While the 40% incidence of gestational diabetes in women with PCOS may be driven more by pre-conception BMI and lifestyle than PCOS per se [73,74], such metabolically challenged pregnancies contribute not only to fetal female hyperglycemia [66,75], but may also contribute to fetal female hyperandrogenism through diminished placental aromatase [76]. This evidence concerns the gene CYP19A1 and polycystic ovary syndrome.