PCOS and Breastfeeding: What's the Issue?
- Define Polycystic Ovarian Syndrome and its effects pregnancy and lactation.
- Identify the potential sequelae of PCOS on milk supply and the implications of this for the breastfeeding infant.
- Analyze different treatment options and therapies that could improve milk supply and meet the emotional needs of this population.
Polycystic Ovarian Syndrome (PCOS) was first described in 1935 as collection of symptoms that included amenorrhea, hirsutism, obesity, and a polycystic appearance to the ovaries. Further investigation has revealed many more endocrine and hormonal influences that lead to further problems such as insulin resistance, hypertension, elevated lipids, infertility, recurrent miscarriages, and insufficient breast development. It is one of the most common female endocrine disorders, estimated to affect 10% to 15% of women. Researchers have now found a correlation between PCOS and an insufficient milk supply. This poster intends to inspire, lead, and forge new directions in the care of breastfeeding women with PCOS and their newborns.
Case:
The pertinent effects of PCOS on milk supply begin long before a woman becomes pregnant. A chronic decrease in estrogen and progesterone, due to oligomenorrhea during puberty, affects breast tissue development. During pregnancy, these effects lead to insufficient glandular tissue and alveoli development, which can impair adequate milk production (Lactogenesis I). Upon assessment, many women with PCOS describe little or no breast changes during the pregnancy, and examination reveals breasts that are tubular in shape, widely spaced, or asymmetrical. Elevated levels of androgens can interfere with prolactin receptors and oxytocin, the two main hormones that affect milk production and ejection. Insulin resistance can also influence breast growth and milk synthesis.
Treatment of these women begins with education starting in the first trimester of pregnancy along with a baseline breast examination, and again in the third trimester to identify potential problems with Lactogenesis I. After delivery, an assessment by a Lactation Consultant is crucial to formulate an appropriate plan of care, which includes careful surveillance for the onset of Lactogenesis II. The newborn must be observed closely for adequate weight gain and signs of dehydration. The goals of therapy for these women must include adequate breast stimulation from the baby and/or a pump. New research has explored other treatment options such as Metformin, to decrease the endocrinopathic effects of PCOS, and the use of galactogogues may also help improve milk supply.
Conclusion:
Many of these women have already emotionally struggled through problems with infertility and/or maintaining a health pregnancy. To realize that they may not be able to nutritionally provide for their newborn can be devastating. Early education and exploration of treatment options is imperative to these women.
Keywords:
Polycystic Ovarian Syndrome, Breastfeeding, Insufficient Milk Supply
