Guest post with Dr. Shawna Darou, ND on PCOSdiva.com January, 2016
You have probably heard that women with PCOS can have a higher risk of pregnancy complications, ranging from miscarriage to gestational diabetes, pregnancy induced hypertension and higher C-section rates.
In an effort not to write yet another scary article about your risks with PCOS, I will focus mainly on proactive steps you can take to greatly reduce these risks. The important thing to know about PCOS is that you are not powerless in your pregnancy, and there are steps you can take to significantly lower your risks.
Here is my top 10 list of proactive steps to take if you have PCOS:
1. Adjust your diet right away in your first trimester to reduce insulin levels.
High insulin is linked to early miscarriage, so this means that sugar, pop, fruit juices and sweets in general should be avoided from the beginning of your pregnancy.
2. The best way to prevent gestational diabetes is to eat as you would to treat diabetes in pregnancy.
Here are the basic guidelines:
- Include protein with each meal and snack – meat, poultry, fish, eggs, beans, lentils, high-protein dairy, nuts and seeds.
- Eat regularly throughout the day with 3 meals and 2-3 snacks daily to support stable blood sugar levels.
- Reduce your carbs, but don’t cut them out. A ketogenic diet is not safe in pregnancy. You want to aim for about 35% of your total calories coming from carbohydrates.
- Choose carbs with a lower glycemic index: sweet potato, root vegetables, legumes, brown rice, quinoa, barley and oatmeal are good choices.
- Aim for 25-35 grams of fiber every day, coming from vegetables, fruits, beans, chia seeds and whole grains.
- Avoid sugar, juices and desserts.
3. Request testing for your blood sugar levels at 20 weeks pregnancy to screen for diabetes, and again at 24 and 28 weeks.
Early screening means you can take steps immediately to manage your blood sugar levels better if needed.
4. Exercise, especially after meals.
Getting out for a 15-20 minute walk after meals can help manage blood pressure and insulin resistance by controlling post-meal blood sugar rises. Remember that exercise in general improves your body’s sensitivity to insulin, and with the increased demands in pregnancy, you will need more!
5. Monitor your weight gain, and aim to be in an optimal range.
For women who are in a healthy weight range pre-pregnancy, optimal pregnancy weight gain is 25-35 pounds, and for women who are overweight, optimal pregnancy weight gain is 15-25 pounds. If you notice that you are gaining weight more rapidly, please seek help with a nutrition plan to manage this better.
6. Prioritize sleep.
Lack of sleep impairs insulin sensitivity and also affects your appetite, creating cravings for more carbohydrates and sugars. Lack of sleep especially impacts blood sugar and insulin when it is less than 6 hours per night.
7. Watch your stress and take steps to lower it.
High stress hormones, especially cortisol can negatively affect insulin resistance and blood sugar levels. Add downtime to your weeks, prioritize self-care, and spend time every day doing something that lowers your stress levels.
8. Take a high quality prenatal vitamin to ensure that your body is properly nourished and prevent deficiency.
This will reduce the chances of other non-PCOS causes of pregnancy complications. Based on the fact that many women (approximately 30%) have issues with metabolism of folic acid due to a gene called MTHFR (methyltetrahydrofolate reductase), choose a prenatal vitamin that contains methyl-folate instead of folic acid, which may be labelled as L-5-MTHF or L-5-methyltetrahydrofolate.
9. If you struggled with insulin resistance pre-pregnancy, consider the use of myo-inositol supplements to reduce your gestational diabetes risk.
In one study with PCOS, the use of myo-inositol in pregnancy reduced gestational diabetes incidence of 17.4% compared to 54% in the control group. Metformin may also be recommended in pregnancy for women with higher risk of gestational diabetes based on pre-pregnancy weight and health. As a naturopathic doctor, my preference is a more natural approach, but there are cases where Metformin can be very useful.
10. L-carnitine may also be a supplement worth considering in order to reduce your risk of gestational diabetes.
L-carnitine levels decrease significantly in pregnancy, and supplementation with L-carnitine during pregnancy from 20 weeks gestation onwards, may help to prevent the development of gestational diabetes especially in overweight women.
In conclusion, there are many steps that you can take once pregnant to reduce your chance of pregnancy complications. Most complications are associated with changes in blood sugar and insulin levels and excessive weight gain, so getting plenty of support with your nutrition and monitoring your blood sugar levels early is highly recommended. If you are considering adding any of the supplements discussed above, please discuss with a qualified health practitioner first to ensure that they are safe for you.
- Begum, M. R., Khanam, N. N., Quadir, E., Ferdous, J., Begum, M.S., Khan, F., et al. (2009). Prevention of gestational diabetes mellitus by continuing metformin therapy throughout pregnancy in women with polycystic ovary syndrome. Journal of Obstetrics and Gynaecology Research, 35, 282–286.
- Boomsma CM, Eijkemans MJ, Hughes EG, et al. (2006). A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Hum Reprod Update.12(6):673-683.
- Boomsma, C. M., Fauser, B. C., & Macklon, N. S. (2008). Pregnancy complications in women with polycystic ovary syndrome. Seminars in Reproductive Medicine 26, 72−84.
- D’Anna, R, Di Benedetto, B. Rizzo, P, Raffone, E., Interdonato, M.L. (2012) Myo-Inositol
may prevent gestational diabetes in PCOS women. Gynecol Endocrinol. 28(6), 440-2.
- Glueck C, Goldenberg N, Pranikoff J, et al. (2004) Height, weight, and motor-social development during the first 18 months of life in 126 infants born to 109 mothers with polycystic ovary syndrome who conceived on and continued metformin through pregnancy. Hum Reprod. 19(6):1323-1330.
- Jakubowicz, D .J., Iuorno, M. J., Jakubowicz, S., Roberts, K. A., & Nestler, J. E. (2002). Effects of metformin on early pregnancy loss in the polycystic ovary syndrome. Journal of Clinical Endocrinology and Metabolism, 87, 524–529.
- Lohninger, A., Radler, U., Jinniate, S., Lohninger, S., Karlic, H. et al. (2010). Relationship between carnitine, fatty acids and insulin resistance. Gynakol Geburtshilfiche Rundsch. 49(4): 2350-5.
- Morin-Papunen, L., Rantala, A.S., Unkila-Kallio, L., Tiitinen, A., Hippelainen, M., Perheentupa, A., et al. (2012). Metformin improves pregnancy and live-birth rates in women with polycystic ovary syndrome (PCOS): A multicenter, double-blind, placebo-controlled randomized trial. Journal of Clinical Endocrinology and Metabolism, 97, 1492-1500.
- Siega-Riz AM, Siega-Riz, AM, Laraia B. (2006). The implications of maternal overweight and obesity on the course of pregnancy and birth outcomes. Matern Child Health J.10(5 Suppl):S153-S156.
- Vahratian A, Siega-Riz AM, Savitz DA, Zhang J. (2005). Maternal pre-pregnancy overweight and obesity and the risk of primary cesarean delivery in nulliparous women. Ann Epidemiol. 2005;15(7):467-474.