Polycystic Ovary Syndrome as a Key Risk Factor in Pregnancy Outcomes: A Midwifery Perspective from the International Guideline

Risk factor identification at preconception and in pregnancy is critical for preventing both short term and long-term morbidity and mortality in women and their offspring.¹ The World Health Organization recommends midwifery-led prenatal care starting before 12 weeks of pregnancy for timely nutrition intervention, proper assessments including risk factor identification, preventive measures, and management of pregnancy specific features.² Effective and timely identification and management of risk factors can guide interventions, prevent complications, and optimize the health of both women and offspring in the short and long-term.³ Polycystic Ovary Syndrome (PCOS) is one such risk factor that significantly influences maternal and offspring pregnancy outcomes.^4-6 However, PCOS is often underrecognized and under-addressed in preconception and prenatal education and care.^{7, 8} Currently, only about half of women with PCOS receive counseling about the implications of PCOS for their pregnancy outcomes at preconception, and the majority are not satisfied with the information they receive.⁹ Midwives, as frontline health care providers, play a pivotal role in identifying and managing PCOS in pregnant women. This commentary aims to underscore the importance of health care professionals, particularly midwives, in recognizing and managing PCOS as a critical risk factor during pregnancy. It also addresses the broader challenges of early identification and management of PCOS in prenatal care. Furthermore, this commentary explores opportunities for improvement through research, education, collaboration, and practice change to enhance both maternal and offspring health outcomes. The 2023 International Evidence-based Guideline for the Assessment and Management of PCOS offers comprehensive, evidence-based recommendations to address these challenges.¹⁰

PCOS affects approximately 17 million pregnancies annually and poses a significant risk for adverse pregnancy outcomes. The 2023 International Evidence-based Guideline for the Assessment and Management of PCOS¹⁰ highlights key recommendations for identification, early screening, prevention, and intervention strategies to improve these outcomes. Despite its prevalence, PCOS remains underrecognized in perinatal care, with challenges such as knowledge gaps, lack of standardized identification and management protocols, underreporting, and inconsistent practice guidelines. Addressing these gaps through a multifaceted approach will enhance both basic and continuing midwifery education, ultimately improving care and health outcomes for women and their newborns.

The author has no conflicts of interest to disclose.