Women with Polycystic Ovarian Syndrome (PCOS) are more likely to develop gestational diabetes after conceiving.
PCOS is one of the leading causes of female infertility, affecting 5-10% of women of reproductive age. Many women with PCOS exhibit insulin resistance resulting in an increase in blood glucose levels. Elevated blood sugar can lead to serious complications during pregnancy including gestational diabetes and early termination.
During pregnancy, the placenta produces certain hormones to help shift nutrients (e.g. glucose) from the mother to the developing fetus. These hormones inhibit the action of insulin to prevent the mother from developing low blood sugar. The body then tries to compensate by produce more insulin.
However, if the pancreas, the gland that produces insulin, cannot catch up to demand, the mom-to-be will develop gestational diabetes. As you can imagine, women with PCOS are insulin resistant to begin with and are more prone to developing gestational diabetes.
If gestational diabetes is left untreated…
- Too much glucose will stimulate excess growth of the baby, increasing the risk of delivery and chances of emergency caesarean section.
- Elevated insulin levels as a result of the mother’s insulin resistance will cause a sudden drop in the baby’s blood sugar level after delivery.
- Children born to mothers with unmanaged gestational diabetes are more prone to childhood obesity and development of Type-2 diabetes later in life.
Administration of metformin during pregnancy reduces PCOS related gestational complications.
Elevated blood glucose has a detrimental effect on fertility. Women with PCOS are therefore treated with insulin sensitizing agents in an attempt to restore ovulation to enhance chances of pregnancy. One of the commonly used insulin sensitizing agents is metformin.
Metformin has been used for treatment of diabetes for over six decades and was first used to treat PCOS in the1990’s. Metformin has a reassuring safety record and was shown to improve fertility by restoring normal insulin and blood glucose level in PCOS patients.
The most common treatment for gestational diabetes is diet control along with insulin administration. Medical reports show that metformin prevents occurrence of gestational diabetes when administered during pregnancy. Continuous metformin therapy reduces the chances of miscarriage and improves pregnancy outcome.
Although research has demonstrated the beneficial effect of metformin administration during pregnancy for PCOS patients without any serious side effects, there are currently no guidelines for the continuous use of metformin during pregnancy. Administration and duration of metformin therapy is based on clinical judgment and experience on a case-by-base base.