A Proactive Approach to PCOS and Pregnancy
Guest post by Dr. Shawna Darou
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:
- 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.
- 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.
- 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.
- 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!
- 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.
- 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.
- 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.
- 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.
- 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.
- 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 onward, 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.
Dr. Shawna Darou is a licensed and registered Naturopathic Doctor, who graduated from the Canadian College of Naturopathic Medicine (www.ccnm.edu) at the top of her class and was the recipient of the prestigious Governor’s Medal of Excellence. Naturopathic medicine is her second career, her first being Engineering Chemistry from Queen’s University. She now uses her analytical brain and problem solving skills especially in the complicated arena of hormonal health, and in solving health puzzles.
Dr. Shawna Darou N.D. is a specialist in women’s health care and fertility who has treated thousands of women in her Toronto clinic since 2004. She is a dedicated and caring doctor with a gentle approach who is committed to the health of her patients. Dr. Darou’s is also an avid health writer, and her popular health blog can be found at http://darouwellness.com/blog-posts/
Outside of the office, Dr. Darou is the mother of two beautiful children who inspire her to evolve the medical model in order to reform healthcare for the next generation.
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Thank you for this article! After a diagnosis of PCOS over the summer, having not had a period in months, I found myself pregnant! It was a shock and a miracle. I’m now in my 14th week of pregnancy. That’s the good news. The bad news is I am still experiencing some serious issues related to wonky hormones, most notably hair loss. I’ve been borderline hypothyroid for a long time, but not enough to treat. Could this be contributing? I’m concerned about mineral/vitamin deficiency, notably iodine or B vitamin. Any recommendations? Also, I should mention I am slender with PCOS and don’t seem to have diabetes-related concerns like many others with PCOS. My main symptoms have been hair loss (when off BC), insomnia, some acne, sensitive to weight gain (although in a healthy range due to clean diet and exercise), irregular period (prior to pregnancy), and cold hands and feet. Thanks in advance!
Oh my goodness, these symptoms are mine! God bless on the pregnancy. I hope the above mentioned will be hopeful for all of us. I do imagine the thyroid issue could contribute.
thank you so much! week 25 and feeling really good.
Hi KD! Your comment sounds similar to the pcos I have .. Only symptom I have is loss of period for just a year now and I also have a thyroid issue Hashimoto’s . I read you got pregant after not having your period for 4 months .. Were you temping and saw you had ovulated? Or just right time kind of thing ?
Actually, I didn’t have a period for about six months (May 2015 was my last period). To be honest, I was not tracking temperatures or anything, and we weren’t trying. We weren’t preventing it either 🙂 It was just by chance and luck that it happened. I had gone in for a blood panel to recheck my hormones when a “faint positive pregnancy” was detected. I was in shock! Prior to that, I had been exploring a few things that I heard could help regulate hormones, including essential oils, myo-inositol + folic acid, and desiccated liver capsules. I wish I could point to what really worked, but I guess it was just right timing. I’m at week 25 right now and things are looking great.
You mention that repetitive testing for diabetes can be a good idea, but I would add that it is not good to keep ingesting the sugar laden drink that they offer. There are other tests that are just as effective and do not involve drinking refined sugars.