There is some evidence to suggest that women with PCOS may have trouble when it comes to breastfeeding due to low milk supply.
Before we look at the reasons and what the evidence says, I want to reassure you that not all mothers with PCOS struggle to breastfeed, and in the studies looking at the relationship between PCOS and breastfeeding there are still large numbers of women who manage to successfully breastfeed. There are a limited amounts of studies looking at breastfeeding and PCOS, so still a lot of work to be done in this area. But I wanted to write this blog post and share the evidence because I believe that arming yourself with knowledge around how PCOS may (or may not) impact your breastfeeding journey may increase your chances of successfully being able to breastfeed – should this be how you wish to feed your baby.
Studies have shown that the main issue when it comes to breastfeeding with PCOS is undersupply. This seems to be caused by the underdevelopment of breast tissue either during puberty, pregnancy or both. Breastfeeding involves interactions between multiple different hormones, many of which can be elevated or slightly lower than normal in women with PCOS. It is thought that it is these hormonal imbalances which have a negative impact on the development of breast tissue (mammogenesis), the production of milk (lactogenesis) and being able to maintain lactation once it’s been established (galactopoesis). The three main hormones at play are progesterone, androgens (testosterone) and insulin.
Throughout puberty and pregnancy estrogen and progesterone stimulate the development of breast tissue. In early pregnancy progesterone and prolactin facilitate alveolar growth. In late pregnancy and after birth there is a drop in progesterone levels which stimulates the secretion of milk by breast tissue. It’s common for women with PCOS to have lower levels of progesterone which may interfere with the alveolar growth in early pregnancy and therefore impact milk supply.
High androgen levels during pregnancy may interfere with the development of the breast in to the lactating state. Postpartum androgen levels that are slight elevated may inhibit lactation. Third, may be the psychological effects of elevated androgen levels that make women less dedicated to breastfeeding. Possibly, a combination of all of the above is to blame.
Insulin resistance which affects women with PCOS may have a role to play. Receptors in the breast must be sensitive to insulin to work effectively with other lactation hormones, should they lose that sensitivity it will be harder to produce a good supply of milk.
Studies have shown that women with insulin resistance have a more sluggish response in milk supply to a nursing infant.
If you are currently pregnant, or thinking about conceiving and preparing yourself then the good news is that there is a lot you can do to help increase your chances of being able to successfully breastfeed.
- Keep moving
Exercising throughout pregnancy or with a newborn is not always easy, however, we know that exercise increases insulin sensitivity so if you are able to move then go for it. This could be anything from walking, a light stretching routine, swimming to something slightly more intense. Make sure you are exercising safely when pregnant or newly post-partum.
- Balance meals with protein
We want to keep those insulin levels down and adding protein to meals helps slow down the release of glucose. Aim to have some source of protein with each of your meals, even snacks.
- Take your inositol supplements
Inositol is an insulin sensitizer and is safe to take throughout your pregnancy. Continuing to take your inositol supplements will help keep insulin levels down and prevent androgen levels from increasing.
- Avoid stress
Easier said than done when pregnant right? But if stress is avoidable remember to take time for some stress reducing activities like yoga, light stretching, relaxing bubble baths. If our cortisol levels stay up for long periods of time, then insulin and testosterone levels increase too.
- Eat plenty fibre, for the same reason we add protein, we want to have lots of fibre in our diet too. Fruits and vegetables are high in fibre and consuming wholegrain, unrefined carbohydrates will help you reach your daily fibre target. Lots of fibre will help keep constipation at bay which is a common pregnancy symptom.
You probably already know that PCOS increases the risk for developing type 2 diabetes. And babies born to mothers with PCOS are genetically more likely to develop type 2 diabetes later in life. Research shows that breastfeeding helps reduce this risk which is great if you are able to breastfeed your baby.
The most important thing to remember is that a fed baby is best, regardless of how you choose to feed them.
If you are currently breastfeeding and feel that you’re struggling with low milk supply, then the above recommendations can still be helpful. You can also reach out to la leche who have great advice on how to increase milk supply, and follow @milkmakingmama on Instagram for great breastfeeding advice.