Polycystic Ovary Syndrome (PCOS) and Preeclampsia

Polycystic ovary syndrome (PCOS) has been associated with an increased risk of preeclampsia, particularly in pregnancies already shaped by insulin resistance, elevated body mass index, chronic hypertension, dyslipidemia, infertility treatment, or a prior history of adverse pregnancy outcomes. Current research places that association within a broader vascular and metabolic framework involving endothelial injury, inflammatory signaling, placental dysfunction, and abnormal adaptation to pregnancy. The practical implication is straightforward. PCOS should be treated as a meaningful risk marker during pregnancy, with early assessment, closer surveillance, and prompt attention to symptoms that may otherwise be minimized.

Overview

What is the relationship between PCOS and preeclampsia?

Repeated Findings Across Modern Research

Large systematic reviews, national registry studies, and the 2023 international polycystic ovary syndrome guidelines have consistently identified PCOS as a pregnancy risk marker for hypertensive disorders, including preeclampsia. In the guideline’s evidence synthesis, the pooled odds ratio for preeclampsia was 2.28 across 36 studies. The largest recent meta-analysis, which included 104 studies and 106,690 pregnancies, likewise found increased odds of preeclampsia in women with PCOS, with the signal remaining significant in analyses matched for age and body mass index and in higher-quality studies. A large population-based cohort has added another important detail, showing a stronger association with early preeclampsia and with preeclampsia accompanied by a small-for-gestational-age infant, findings that place PCOS within the more placentally mediated end of hypertensive pregnancy disease.

Broader Views of PCOS

PCOS belongs within a broader cardiometabolic and vascular framework. Many patients with PCOS carry some combination of insulin resistance, hyperinsulinemia, central adiposity, dyslipidemia, chronic low-grade inflammation, endothelial dysfunction, and altered sympathetic and renin-angiotensin signaling. Pregnancy places immediate demands on each of those systems. The placenta requires precise trophoblast invasion and vascular remodeling. The maternal circulation must expand and adapt without losing endothelial integrity. The kidneys must handle shifts in volume and perfusion. When PCOS is present, pregnancy often begins within a physiologic environment already marked by impaired vascular flexibility and metabolic strain, which helps explain why the diagnosis reaches beyond ovulation and fertility alone.

Why the Association Deserves Clinical Attention

Preeclampsia is a multisystem vascular disorder of pregnancy characterized by hypertension, endothelial injury, placental dysfunction, and organ involvement affecting the brain, liver, kidneys, lungs, and the coagulation system. It may emerge after weeks or months of apparently routine prenatal care. It may also progress quickly once symptoms begin. For patients with PCOS, the relevance lies in timing and interpretation. A diagnosis already associated with higher rates of insulin resistance, vascular dysfunction, and adverse pregnancy outcomes changes the threshold for concern at the first prenatal visit. It supports earlier metabolic assessment, closer blood pressure surveillance, and faster evaluation of symptoms that might otherwise be written off as ordinary discomforts of pregnancy.

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Mechanisms

Why would PCOS increase the likelihood of preeclampsia?

Insulin Resistance

Insulin resistance is one of the most clinically important biologic features of PCOS because its effects extend directly into vascular function. Hyperinsulinemia alters nitric oxide signaling, reduces insulin-mediated vasodilation, promotes sympathetic activation, and contributes to endothelial stress. It is also associated with elevated triglycerides, greater inflammatory signaling, and impaired placental adaptation in early pregnancy. This matters because preeclampsia develops within a setting of maternal vascular maladaptation. Research has also shown that insulin resistance in early pregnancy predicts later preeclampsia, which places a central feature of PCOS directly inside the disease pathway.

Endothelial Dysfunction

The endothelium regulates vascular tone, barrier function, platelet interaction, and local coagulation balance. In PCOS, endothelial dysfunction has been documented even outside pregnancy, particularly in patients with obesity, hypertension, dyslipidemia, and hyperinsulinemia. Reduced endothelial responsiveness limits the body’s ability to adapt to the profound circulatory changes pregnancy requires. Preeclampsia is likewise characterized by widespread endothelial injury following the entry of placental stress signals into the maternal circulation. This shared endothelial vulnerability offers one of the clearest biologic links between PCOS and hypertensive pregnancy disease.

Inflammatory Activation

Chronic low-grade inflammation is common in PCOS and contributes to insulin resistance, altered vascular behavior, and dysregulated immune signaling. During pregnancy, inflammatory pathways also shape implantation, placental development, and maternal immune tolerance. Preeclampsia is associated with inflammatory activation that intensifies as placental dysfunction progresses and maternal endothelial injury becomes more pronounced. The overlap is important because it suggests that some patients with PCOS enter pregnancy with an inflammatory baseline already shifted in an unfavorable direction, which may lower the margin for healthy placental and vascular adaptation.

Oxidative Stress

Oxidative stress has been implicated in both PCOS and preeclampsia as a mechanism of vascular and placental injury. An increased oxidative burden can damage endothelial cells, disrupt angiogenic signaling, impair trophoblast function, and amplify inflammatory cascades. In PCOS, oxidative stress may already be present before conception as part of the broader metabolic phenotype. During pregnancy, that preexisting burden may interact with placental development and maternal vascular response in ways that increase susceptibility to hypertensive complications, particularly when insulin resistance and dyslipidemia are also present.

Abnormal Placentation

Preeclampsia is strongly linked to defective remodeling of the maternal spiral arteries and reduced placental perfusion. In early gestation, trophoblast cells should invade the decidua and myometrium, converting high-resistance uterine vessels into low-resistance channels capable of sustaining placental blood flow. Evidence reviewed in recent PCOS literature suggests that hyperinsulinemia, androgen excess, inflammatory signaling, and lipid abnormalities may disrupt that process. The result may be shallower trophoblast invasion, impaired vascular remodeling, placental hypoxia, and release of antiangiogenic and inflammatory factors into the maternal circulation. The stronger association reported for early preeclampsia in women with PCOS further supports the view that placental dysfunction is part of this relationship.

Hyperandrogenism

Hyperandrogenism remains one of the most closely watched variables in PCOS pregnancy research because androgen excess may affect placental development, vascular reactivity, and metabolic regulation before and during gestation. Recent literature suggests that hyperandrogenic phenotypes may carry greater obstetric risk in some cohorts, particularly when androgen excess appears alongside elevated body mass index and insulin resistance. At the same time, the evidence is not fully uniform across all studies, and recent population-level work has not resolved hyperandrogenism as the sole explanation for the increased risk of preeclampsia in PCOS. The most accurate clinical reading is that androgen excess may amplify risk within a broader metabolic and placental framework, especially in patients who already show clear signs of cardiometabolic dysfunction.

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High Risk Populations

Which patients with PCOS appear to face the greatest risk?

Patients With Elevated Body Mass Index

Elevated body mass index remains one of the clearest modifiers of pregnancy risk in PCOS because it tends to intensify the very pathways already implicated in preeclampsia, including insulin resistance, endothelial dysfunction, dyslipidemia, inflammatory activation, and abnormal blood pressure regulation. The 2024 Nature Communications meta-analysis found that women with PCOS were not only more likely to enter pregnancy with higher body mass index around conception, but also to experience greater gestational weight gain, both of which help widen the metabolic burden carried into pregnancy. That matters clinically because preeclampsia risk appears to become sharper when PCOS is layered onto an already dysregulated cardiometabolic profile. At the same time, body mass index does not fully account for the association. BMI-matched analyses have still shown increased odds of preeclampsia in women with PCOS, which means elevated adiposity strengthens risk without exhausting the explanation.

Patients With Insulin Resistance, Prediabetes, or Diabetes

Glucose dysregulation identifies a subgroup of PCOS patients whose pregnancies deserve especially close attention. Insulin resistance in PCOS is associated with impaired vasodilation, greater endothelial stress, higher triglyceride levels, and early pregnancy metabolic instability, all of which have direct relevance to placental development and hypertensive disease. The 2023 international guideline recommends glycemic assessment before conception or at the first prenatal visit, and repeat oral glucose tolerance testing at 24 to 28 weeks when needed, reflecting the high prevalence of clinically significant glucose abnormalities in this population. The concern extends beyond established diabetes. A patient with elevated fasting insulin, impaired fasting glucose, prior gestational diabetes, or strong signs of insulin resistance may enter pregnancy with a vascular burden already in motion, long before blood pressure begins to rise.

Patients With Chronic Hypertension

Chronic hypertension changes the risk structure of pregnancy immediately because it places the maternal vasculature under sustained stress before placentation is complete. In a patient who also has PCOS, that history becomes more meaningful because both conditions are tied to endothelial dysfunction, altered vascular reactivity, and long-term cardiometabolic risk. The 2023 PCOS guideline specifically recommends blood pressure measurement when planning pregnancy or seeking fertility treatment due to the high prevalence of hypertensive disease and preeclampsia in this population. Clinically, the concern should extend beyond patients with a formal hypertension diagnosis. Borderline preconception readings, prior gestational hypertension, renal disease, and a family history of hypertensive pregnancy disorders can all signal a pregnancy that deserves tighter surveillance from the outset.

Patients Conceiving Through Fertility Treatment

Patients with PCOS are overrepresented in fertility care, and these pregnancies often carry a more complex baseline history before conception even occurs. That complexity may include longer-standing anovulation, prolonged exposure to untreated insulin resistance, prior pregnancy loss, older maternal age at conception, and hormonal stimulation related to ovulation induction or assisted reproductive technologies. Recent literature suggests that adverse pregnancy risks in PCOS persist irrespective of whether conception occurs naturally or through ART, which indicates that fertility treatment does not erase the underlying biologic risk profile associated with PCOS. This is one reason pregnancies achieved after ovulation induction or ART in patients with PCOS merit careful cardiovascular and placental surveillance, especially when other risk factors such as obesity, hyperandrogenism, or prior hypertensive pregnancy disease are also present.

Patients With Prior Adverse Pregnancy Outcomes

Prior obstetric history can reveal the architecture of risk more clearly than any single laboratory value. A history of gestational hypertension, preeclampsia, fetal growth restriction, placental insufficiency, stillbirth, gestational diabetes, or recurrent miscarriage should sharpen concern in a subsequent pregnancy affected by PCOS because these outcomes often cluster around the same placental and vascular fault lines. Recent cohort data showing a stronger association between PCOS and early preeclampsia, as well as between PCOS and preeclampsia accompanied by a small-for-gestational-age infant, suggest that some patients with PCOS may be especially vulnerable to the placental form of disease. When such a history already exists, it should be read as evidence of a recurrent physiologic pattern rather than as a series of unrelated obstetric events.

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Clinical Interpretation

Does PCOS itself cause preeclampsia?

PCOS As A Risk Marker

The most accurate clinical reading is that PCOS functions as a meaningful risk marker for preeclampsia and other adverse pregnancy outcomes. That conclusion matters because risk markers shape care before the disease fully declares itself. The 2023 international PCOS guideline and the largest recent meta-analyses support the view that women with PCOS have higher rates of hypertensive pregnancy disorders, with risk remaining elevated in BMI-matched and higher-quality analyses. In practice, this means PCOS belongs in early pregnancy risk assessment even when it is not the sole driver of disease. It identifies a population that benefits from earlier metabolic screening, closer blood pressure monitoring, and lower tolerance for delayed evaluation when symptoms appear.

A Condition That Often Arrives With Companions

PCOS rarely appears as an isolated endocrine label. It often travels with obesity, insulin resistance, dyslipidemia, sleep-disordered breathing, chronic inflammation, subclinical vascular dysfunction, and infertility. Those companion conditions matter because they can each add pressure to the same placental and cardiovascular systems involved in preeclampsia. This broader framing is now reflected in contemporary guideline language, which treats PCOS as a condition with reproductive, metabolic, and cardiovascular implications rather than one confined to menstrual irregularity or fertility alone. Clinically, this means the diagnosis should prompt a broader assessment of blood pressure history, glucose regulation, lipid health, adiposity, and prior pregnancy outcomes, all of which help determine the actual risk in the individual patient.

Variation Across PCOS Phenotypes

PCOS is a syndrome, and its pregnancy implications are unlikely to be uniform across every phenotype. Emerging phenotype research has shown that hyperandrogenic PCOS is associated with higher body mass index, higher fasting insulin, and higher insulin resistance scores than nonhyperandrogenic PCOS, findings that may help explain why some patients carry a heavier obstetric risk burden than others. This does not mean that nonhyperandrogenic or lean PCOS is benign. BMI-matched studies still show increased risk of preeclampsia in women with PCOS, which argues against reducing risk assessment to weight or visible phenotype alone. The more useful clinical approach is to assess the full pattern, including androgen status, metabolic health, blood pressure history, body composition, fertility history, and prior obstetric outcomes, because the diagnosis itself can encompass very different physiologies under a single name. 

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Symptoms

Which symptoms should never be minimized during pregnancy?

Severe Headache

A persistent headache that is new, escalating, unusually intense, or resistant to rest and routine measures deserves urgent evaluation in pregnancy. In preeclampsia, headache may reflect severe hypertension, cerebral edema, vasospasm, or other central nervous system involvement. ACOG specifically identifies a bad headache as a warning sign of preeclampsia, and NIH patient guidance includes severe headache among the key symptoms requiring attention. In clinical practice, the concern rises when the headache feels qualitatively different from prior headaches, appears with visual symptoms, or is paired with elevated blood pressure, nausea, shortness of breath, or upper abdominal pain.

Visual Changes

Blurred vision, flashing lights, spots, temporary dimming, light sensitivity, and double vision require prompt medical assessment, as these visual symptoms can signal significant neurologic and vascular involvement in preeclampsia. These changes may reflect retinal vasospasm, cerebral irritation, or rising disease severity. ACOG and postpartum preeclampsia guidance both identify changes in vision as a major warning sign during pregnancy and after delivery. Visual symptoms are particularly important because they often accompany severe headache or marked blood pressure elevation and may indicate the need for immediate escalation of care.

Upper Abdominal Pain

Pain beneath the ribs, especially on the right side or in the upper central abdomen, warrants serious evaluation in pregnancy because it can reflect hepatic involvement, including liver swelling, irritation of the liver capsule, or progression toward severe preeclampsia or HELLP syndrome. preeclampsia Foundation guidance notes that this pain is often confused with heartburn, gallbladder problems, indigestion, or discomfort from pregnancy itself, which is one reason it can be missed. NIH materials also include upper abdominal pain among the core symptoms of preeclampsia and postpartum preeclampsia. The symptom becomes especially concerning when it is persistent, sharp, radiates to the shoulder, or appears with headache, nausea, vomiting, or visual disturbance.

Sudden Swelling

Swelling is common in pregnancy, but a noticeable change in baseline, especially swelling of the face, hands, or around the eyes, deserves clinical review in the setting of possible hypertensive disease. ACOG and postpartum guidance both list swelling of the face or limbs among the signs that should raise concern for preeclampsia after childbirth. Swelling alone does not diagnose preeclampsia, yet sudden fluid retention can carry more significance when it appears with elevated blood pressure, headache, visual symptoms, or rapid weight gain. The key issue is change. A symptom that appears abruptly or intensifies quickly belongs in the clinical picture.

Shortness of Breath or Chest Symptoms

New shortness of breath, chest pressure, difficulty breathing when lying flat, or a sense of sudden physical decline needs urgent evaluation because severe preeclampsia can lead to pulmonary edema, cardiac strain, or other life-threatening complications. ACOG postpartum guidance includes shortness of breath among the warning signs that require urgent attention after childbirth, and postpartum preeclampsia resources advise emergency evaluation when these symptoms appear. The symptom warrants particular urgency when it occurs suddenly, worsens over hours, or is accompanied by swelling, headache, visual changes, or elevated blood pressure.

Elevated Home Blood Pressure Readings

Home blood pressure readings can provide clinically important early information, especially in pregnancies already carrying an elevated risk. CDC defines preeclampsia as new high blood pressure after 20 weeks with proteinuria or other systemic findings, and ACOG advises some postpartum patients to check their blood pressure at home because serious complications can unfold after discharge. A single elevated number may need repetition and context, yet a clearly abnormal reading, a rise from baseline, or any elevated reading paired with symptoms should prompt same-day guidance. Home monitoring is particularly valuable in patients with PCOS who also have chronic hypertension, obesity, diabetes, prior hypertensive pregnancy disease, or concerning symptoms between visits.

Reduced Fetal Movement

A significant decrease in fetal movement warrants urgent communication with the obstetric team, as fetal movement is one of the most accessible day-to-day signs of fetal well-being. Preeclampsia can impair placental perfusion and is associated with fetal growth restriction, preterm birth, and placental complications, so a change in movement pattern should never be minimized in a pregnancy already carrying vascular or placental risk. The concern rises further when decreased movement is accompanied by rising blood pressure, headache, swelling, or symptoms suggesting worsening placental function.

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Clinical Care

How should pregnancy care change in patients with PCOS?

Preconception Assessment

Preconception care is one of the clearest opportunities to reduce the risk of a future pregnancy affected by PCOS. The 2023 international PCOS guideline recommends blood pressure measurement before conception or fertility treatment and emphasizes metabolic assessment because women with PCOS have an increased risk of pregnancy complications, including hypertensive disorders and gestational diabetes. A strong preconception evaluation should include blood pressure, glycemic status, weight pattern, medication review, renal history, prior pregnancy outcomes, and other cardiovascular risk indicators. This establishes a true baseline before pregnancy-driven physiologic changes begin to obscure the picture.

Early Metabolic Screening

Early glucose assessment is important in PCOS because dysglycemia often precedes conception and may remain clinically silent until pregnancy increases metabolic demand. The 2023 international PCOS guideline recommends an oral glucose tolerance test when planning pregnancy or seeking fertility treatment, given the high risk of hyperglycemia and adverse pregnancy outcomes in this population. If not completed before conception, the guideline advises testing at the first antenatal visit and repeating it at 24 to 28 weeks. This recommendation reflects a key clinical reality. Glucose dysregulation and hypertensive disease frequently arise from the same metabolic terrain, so early screening helps identify a pregnancy that may require closer surveillance across several systems at once.

Closer Blood Pressure Surveillance

Blood pressure surveillance should be more deliberate when PCOS appears alongside additional metabolic or vascular risk factors. The international PCOS guideline recommends measuring blood pressure before pregnancy or fertility treatment, and ACOG postpartum guidance supports home blood pressure checks for some patients after delivery because serious hypertensive disease may develop outside the clinic setting. This has practical value during pregnancy as well. Office readings provide snapshots. Home monitoring can reveal trends, variability, and early upward drift that may otherwise remain hidden until symptoms appear. In patients with prior preeclampsia, chronic hypertension, borderline readings, renal disease, or obesity, serial blood pressure data can materially change the timing of intervention.

Individualized Aspirin Assessment

Low-dose aspirin should be considered based on the full risk profile rather than PCOS in isolation. The USPSTF recommends 81 mg of aspirin after 12 weeks of gestation for pregnant persons at high risk for preeclampsia and advises considering aspirin when several moderate-risk factors are present. ACOG aligns with that framework and lists high-risk factors such as chronic hypertension, pregestational diabetes, kidney disease, autoimmune disease, and a history of preeclampsia, along with moderate-risk factors such as nulliparity, obesity, maternal age 35 years or older, family history of preeclampsia, and in vitro conception. Many pregnant patients with PCOS carry one or several of these additional factors, which makes individualized review essential early in pregnancy.

Symptom Interpretation With Greater Urgency

Delayed recognition remains one of the most consequential failures in hypertensive pregnancy care. ACOG, NIH, and postpartum preeclampsia guidance all identify headache, visual changes, upper abdominal pain, shortness of breath, swelling, and elevated blood pressure as symptoms that can signal serious disease during pregnancy or after delivery. In patients with PCOS, especially those with obesity, insulin resistance, chronic hypertension, diabetes, infertility treatment history, or prior adverse pregnancy outcomes, these symptoms belong in a higher-risk frame from the outset. The practical implication is simple. Symptoms should be assessed early, blood pressure should be checked quickly, and the threshold for escalation should stay low.

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What Research Supports and What It Does Not

What must be understood about the connection between these conditions?

Metformin

Metformin remains an important medication in selected patients with PCOS, particularly for insulin resistance and aspects of ovulatory dysfunction, yet the 2023 international PCOS guideline states that metformin in pregnancy has not been shown to prevent gestational diabetes, late miscarriage, hypertension in pregnancy, preeclampsia, or macrosomia. The guideline notes that metformin may be considered in some circumstances to reduce preterm delivery and limit excess gestational weight gain, but these effects do not replace surveillance for hypertensive disease. A patient taking metformin still requires the same attention to symptoms, blood pressure trends, and placental risk as any other pregnancy carrying an elevated risk.

Risk Is Not Uniform

Current evidence supports increased risk across the PCOS population overall, yet risk is not evenly distributed. Large meta-analyses and guideline reviews show persistent elevation in adverse pregnancy outcomes in PCOS, while phenotype studies suggest that hyperandrogenism, higher fasting insulin, greater adiposity, and broader metabolic dysfunction may identify patients with a heavier obstetric burden. This means the diagnosis should open an assessment, not close one. Phenotype, blood pressure history, glucose regulation, body composition, prior pregnancy outcomes, and fertility treatment history all help determine the risk in the individual pregnancy.

Normal Early Pregnancy Does Not End Care

A reassuring first trimester or second trimester does not eliminate the possibility of later preeclampsia. NIH notes that preeclampsia usually develops after 20 weeks of pregnancy, and postpartum preeclampsia can arise after delivery, usually between 48 hours and 6 weeks postpartum. This timing matters because many patients feel well until late pregnancy or after discharge from the hospital. Ongoing surveillance through late gestation and the postpartum period remains necessary even when earlier prenatal care appeared routine.

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Postpartum and Long-Term Health

What is this even more critical to understand post-delivery?

The Postpartum Period Remains Clinically Important

Delivery does not close the risk window for hypertensive disease. NIH states that postpartum preeclampsia usually develops between 48 hours and 6 weeks after delivery, and ACOG warns that untreated postpartum preeclampsia can lead to stroke, seizures, and other serious complications. Preeclampsia Foundation guidance advises emergency evaluation for postpartum warning signs such as headache that will not go away, visual changes, shortness of breath, abdominal pain, swelling, nausea, vomiting, or elevated blood pressure. For patients with PCOS who developed gestational hypertension or preeclampsia, postpartum follow-up should reflect the fact that clinically important deterioration can occur after hospital discharge.

Pregnancy As A Vascular Stress Test

Pregnancy can reveal an underlying susceptibility that was already present before conception. The American Heart Association describes adverse pregnancy outcomes, including hypertensive disorders of pregnancy, as markers of future cardiovascular risk because they can uncover latent vascular and metabolic vulnerability. In a patient with PCOS who develops preeclampsia, the pregnancy complication may reflect a shared foundation of endothelial dysfunction, insulin resistance, inflammation, and blood pressure dysregulation that continues after delivery. This is one reason the obstetric history should inform future medical care instead of being treated as a closed chapter once the pregnancy ends.

Long-Term Cardiovascular Implications

Long-term cardiovascular implications deserve direct discussion because hypertensive pregnancy disorders carry measurable future risk. NIH reports that, compared with women with normal blood pressure in pregnancy, women with preeclampsia had a 72% increased cardiovascular risk and were more likely to experience coronary events as early as 10 years after their first pregnancy. The American Heart Association also recognizes adverse pregnancy outcomes as important markers in cardiovascular risk assessment. For patients with a history of both PCOS and preeclampsia, this supports continued follow-up focused on blood pressure, glucose regulation, lipid patterns, weight trajectory, kidney health, and broader vascular symptoms across the years after delivery.

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Key Takeaway

What should patients and clinicians remember most?

PCOS Deserves A Wider Clinical Frame

PCOS should be approached as a condition with reproductive, metabolic, vascular, and obstetric implications. The 2023 international guideline explicitly recommends recognizing PCOS status in pregnancy because it is associated with increased risk of gestational diabetes, hypertensive disorders, preeclampsia, preterm birth, and other complications. That wider frame changes how pregnancy is assessed from the beginning.

Preeclampsia Risk Should Be Taken Seriously From the Start

The association between PCOS and preeclampsia is supported by large evidence syntheses and current international guidance. That support justifies earlier metabolic assessment, careful review of blood pressure risk, and closer surveillance during pregnancy, especially when PCOS appears alongside obesity, chronic hypertension, diabetes, renal disease, autoimmune disease, or infertility treatment.

Symptoms Need Prompt Evaluation

Headache, visual changes, upper abdominal pain, sudden swelling, shortness of breath, elevated blood pressure, and reduced fetal movement all require timely attention in a pregnancy affected by PCOS, particularly when other metabolic or vascular risk factors are present. These symptoms are established warning signs in ACOG, NIH, and postpartum preeclampsia guidance, and should be recognized promptly when they emerge.

Better Recognition Improves Care

The value of this evidence lies in earlier recognition of who may need closer monitoring and faster evaluation. Preeclampsia can progress quickly, postpartum disease can emerge after discharge, and future cardiovascular risk can extend years beyond the affected pregnancy. For patients with PCOS, attention paid early has the potential to change pregnancy care, postpartum follow-up, and long-term cardiovascular screening in concrete ways. 

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References

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American College of Obstetricians and Gynecologists. (n.d.). Headaches and pregnancy. https://www.acog.org/womens-health/faqs/headaches-and-pregnancy

American College of Obstetricians and Gynecologists. (n.d.). Infographic: Preeclampsia and pregnancy. https://www.acog.org/womens-health/infographics/preeclampsia-and-pregnancy

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Centers for Disease Control and Prevention. (2024, December 13). High blood pressure during pregnancy. https://www.cdc.gov/high-blood-pressure/about/high-blood-pressure-during-pregnancy.html

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Eunice Kennedy Shriver National Institute of Child Health and Human Development. (n.d.). Preeclampsia and eclampsia. https://www.nichd.nih.gov/health/topics/preeclampsia

Monash University. (2023). International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2023. https://doi.org/10.26180/24003834.v1 

National Institutes of Health. (2022, May 9). Hypertensive pregnancy disorders linked to future cardiac events. https://www.nih.gov/news-events/news-releases/hypertensive-pregnancy-disorders-linked-future-cardiac-events

Parikh, N. I., Gonzalez, J. M., Anderson, C. A. M., Judd, S. E., Rexrode, K. M., Hlatky, M. A., Gunderson, E. P., Stuart, J. J., & Vaidya, D. (2021). Adverse pregnancy outcomes and cardiovascular disease risk: Unique opportunities for cardiovascular disease prevention in women: A scientific statement from the American Heart Association. Circulation, 143(18), e902–e916. https://doi.org/10.1161/CIR.0000000000000961 

Preeclampsia Foundation. (n.d.). Signs and symptoms of preeclampsia. https://www.preeclampsia.org/signs-and-symptoms

Valdimarsdottir, R., Glintborg, D., Stephansson, O., Wikström, A.-K., Hesselman, S., & Schmidt, L. (2024). Polycystic ovary syndrome and risk of pre-eclampsia: A national register-based cohort study. BJOG: An International Journal of Obstetrics & Gynaecology, 131(7), 985–995. https://doi.org/10.1111/1471-0528.17734 

Xie, N., & Zhao, W. (2025). Adverse pregnancy and perinatal outcomes in women with polycystic ovary syndrome undergoing assisted reproductive technology: A systematic review and meta-analysis. Frontiers in Medicine, 12, 1656389. https://doi.org/10.3389/fmed.2025.1656389 

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