Pregnancy complications and PCOS
Pregnancy complications are increased in patients with PCOS. In one study, 5/13 patients with PCOS developed gestational diabetes by the 3rd trimester. Additionally, increases in pre-eclampsia, pre-term labor, and stillborns have been reported. The risk of early 1st trimester pregnancy loss is 30 %, compared to about 15 % in the general population. This high miscarriage rate may be due to low progesterone levels, tonic elevations of Luteinizing Hormone, endometrial dysfunction (luteal phase defect), or poor eggs derives from degenerating follicles. It is very possible that the abnormalities discussed above play a role in these problems. Recently, insulin resistance has been shown to be associated with decreased uterine vascularity, decreased IGF-Binding Protein 1 (a protein that helps implantation), and decreased glycodelin (a protein that protects the fetus from attack by the maternal immune system). Studies have shown that on-going pregnancies are increased when the insulin resistance is treated.
Hopefully, by better pre-conceptual treatment we can decrease some of these complications. Studies have shown that the use of metformin to reduce insulin levels lowers the miscarriage rate.