polycystic ovary syndrome bagus

8/9/2019 Polycystic Ovary Syndrome Bagus

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Polycystic Ovary Syndrome — Unique Concerns During Pregnancy and LactationBy Angela Grassi, MS, D, LD!Today’s Dietitian"ol# $% !o# $& P# '(

For many women with PCOS, conceiving is only the first hurdle. These women face particular challenges,but Rs can help them achieve healthy pregnancies by addressing their special emotional, health, anddietary needs.

Polycystic ovary syndrome (PCOS) is identified as a state of hyperinsulinemia and hyperandrogenism. Affecting 8% to 1% of reproductive!age "omen# it is the main cause of ovulatory infertility in the $nitedStates.1 Pregnancy can e an e&citing time for "omen "ith PCOS# especially ecause so many of them may haveeen trying to conceive for years# "ith or "ithout fertility treatments. 'n addition# eing pregnant is a signof femininity# and it may e a relief to some "omen "ho have felt masculine due to their male shape andsymptoms such as e&cess hair gro"th and alding.

*o"ever# having PCOS and eing pregnant does pose some concerns. Some "omen "ho haveundergone fertility treatments may carry multiple aies and "ill have special dietary and medical needs.

Also# ecause many "omen "ith PCOS have hormonal imalances and are over"eight or oese# theyare at higher ris+ for miscarriage and complications such as gestational diaetes mellitus andhypertensive disorders during pregnancy.,!- Proper medical management and medical nutrition therapyare imperative to prevent the onset of these complications and optimie fetal gro"th and development. )motional Concerns/any "omen "ith PCOS "ho are ale to conceive may have misconceptions aout eating healthfullyduring pregnancy. Popular diet guidelines for PCOS (mostly from the 'nternet) recommend a very lo"!carohydrate diet# ut current evidence does not support it. 0omen "ho follo" these recommendationsmay feel apprehensive aout eating foods containing carohydrates during pregnancy# including fruits#vegetales# legumes# and grainsall of "hich provide important vitamins# minerals# and fier and are

essential for fetal gro"th and development. 0omen may also e inclined to limit carohydrates out of fear of gaining too much "eight or to prevent gestational diaetes mellitus. (Currently# no evidence supportslimiting carohydrates during pregnancy to prevent gestational diaetes mellitus.) 2ietitians should screenpatients "ith PCOS for negative attitudes to"ard food and "eight and convey the importance ofconsuming "hole grain and "hole food carohydrates in sufficient amounts.

On the other hand# some "omen may thin+ pregnancy gives them license to eat anything they "ant. 3orthe first time# they may feel less pressure to restrict their inta+e in a society preoccupied "ith thinness. 'fthese "omen "ere very restrictive "ith their diet prior to conceiving# this could lead to inging duringpregnancy# resulting in e&cessive "eight gain. Additionally# "omen "ho already struggle "ith an&iety anddepression may feel that these conditions are e&acerated during pregnancy and may turn to food foremotional support. A study pulished in the Journal of the American Dietetic Association in ,4found that pregnant "omen "ho reported high stress# an&iety# and fatigue consumed more

carohydrates# fats# and protein and less vitamin C and folate.

't is common for a "oman "ho follo"ed a prepregnancy limited!carohydrate diet to aandon this "ay ofeating "hile pregnant# turning to once!foridden refined carohydrates and high saturated fat!containingfoods. As one patient put it# ' am pregnant no" and do not have to "orry aout managing my insulinlevels or my "eight. Such an attitude can lead to e&cessive "eight gain during pregnancy# increasing thechances of adverse health ris+s such as gestational diaetes mellitus.



role in mil+ production# and having insulin resistance may contriute to lactation prolems in "omen "ithPCOS# according to /arascos research.

As a precaution# lactation consultants recommend that all "omen "ith PCOS pump after feedings for atleast 1 to 14 minutes on each reast to help estalish an ade=uate mil+ supply in the first t"o "ee+s ofinitiating nursing. 3re=uent feedings "ith full drainage can also help ma&imie mil+ production# as can

consuming an ade=uate amount of food and fluid each day. 3or mothers "ith a lo" mil+ supply# e&trareast stimulation via fre=uent nursing or pumping sessions is crucial. S+in!to!s+in contact is alsoencouraged to oost mil+ production.17

/il+ supply prolems may e prevented or ameliorated y estalishing early intervention strategies duringpregnancy. 6his may include otaining resources for local reast!feeding support groups and preparing to"or+ "ith a oard!certified lactation consultant soon after giving irth. @ood reast!feeding management#including proper latch and positioning# are imperative to successful mil+ production and proper infantgro"th and development.

According to /arasco# all of these tactics "ill help estalish the foundation to good mil+ supply# yet theydo not address the underlying prolems. Although not scientifically tested# goats rue# fennel# +ale#verena# chasteerry# and fenugree+ are heral supplements reputed to increase mil+ supply and

possily stimulate reast gro"th.18#1> $sing progesterone supplements and metformin during pregnancymay also help support an ade=uate mil+ supply in "omen "ith PCOS and possily support reastdevelopment during pregnancy. /arasco has tried metformin "ith a numer of PCOS moms "ith lo"supply and# in some cases# metformin alone increases mil+ production. *o"ever# she adds# /etformin isnot going to help much if the "oman does not have enough reast tissue in place to egin "ith./edications such as metoclopramide can also e prescried to oost mil+ supply. 'nterestingly# "hilesome "omen "ith PCOS e&perience lo" mil+ supply# others report an overaundance of mil+ production.vidently# this area needs more research.

1s Met-ormin Sa-e to Use +ile Breast./eeding0Since many "omen choose to ta+e metformin during pregnancy for the enefits discussed previously#they may e inclined to continue ta+ing metformin "hile they reast!feed to prevent a reounding ofPCOS symptoms after irth# control insulin levels# and possily help produce an ade=uate mil+ supply.

*o"ever# the use of metformin during lactation is controversial.

?imited information e&ists aout "hether metformin is safe to ta+e "hile reast!feeding# as the ris+s to theinfant are still un+no"n. 6he fe" studies that are availale have consisted of relatively limited samplesies# and results sho" that "hile metformin does cross into the mil+ supply# it is in clinically insignificantamounts "ith no adverse effects on infants.,!,, 6he most recent and largest study "as conductedamong -1 nursing infants and 4 formula!fed infants orn to mothers "ith PCOS "ho too+ an average of,.44 grams of metformin per day throughout pregnancy and lactation.,9 6he infants "ere follo"ed up to -months of age# "ith results sho"ing that the reast!fed infants of mothers "ho too+ metformin had noadverse health ris+s in regard to gro"th or motor!social development.,9

*o"ever# as ' researched this article# numerous pediatricians# ostetricians# and reproductiveendocrinologists offered conflicting advice aout "hether to ta+e metformin "hile nursing. Some

physicians do not feel comfortale advising "omen to reast!feed "hile ta+ing the medication ecause ofthe lac+ of evidence supporting safety# especially ecause research has indicated that metformin doescross into the mil+ supply. Other physicians say they have een instructing moms to stay on metformin"hile reast!feeding as infants have already een e&posed to it in utero (metformin does cross theplacenta) and ecause it does not appear to e teratogenic# cause hypoglycemia# or pose any adversehealth ris+s. $ntil more long!term and larger studies are conducted# "omen "ith PCOS "ho plan toreast!feed "hile on metformin should discuss their options "ith their physician and carefully ma+e a ris+!enefit analysis eforehand. 'f a "oman does decide to ta+e metformin "hile nursing# monitoring theinfants health and feeding haits fre=uently is advised.,1#,,



Summary6he <oyous time of pregnancy can pose additional concerns to "omen "ith PCOS# as they are at a higher ris+ for miscarriage and ostetrical complications such as gestational diaetes mellitus# preterm laor#pregnancy!induced hypertension# and macrosomia. Some "omen may e resistant to eatingcarohydrate foods "hile others may consume too many of them# posing additional ris+s to mother andfetus. 2ietitians must educate patients aout the enefits of a good diet and lifestyle to sustain a healthypregnancy. 'n general# PCOS in pregnancy should e considered a state of pre!gestational diaetesmellitus and dietary guidelines should resemle those for gestational diaetes mellitus. 'n addition# some"omen "ith PCOS may have difficulty reast!feeding and producing an ade=uate mil+ supply for theirinfants due to hormonal imalances. 2ietitians can play an integral part in the health of "omen "ithPCOS during pregnancy and throughout the lactation period.

! "ngela #rassi, $S, R, %&, is the author of The Dietitian’s Guide to Polycystic OvarySyndrome and The PCOS Workbook !our Guide to Com"lete Physical and #motional $ealth.

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unselected population. J Clin #ndocrinol %etab. ,;8>(-)D,7;4!,7;>.

,. Seale 3@# 'E# :oinson :2# Feal @S. Association of metformin and pregnany in the polycystic ovarysyndrome. A report of three cases. J &e"rod %ed . ,;4(-)D47!41.

9. 5arieri :?. /etformin for the treatment of polycystic ovary syndrome. Obstet Gynedcol .,911(;)D784!7>9.

;. 6hadhani :# Stampfer /G# *unter 2G# et al. *igh ody mass inde& and hypercholesterolemiaD :is+ ofhypertensive disorders of pregnancy. Obstet Gynecol .1>>>>;(;)D4;9!44.

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7. Solomon C@# 0illett 0C# Carey EG# et al. A prospective study of pregravid determinants of gestationaldiaetes mellitus. JA%A. 1>>7,78(19)D178!189.

8. Anderson G?# 0aller 2B# Canfield /A# et al. /aternal oesity# gestational diaetes# and central nervoussystem irth defects. #"idemiolo+y . ,41-(1)D87!>,.

>. Eahratian A# Siega!:i A/# Savit 2A# Hhang G. /aternal pre!pregnancy over"eight and oesity andthe ris+ of primary cesarean delivery in nulliparous "omen. Ann #"idemiol . ,414(7)D;-7!;7;.

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11. :osenerg 6G# @arers S# Chav+in 0# Chiasson /A. Prepregnancy "eight and adverse perinataloutcomes in an ethnically diverse population. Obstet Gynecol . ,91,D1,,!1,7.



1,. Eahratian A# Hhang G# 6roendle G3# Savit 2A# Siega!:i A/. /aternal pre!pregnancy over"eight andoesity and the pattern of laor progression in term nulliparous "omen. Obstet Gynecol . ,;1;(4 Pt1)D>;9!>41.

19. ?arsen C# Serdula /B# Sullivan B/. /acrosomiaD 'nfluence of maternal over"eight among a lo"!income population. Am J Obstet Gynecol . 1>>1-,(,)D;>!;>;.

1;. 5oomsma C/# i<+emans /G# *ughes @# et al. A meta!analysis of pregnancy outcomes in "omen"ith polycystic ovary syndrome. $um &e"rod -"date. ,-1,(-)D-79!-89.

14. @luec+ C# @oldenerg F# Prani+off G# et al. *eight# "eight# and motor!social development during thefirst 18 months of life in 1,- infants orn to 1> mothers "ith polycystic ovary syndrome "ho conceivedon and continued metformin through pregnancy. $um &e"rod . ,;1>(-)D19,9!199.

1-. /arasco ?# /armet C# Shell . Polycystic ovary syndromeD A connection to insufficient mil+ supplyJ J$um (act . ,1-(,)D1;9!1;8.

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,1. *ale 60# Bristensen G*# *ac+ett ?P# Bohan :# 'lett B3. 6ransfer of metformin into humanmil+. Diabetolo+ia. ,,;4(11)D14>!141;.

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polycystic ovary syndrome bagus

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