Pregnant with PCOS: What You Need to Know About Diet and Lactation

Women with PCOS have heard it before: a common side effect of this syndrome is infertility. Some women with PCOS are able to become pregnant on their own. Others may need to seek fertility assistance or are still hoping for a positive pregnancy test. When a woman with PCOS does become pregnant, though, it seems that the PCOS conversation drops off – You’re pregnant now! You got over the biggest hurdle! Well, it turns out that being pregnant with PCOS still offers moments to be mindful of the condition.

I have PCOS and learned this firsthand during my pregnancy. There was a fear of never getting pregnant, anxiety during intense fertility treatment, and finally the joy of becoming pregnant. I had made it, I thought. Then came the pressures of the gestational diabetes glucose test and, my personal struggle, breastfeeding. Both of these milestones were reminders that I’m dealing with a hormonal condition daily, and even though I became pregnant, the side effects don’t stop. In fact, they present themselves in new ways.

In my genuine curiosity, I spoke with Expectful Advisor, Janine Higbie, a clinical nutritionist for pre-and postnatal women. I had legitimate concerns about how PCOS can flare during the transition to motherhood and how we can combat the side effects, allowing us to truly thrive in our new role as Mom.

An Interview with Perinatal Nutritionist on Pregnancy and PCOS:

Q: How does insulin-resistance play a role in pregnancy?

A: Insulin is a hormone made by your pancreas that helps bring glucose into your liver, fat, and muscle cells, where, it is used for energy. This process also maintains a delicate blood sugar balance. Insulin resistance (IR) occurs when your cells become less responsive to circulating insulin, increasingly requiring more to have the same effects.

Insulin Resistance, PCOS, and Pregnancy

Throughout pregnancy, placental hormones increase IR. By the end of pregnancy, your body requires a 200-250% increase in insulin secretion to maintain healthy blood sugar. In a normal pregnancy, the body is able to adapt by producing more insulin. However, in some cases, the pancreas is unable to overcome the higher insulin demands, leading to elevated blood sugar and gestational diabetes. As many as 50-70% of women with PCOS experience insulin resistance prior to pregnancy. For these women, their pre-pregnancy IR can be exacerbated by pregnancy-related IR, increasing ther risk of developing gestational diabetes.

Q: What are the best ways we can avoid getting gestational diabetes?

A: While PCOS is a risk factor for gestational diabetes, it’s not a guarantee. In many cases, lifestyle changes prior to and during pregnancy can reduce IR and prevent or mitigate gestational diabetes mellitus (GDM). Here are some of the best approaches to reduce your risk:

1. 1. Maintain a healthy weight prior to pregnancy. A body mass index (BMI) greater than 30 comes with a 3-fold increased risk of developing GDM than a BMI of 25 or less.
   2. Stay active. Beyond helping to maintain a healthy weight, movement and exercise increase insulin sensitivity, combatting IR. The American College of Obstetricians and Gynecologists (ACOG) recommends a minimum of 150 minutes per week, or at least 5 days of moderate-intensity exercise for 30 minutes and walking after meals to improve blood sugar control. Speak with your doctor before starting an exercise regime.
   3. Get enough vitamin D. Vitamin D plays a role in insulin and glucose regulation. Several studies have demonstrated that women with low levels of vitamin D are at increased risk for GDM and supplementation can reduce that risk. Your doctor can order a simple blood test to check your levels. Getting adequate sun exposure is the best way to maintain healthy vitamin D, but as we get into the fall and winter, most women need supplementation as food sources alone are not enough.
   4. Focus on a nutritious, low glycemic diet. Low glycemic does not mean no carbohydrates. Eating the right kind of carbohydrates and pairing them with lean protein and healthy fats is critical to getting the energy and nutrients you need while maintaining healthy blood sugar. Highly processed carbs like breads, pastas, rice, pastries, and sugary foods and drinks increase insulin needs, further taxing an already strained pancreas. Instead, focus on nutrient dense carbs like vegetables, whole fruits, legumes, and whole grains in moderation. You can find more details on my recommendations for the optimal PCOS Diet to boost fertility, support a healthy pregnancy, and maintain balanced hormones at any time.

Q: Do you have any quick-fix recipes that can be easily whip up while maintaining nutrition goals?

A: I love any meal that comes together quickly and can be cooked in one pan for easy clean up. This Cauliflower Rice Stir Fry is a great option for a quick, low-glycemic, veggie loaded dish that is satisfying and nutritious.

Q: Cravings in pregnancy are a real thing. How can we satisfy them but not ruin all our hard work?

A: Great question. I work with so many women who really struggle with stress and guilt around this topic. First, it’s important to know that it’s normal and okay to have a less than ideal diet in your first trimester. Nausea, fatigue, and food aversions are all very real and play a role in your dietary intake.

Check in with yourself to understand why you might be craving something. If you’re craving a piece of toast or bagel because you’re nauseated and need something in your stomach? Go for it. Try to add a little nut butter for protein or avocado for fat. Either would provide additional nutrients and help prevent nausea related to a blood sugar crash. Similarly, are you craving pickles? That may be your body signaling a need for increased salt, or simply because cold sour foods are typically well tolerated despite nausea. Again, go for it. Maybe add in some olives for that same salty flavor with heart-healthy fat. Contrast that with the craving of a pint of Ben and Jerry’s. That may be more related to enjoying dessert and the cultural expectation that you get to eat a certain way during pregnancy. Honor those cravings the same way you would prior to pregnancy, meaning enjoy them guilt-free within moderation. Eat a reasonable portion, but don’t make it a daily habit. Pregnancy only requires an additional 300 calories/day so the old saying “eating for two” is misleading. Discuss cravings with your doctor or a nutrition professional because some may be indicative of a nutrient deficiency. For example, craving ice may be a sign of anemia, or craving sweets may be a sign you’re not eating enough healthy fats.

Q: If a new mom with PCOS wants to breastfeed, will she face any added hurdles? Can nutrition help?

A: Maybe—research is mixed on whether PCOS alone increases risk for low milk supply. Several factors associated with PCOS like obesity, insulin resistance, and excess androgens, are known to inhibit milk production.

Focusing on a nutrient-dense low glycemic PCOS diet can help manage hormone and weight-related obstacles to breastfeeding. It’s also important to make sure you’re eating and drinking enough. You will need to ensure an adequate amount of calories and hydration to maintain your milk supply. Navigating breastfeeding issues can be incredibly isolating and challenging (trust me I know!). Meeting with a certified lactation consultant who can guide and support you in your breastfeeding journey can be incredibly beneficial, PCOS or not.

If you are pregnant with PCOS, you are not alone. There are resources out there to help guide you on this new journey, from nutrition to breastfeeding prep and maintenance to sleep help, inching you closer to (and through!) parenthood. And, as you well know as a pregnant mama-to-be, you can overcome the hurdles of PCOS. It takes diligence, research, and maybe a nudge in the right direction, but as real as that baby is growing inside of you, it’s possible to thrive as a Mom with PCOS.

References: https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4290225/ https://www.ncbi.nlm.nih.gov/books/NBK441575/  https://care.diabetesjournals.org/content/30/8/2070.short https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122001/  https://academic.oup.com/jes/article/4/Supplement_1/SUN-018/5833722 https://doi.org/10.1111/j.1552-6909.2011.01244_10.x