Preconception Care for Women with PCOS: A Holistic Approach
Women with Polycystic Ovary Syndrome (PCOS) face significantly higher risks during pregnancy, including miscarriage, gestational diabetes, gestational hypertension, pre-eclampsia, preterm birth, low birth weight, intrauterine growth restriction, and caesarean section. Additionally, they are more likely to experience higher gestational weight gain and have a higher body mass index (BMI) compared to women without PCOS, which can further impact birth outcomes. Despite these elevated risks, the NHS currently does not allocate specific funding for preconception care for women with PCOS.
At Sirona Health, we believe that empowering women with access to preconception care is crucial for improving both maternal and infant outcomes. By addressing the unique needs of women with PCOS before conception, we can help optimise health and reduce pregnancy complications.
Key Elements of Preconception Care for PCOS
Preconception care for women with PCOS includes optimising factors such as weight, blood pressure, smoking, alcohol intake, diet, folate supplementation, exercise, sleep, and mental health. The International Evidence-Based Guidelines for the Assessment and Management of PCOS emphasize three primary areas of focus:
BMI Management
Blood Pressure Control
Insulin Resistance Management
1. BMI Management in PCOS
Many women with PCOS struggle with excess weight, particularly in the abdominal area. A BMI over 30, particularly with central obesity, increases insulin resistance, which worsens the symptoms of PCOS and contributes to pregnancy complications. This is a key area for both prevention and management. Excess weight in PCOS not only affects fertility but also increases the likelihood of excessive gestational weight gain, further complicating pregnancy.
Exercise and Physical Activity
While no single type of exercise has been proven superior in managing PCOS, staying physically active is essential. Women trying to conceive should engage in regular physical activity, as even light activity can offer health benefits. The goal is at least 150 to 300 minutes of moderate-intensity or 75 to 150 minutes of vigorous-intensity aerobic activity each week, alongside muscle-strengthening exercises. Self-monitoring using fitness trackers may also be helpful for maintaining an active lifestyle.
Diet and Nutrition
There’s no one-size-fits-all diet for women with PCOS, but adopting a balanced, flexible approach to nutrition is key. The British Dietitian Association recommends:
Eat Regularly: Regular meals help stabilize blood sugar and reduce insulin resistance.
Choose Low-GI Carbs: Low glycemic index (GI) foods can improve insulin sensitivity and regularize menstrual cycles. Incorporating whole grains and low-GI carbs is beneficial.
Balance Your Meals: A mix of protein, healthy fats, and low-GI fruits and vegetables can help manage blood sugar levels and reduce cravings.
Include Omega-3 Fats: Omega-3s from oily fish or plant-based sources like chia seeds and walnuts can help reduce inflammation.
2. Blood Pressure Monitoring
Women with PCOS are twice as likely to develop pregnancy-induced hypertension and pre-eclampsia. It’s essential that blood pressure is monitored regularly, particularly when planning a pregnancy or undergoing fertility treatments.
3. Insulin Resistance and Blood Sugar Control
Women with PCOS are also twice as likely to develop gestational diabetes. A 75g oral glucose tolerance test (OGTT) is recommended for assessing glycemic status, ideally before conception or early in pregnancy, to mitigate the risks of hyperglycemia and related complications.
The Role of Metformin in Preconception Care
Metformin, a widely used medication for type 2 diabetes, is often prescribed for women with PCOS to manage insulin resistance and support fertility. While metformin has shown benefits in regulating menstrual cycles and promoting weight management, its effectiveness in preventing pregnancy complications like gestational diabetes or pre-eclampsia is not well-established. In certain cases, however, it may reduce the risk of preterm birth and excessive gestational weight gain, particularly in women with a BMI over 25.
Women using metformin should be aware that it can lower vitamin B12 levels, especially in those with additional risk factors like diabetes or a vegan diet. Monitoring and supplementation may be necessary.
Empowering Women with PCOS for Healthier Pregnancies
Preconception care tailored to the needs of women with PCOS is critical in improving pregnancy outcomes and overall well-being. At Sirona Health, we aim to provide the resources and support necessary to help women with PCOS take control of their reproductive health, reduce complications, and achieve healthy pregnancies. By focusing on key areas like weight management, blood pressure control, and insulin resistance, we can create a solid foundation for healthier mothers and babies.