Miscarriage and Premature Delivery

Miscarriage and Premature Delivery

Pregnancy-induced High Blood Pressure
Some studies have demonstrated that there is a higher risk of pregnancy-induced high blood pressure among patients with PCOS (4). However, other studies showed no relationship between PCOS and the development of hypertension during pregnancy. A woman with borderline hypertension before pregnancy is more likely to have increased blood pressure in pregnancy, but most doctors check all patients for blood pressure issues. Women with PCOS should ensure that their physicians document their blood pressure throughout the pregnancy.
Miscarriage and Insulin Resistance
Women who have PCOS and are successful at becoming pregnant typically experience a higher rate of miscarriage than those who don’t have PCOS. Some studies put the rate of miscarriage for women with PCOS at 45 percent, as compared to the national average of 15 percent (5). PCOS is a syndrome of hormone imbalances; women who suffer from it have some hormones at too high of levels while others are too low. In a pregnant woman with PCOS, elevated levels of insulin may interfere with the normal balance between factors promoting blood clotting and those promoting the breakdown of the clots. High insulin levels may actually result in increased blood clotting at the interface between the uterine lining and the placenta, leading to placental insufficiency, which is the failure of the placenta to supply nutrients to the fetus and remove toxic wastes. The result is miscarriage (6).
Premature Delivery
PCOS is associated with a 30 to 40 percent rate of early pregnancy loss (EPL), defined as miscarriage during the first trimester. In most cases no apparent cause can be identified but, in addition to defects in the developing embryo, adverse alterations in endometrial function may play a role. Insulin dysfunction has been identified as an independent risk factor for EPL. Studies in PCOS suggest that hyperinsulinemia suppresses endometrial expression of glycodelin, a protein whose circulating concentration may reflect endometrial function. Glycodelin is secreted by the endometrium and may inhibit the endometrial immune response to the embryo, and likely plays a critical role during implantation and in the maintenance of pregnancy (7).
Pre-eclampsia and Macrosomia
Pre-eclampsia is a dangerous complication of pregnancy, involving high blood pressure, protein traces in the urine and edema (abnormal fluid accumulation in parts of the body). It is one of the most dangerous complications that can occur during pregnancy and is a major cause of both maternal and child death during pregnancy and immediately after birth. Macrosomia is the term for a newborn with an excessive birth weight. Factors associated with fetal macrosomia include gestational diabetes and Diabetes Mellitus, demonstrating once again a link to hormonal disorder (8)