Many women come to their Polycystic Ovarian Syndrome (PCOS) diagnosis as a result of wrestling with fertility issues, so the thrill of pregnancy is all that more sweet.
I often receive questions from women concerned about complications with PCOS and pregnancy.
Women with PCOS share all the same concerns as any woman, but there are some extra things you may want to keep in mind and discuss with your healthcare team to be sure that your little bundle of joy arrives with as few complications as possible. While there are extra risks in pregnancy with PCOS, I am here to tell you that the outcome can be glorious.
Here are the top 4 risks to discuss with your doctor:
#1: Gestational Diabetes (GD): Only pregnant women get this variety of diabetes which presents at about 20 weeks in pregnancy and disappears afterward. Since many women with PCOS already have issues with insulin, you may be at increased risk. If not controlled, GD can cause significant problems for mother and fetus such as very high birth weight and need for a caesarean section.
Proper medical and nutritional management may not prevent gestational diabetes, but it can greatly lessen the resulting complications. Many physicians recommend that a mother with PCOS take an oral glucose tolerance test at 20 weeks, about 4 weeks before the normal benchmark. If you are already following the PCOS Diva diet and lifestyle guidelines, you are well on your way to managing potential GD issues. For example, you should eat 3 meals and 2-3 snacks a day composed of whole, high fiber and protein rich foods and avoid all simple carbohydrates like white bread, sodas, juices, candies and desserts.
#2: Blood Pressure: Even before pregnancy, many women with PCOS have high blood pressure. There are several interconnected risks for women in this situation. Preeclampsia is a sudden increase in blood pressure after the 20th week of pregnancy and can affect the mother’s liver, brain and kidneys. Unchecked, it can turn into eclampsia which causes organ damage, seizures, or even death. Pregnancy-induced High Blood Pressure also occurs after the first trimester and, untreated, results in eclampsia. All of these conditions typically result in a Cesarean-section delivery. To prevent issues, follow the guidelines for preventing gestational diabetes. A brisk walk after a meal is another great way to manage your blood pressure and insulin levels.
#3: Miscarriage: Miscarriage is a very common result of pregnancy for all women, possibly as high as 25% of all pregnancies. For women with PCOS, that rate may be closer to 45%. Reasons for miscarriage are numerous, and many of them are out of a mother’s control. Environmental, immunological, anatomical, genetic and lifestyle (smoking, alcohol or drug use) factors are all common causes. Two more causes are of particular concern to women with PCOS- progesterone and folate/MTHFR.
- Progesterone– Many women with PCOS have low levels of progesterone in their system. This is problematic because progesterone is a vital element in preparing the uterus to attach a fertilized egg. If you have deficient progesterone, you may suffer early term miscarriages because your uterus is not prepared to sustain the fetus. Some studies show that progesterone supplementation between 7-10 weeks of pregnancy may help with implantation and maintaining pregnancy.
- Folate/MTHFR– I have written before about the important difference between folic acid and folate, but pregnancy is an important time to revisit this topic. Folic acid is a synthetic, lab-produced B vitamin that cannot be used in our bodies without going through extensive conversion in our intestines. Folate, on the other hand, is found in green leafy vegetables and can be readily used.
Folate is important to our bodies for many reasons. It is needed for growth and metabolism and is especially crucial during pregnancy since it is important for healthy DNA production and cell division in fetal development. Women with low folate levels are 50% more likely to miscarry.
Unfortunately, approximately 40% of the population has a gene mutation called MTHFR. MTHFR is a gene that (among other things) turns unusable folic acid into usable folate. People who have the mutation are as much as 80% less efficient at converting folic acid into something useful. That means you have unprocessed folic acid floating around in your body. Since synthetic folates stay in your system for a long time and bind even more strongly to folate receptors than active folate, the result is blocked nutrients that you need for your own cell generation and repair as well as development of the growing embryo. For more detailed information about MTHFR, read my article, MTHFR- What is it and how can it affect your fertility?
- Get tested for MTHFR.
- Consider your diet. What you eat may affect your risk of miscarriage. Women with a diet low in fiber and high in refined carbohydrates are at higher risk of miscarriage due to the hormonal imbalances which result from that sort of diet. Avoid vitamins and enriched foods that contain folic acid. Eat lots of leafy greens, lentils, pinto beans and chick peas. A diet high in fiber and rich in leafy green vegetables will reduce your risk. Finally, consider a supplement that contains bioavailable folate such as PCOS Diva Perfect Prenatal.
#4: Hypothyroid Complications: Many women with PCOS have thyroid issues as well. Ideally, these conditions are diagnosed before pregnancy since many serious complications can arise. Specifically, hypothyroidism increases the risk of pregnancy complications such as miscarriage, still birth, infertility, maternal anemia, pre-eclampsia, placental abruption, postpartum hemorrhage, premature delivery, low birth weight and deficits in intellectual development in infants. Careful testing and monitoring throughout pregnancy is required. For more information about hypothyroid and pregnancy, visit Hypothyroid Mom.
Every pregnant woman worries and is prone to certain risks. Knowing the risks and symptoms ahead of time can help you head off many issues that arise from conditions that you can control. Talk to your health care team about your particular situation. Clear communication will allay many of your worst fears and help you be prepared should a problem arise.
What else can you do to manage your pregnancy risks?
Consider avoiding gluten. Women with PCOS often have Celiac disease or are at least gluten intolerant. If you are sensitive to gluten, every time you eat food containing gluten, it irritates and damages the lining of your intestine and reduces your ability to absorb nutrients. It can also affect the way the rest of your body absorbs nutrients and vitamins that are vital to your health, especially when you are pregnant. Nutrient deficiencies in your body affect the fetus- that is true whether you are gluten sensitive or just have a poor diet. This is the main reason that my seasonal meal plans are gluten-free. For more information about living gluten-free, read my article, Go Gluten Free for PCOS, try one of my seasonal meal plans, or join my 7-day Jumpstart program.
Congratulations! This is a joyous time in your life. I hope that you have a safe and uneventful pregnancy, and that you take this opportunity to get (or keep) yourself healthy and strong. Your baby needs a healthy mom!