How PCOS Impacts Pregnancy, Delivery, and Breastfeeding: What You Need To Know To Stay Equipped

Most women with PCOS try so hard to conceive that when they do, they sometimes forget that pregnancy and delivery come with their own set of complications and dangers.

It’s a fact that women with PCOS are at higher risk for pregnancy and delivery complications.

Studies peg the miscarriage risk in early pregnancy in women with PCOS as three times more compared to women without PCOS.

Women with PCOS are also at an elevated risk for the following  major problems apart from miscarriage:

1. High insulin levels and gestational diabetes or diabetes during pregnancy which can lead to large babies.

2. High blood pressure- Many women have high BP even before pregnancy and elevated BP can result in pre-eclampsia, a condition in which the blood pressure of the expectant mother goes up suddenly after the 20th week of pregnancy. This can cause eclampsia which can cause even the death of the foetus.

3. Premature birth and C-section delivery​

If you have PCOS and are pregnant- please read on for some simple, proactive steps you can take to greatly reduce the risks for the scary four mentioned above.

• Adjust your diet in your first trimester to reduce insulin levels as high insulin is linked to early miscarriage. Get rid of the simple carbs like sweets and high saturated fats from your diet and avoid all canned fruit juices and sweets in general from the very beginning of your pregnancy.

• The very best way to eat for lowering your risk of gestational diabetes is to eat as you would if you already had diabetes. This means including more fibre and protein with each meal and snack, like meat, poultry, fish, eggs, beans, lentils, dairy, nuts and seeds. Also eat sparsely though at regular, shorter intervals to support stable blood sugar levels.

• Cut down on carbs, especially the processed ones. Remember, though that a ketogenic diet which is a high protein diet with very little carbs can be very dangerous for pregnant women.

• Eat so that about 35% of your total calories come from complex carbohydrates like oatmeal.

• Also get your blood sugar levels tested at 20 weeks pregnancy to screen for diabetes, and repeat at 24 and 28 weeks.

• You will also need more exercise as compared to a pregnant woman without PCOS. Exercise, especially after meals, controls post-meal blood sugar rise. Hence, you should aim for a 15-20 min walk post-meals to reduce insulin resistance as well as keep BP under control.
  Remember that women with PCOS suffer from insulin resistance and high insulin in blood more than any other factor causes their ovaries to malfunction.
  Keep your BP well under set limits to prevent pre-eclampsia and eclampsia, conditions which typically result in a cesarean-section delivery. 

• And lastly, monitor your weight gain and try to be in an optimal range throughout gestation. And if you notice that you are gaining weight very rapidly, do seek help to slow down the gain.

• Sleep well as lack of sleep impairs insulin sensitivity and also affects your appetite, creating cravings for unhealthy foods. Aim at getting at least 6 hrs. of sleep at night, as anything less than this can impact insulin and blood sugar levels.

• Prep up your body by eating vitamin and folate supplements to reduce other risks like anaemia during pregnancy.

• And cut down on stress levels as enhanced levels of stress hormone cortisol can elevate blood sugar too.

• Also, do ask your doctor about whether you need higher levels of metformin which is used to increase insulin sensitivity. If you have a higher risk of gestational diabetes based on your pre-pregnancy weight and health, your doctor may recommend a higher dose.

• Hypothyroid complications should be factored in too. Many women with PCOS have thyroid issues as well.  Many serious complications can arise if a thyroid disorder is not diagnosed pre-pregnancy.

• Specifically, hypothyroidism increases the risk of complications like miscarriage, stillbirth, maternal anaemia, pre-eclampsia, placental abruption during pregnancy, as well as, postpartum haemorrhage, premature delivery, low birth weight and deficits in intellectual development in infants.

The important thing to remember, however, is that you got so far and conceived, so just remind yourself that you are not powerless in your pregnancy and childbirth too. 

Breastfeeding in new mothers with PCOS

A common concern for all new mothers with PCOS is whether they will be able to breastfeed. And it is a valid concern as PCOS disrupts a delicate balance of hormones that affect adequate milk supply for infants.

The hormonal aberrations in PCOS involve insulin, progesterone, and estrogen, all of which are important to the development of breast tissue and its milk-secreting ability.

Women with PCOS produce less breast milk due to these two main reasons:

1. Their breast tissue fails to undergo the normal physiological changes during pregnancy needed for normal lactation and sometimes some women with PCOS also don’t have enough breast tissue prior to pregnancy, a condition called hypoplasia, to produce adequate milk.
   
   Hypoplasia occurs because women with PCOS have low levels of progesterone, which is needed for breast tissue development.

2. Insulin also plays a role in production of breast milk and having insulin resistance may contribute to lactation problems in women with PCOS.

The Metformin conundrum

Metformin is recommended for pregnant women with PCOS, as it helps prevent gestational diabetes and improves the chances of safe delivery in women with PCOS by helping reduce pregnancy weight gain, high levels of insulin and insulin resistance, and reducing the incidence of preeclampsia and pre-term labour.

Using progesterone supplements and metformin during pregnancy may also help support adequate milk for breast feeding in women with PCOS and possibly support breast development during pregnancy.

But, is metformin safe to use while breastfeeding?

The use of metformin during breastfeeding is controversial at best.

The drug crosses over to the blood supply, for one, which is problematic for many experts.

So, just to be on the safe side, stop taking metformin while nursing or feed your infant formula milk.

We suggest that if you are pregnant or are trying, then choose your obstetrician and paediatrician carefully to avoid problems during pregnancy, childbirth and breastfeeding.

You should also have an excellent dietician on hand to address your diet issues to keep your insulin levels sane throughout this hormonally sensitive time.