeat testing later.
Blood pressure monitoring at each appointment helps catch hypertension or preeclampsia early.
Ultrasound monitoring may be more frequent to track your baby’s growth and health.
Medication considerations: Some healthcare providers continue medications during pregnancy in PCOS, as research suggests it may reduce miscarriage and gestational diabetes risk. This is an individual decision to discuss with your provider. If you were taking spironolactone or other anti-androgens before pregnancy, these are discontinued as they can affect foetal development.
Managing Stress and Mental Health
Pregnancy with PCOS can feel like holding your breath for nine months, particularly if you struggled with infertility, have experienced previous pregnancy loss, or have a preexisting mental health challenge.
Anxiety during pregnancy isn’t just emotionally difficult—chronic stress affects your hormones, blood sugar regulation, and even the behaviours and emotional health of your baby. Your mental health deserves the same attention as your physical health.
Consider:
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Therapy or counselling, particularly with someone who understands pregnancy anxiety
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Mindfulness or meditation practices
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Prenatal yoga (addresses both movement and stress)
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Connection with other pregnant folks with PCOS
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Setting boundaries around triggering information or comparisons
You don’t have to manage this alone. Asking for support is a strength, not a weakness.
If Gestational Diabetes Develops
If you develop gestational diabetes despite your best efforts, know that this isn’t failure. Sometimes, the physiological demands of pregnancy exceed your body’s capacity to maintain normal blood sugar.
Gestational diabetes is manageable, and most people with it have healthy babies.
You’ll work with your healthcare team to:
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Monitor blood sugar regularly (typically four times daily)
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Follow a structured eating plan that distributes carbohydrates throughout the day
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Continue regular physical activity
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Some people may benefit from medication if blood sugar can’t be controlled through lifestyle alone
The key is consistent management. Well-controlled gestational diabetes doesn’t significantly increase risk for your baby.
Labour, Birth, and Immediate Postpartum
PCOS can influence your birth experience. Pregestational diabetes as is more common in PCOS raises the likelihood of a caesarian (C-section) birth. However, vaginal birth is absolutely possible and common.
If your baby is larger than average, your healthcare team will discuss the safest delivery approach. If you’ve had gestational diabetes, your baby’s blood sugar will be monitored after birth, as babies sometimes experience low blood sugar in the first few hours of life. This is temporary and manageable.
After Birth: The “Fourth Trimester” and Beyond
PCOS doesn’t disappear after delivery. Your ongoing metabolic health continues to matter—both for you and your baby.
Breastfeeding with PCOS
Many with PCOS successfully breastfeed, though some experience challenges with milk supply, particularly if insulin resistance is severe. Optimising your metabolic health, ensuring adequate calories and hydration, and working with a lactation consultant can help.
Breastfeeding provides metabolic benefits for both you and your baby. For babies exposed to gestational diabetes in utero, breastfeeding appears to reduce their later-in-life metabolic disease risk.
Your Baby’s Health
If you had gestational diabetes, your baby has an increased risk of developing obesity, insulin resistance, and type 2 diabetes later in life. This isn’t inevitable—it’s about risk. The lifestyle environment you create for your child as they grow makes an enormous difference.
Focus on:
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Breastfeeding if possible
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Introducing whole, minimally processed foods once food consumption begins
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Encouraging active play and limiting screen time as they grow
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Modelling healthy eating and movement yourself
Your Own Recovery
Postpartum life is demanding. Healing from birth, sleep deprivation, hormonal shifts, and the work of caring for a newborn all affect your health. Don’t abandon the PCOS management strategies that served you during pregnancy.
If you had gestational diabetes, you have a significantly increased risk of developing type 2 diabetes within 5-10 years. Maintaining a low-glycaemic way of eating, staying active, and getting regular metabolic screening (at your 6-week postpartum visit and annually thereafter) matters.
The Bottom Line: Knowledge and Action
PCOS does increase certain pregnancy risks. That’s the truth. But the many people with PCOS have healthy pregnancies and healthy babies—especially when they understand the risks and take proactive steps to manage them.
You’ve already shown incredible strength by learning about PCOS and seeking evidence-based information. That same determination serves you beautifully through pregnancy.
Your baby’s health is influenced by the metabolic environment you create during these nine months. You have the power to optimise that environment through your food choices, movement, stress management, and partnership with knowledgeable healthcare providers.
This isn’t about perfection. It’s about consistency, knowledge, and self-compassion. Small, sustainable actions maintained throughout pregnancy create the foundation for your baby’s lifelong health.
Wherever you are in your pregnancy journey—just beginning to think about conception, actively trying, newly pregnant, or well into your third trimester—there is always value in the choices you make today. Your body is doing remarkable work. Support it well, trust the process, and know that you’re creating the best possible start for your baby.
From PCOS to perfect health, with love,
Dr. Rebecca Harwin
The PCOS Expert
Chiropractor & Bestselling Author of
Conquer Your PCOS Naturally
www.ConquerYourPCOSNaturally.com
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