PCOD or Polycystic ovarian disease is a kind of hormonal disorder. 1 in 10 women suffers from PCOS. Patients generally present with irregular periods. The associations include infertility, acne, excessive hair growth, diabetes, obesity, etc. If uncontrolled, PCOS can lead to serious complications such as high blood pressure, heart disease, diabetes, and endometrial cancer. There is no exact cause and it runs in the families. The diagnosis is made based on symptom, clinical features, Ultrasonography showing multiple cysts in the ovaries and biochemical reports of excessive androgenic hormones. The basic pathology is resistance to insulin. The main culprit for increasing number of PCOS patients is the sedentary life style and the unhealthy junk food diet. There's no permanent cure for PCOS but the symptoms can be managed. With the right diet and adequate exercise, few women have reported remarkable improvement. 

If you are a PCOS patient and now pregnant, many congratulation as pregnancy in PCOS is difficult and you must have surely struggled to have one. You need to take care of your pregnancy all similar to a routine pregnancy but you need to be extra vigilant and careful about points, complication and diet.

Do focus very well on your diet

After the struggle to get pregnant, you are at increased risk of complication. These can be well controlled by diet. You also need to really focus well on your diet to keep yourself and baby nourished as well as to keep the PCOS symptoms in control. Because of your weight issues, fluctuating hormones and hormonal imbalances, hypothyroidism, insulin resistance, you need to carefully plan your diet.

Eat a high fibre diet - green leafy vegetables, fruits with skin, etc. A high-fiber diet improves blood sugar control and keeps insulin levels in check. Fiber slows down digestion, and thus the carbohydrates we eat take longer to be broken down into glucose (or blood sugar). This helps in keeping your blood sugar in check. Dietary fiber also helps you feel full for longer which ensures appetite control.

Eat a high protein diet -Although they do not have much fiber, lean-protein foods such as chicken, fish and egg whites keep you feeling full longer and help stabilize your blood sugar. Protein fuels growth and aids healthy development of your baby. You can eat a combination of both good quality proteins from animals and plants. Vegetarian proteins like beans, lentils, legumes, nuts, seeds etc. help in keeping blood sugar levels under control. On the other hand, good quality animal proteins like grass-fed organic meat, oily fish, and organ meats are a must-add as they are a good source of iron.

Eat complex carbohydrates and avoid simple ones -A moderate carb diet that includes up to 75-150g carbs a day is recommended. Make sure you choose good sources of carbs; prefer foods with low glycemic index such as that made from whole wheat, wheat flour, whole grain, brown rice, poha and wheat pasta. Some good options are – healthy fruits eaten with skin and gluten-free sources of grains and legumes. Lentils, beans, steel-cut oats and vegetables such as green beans, broccoli, cauliflower, sweet potatoes, and zucchini are also good choices.

Choose healthy fats -Fats are crucial for hormone health and the development of your baby during pregnancy. Avoid saturated fats that increase your calories and cholesterol. Instead, consume healthy fats with plenty of EFA (essential fatty acids) as that will ensure healthy brain and eye development of your baby as well as good birth weight. Good quality fats also help make rich, nourishing breast milk. Also, fat-soluble vitamins like A, D, E, K are all crucial for a healthy pregnancy. Nutritional deficiencies can lead to miscarriage and/or underdeveloped organs in the baby. Eat omega-3 rich fats from fatty fish, egg yolks, nuts, coconut oil, coconut cream/milk, grass-fed butter, ghee, and seeds.

Do have more anti-inflammatory foods -Inflammation is part of the underlying mechanism of PCOS and foods with anti-inflammatory properties which include tomatoes, spinach, strawberries, walnuts, almonds, turmeric, and fatty fish help to reduce the symptoms of PCOS.

Avoid all refined carbs that will cause wild insulin spikes and crashes. Avoid any form of sugar, jaggery, honey and refined cereals like maida, sooji, white rice, white rice poha, etc.

Do not consume empty calories.

Don’t have inflammatory foods - These are foods rich in omega 6 fatty acids. These foods exacerbate PCOS symptoms. Foods such as French fries, margarine, red meat, and other processed meats belong to this group and should be avoided as much as possible.

Some experts advise to avoid dairy products as many health experts believe that dairy-based products can increase insulin levels which can aggravate acne and other symptoms.

Try not to consume high amounts of coffee as it increases your stress hormones, disrupts sleep, causes anxiety, causes indigestion and promotes insulin resistance.

Try to reduce your soy intake as it is found not to interfere with your insulin but does with your thyroid hormone.

PCOD patients might experience water retention and the best way to treat that would be to eat small frequent meals and a lot of water through the day.

Take the right supplements

The right supplements can support a healthy pregnancy. For PCOS patients who are pregnant, supplements recommended are:

• Prenatal vitamins to cover any nutritional gaps in your diet.
• Myo-inositol helps restore insulin sensitivity, and decrease anxiety.
• Vitamin D – It aids in proper growth and development of the baby and also reduces the risk of postnatal depression.
• Fish oils – omega 3 supplementation is beneficial for PCOS as an anti-inflammatory product.

Be more vigilant about certain complications as PCOS patients are more prone to them.

Gestational diabetes:

This variety of diabetes develops during pregnancy and disappears within 6 weeks. Since the basic culprit in PCOS is insulin resistance, PCOS patients might be more prone to developing diabetes. A oral glucose challenge test is generally done at 24 to 28 weeks but in PCOS patients, an earlier check on glucose tolerance may be advised at around 20 weeks in the form of oral glucose tolerance test. Diabetes per se can bring various complications in the mother and the baby so with proper diet and exercise during pregnancy, you may be able to all together avoid or control the pathology. With frequent meal, 3 major and 3 minor, fiber rich diet, complex carbohydrates, avoiding empty calories and simple carbohydrates, protein rich diet & regular exercise, you might be the lucky one not to develop GDM .

Hypothyroidism :

Many PCOS patients have accompanied hypothyroid issues. Hypothyroidism is generally diagnosed during the prenatal period. Hypothyroidism increases the risk of pregnancy complications such as miscarriage, still birth, infertility, maternal anemia, pre-eclampsia, placental abruption, postpartum hemorrhage, premature delivery, low birth weight and low IQ in infants. Careful testing and monitoring throughout pregnancy is required.

Pregnancy induced hypertension:

PCOS patients are more prone to hypertensive disorders. PIH develops generally after 20 weeks of pregnancy. If uncontrolled, it may progress to pre eclampsia and eclampsia (seizures with hypertension). The patients generally land up in a C-section. PCOS patients may develop raised BP right from the first trimester. Early diagnosis and timely treatment is of utmost importance.

Miscarriage :

20% of the normal pregnancies land up in miscarriage. This rate is higher around 40 % in PCOS.

Various factors responsible for this increased rate include environmental, immunological, anatomical, progesterone deficiency, folic acid deficiency, genetic and lifestyle (smoking, alcohol or drug use).

Supplementing the patient with active form of folic acid and progesterone in any form can help reduce this rate. Consider a supplement that contains bio available folate.

Women with a diet low in fiber and high in refined carbohydrates are at higher risk of miscarriage due to the hormonal imbalances which result from that sort of diet. A diet high in fiber and rich in leafy green vegetables will reduce your risk.  

Concentrate on exercise:

Along with the right kind of diet, it's absolutely crucial to exercise for around 30 to 60 minutes a day as it can reduce your insulin resistance by increasing your basal metabolic rate. A high insulin resistance can cause you to be overweight; it can cause darkening of the skin and produce more testosterone. Regular physical activity can take care of all these issues.

Keep a Menstruation record:

Keep a daily for the record of your periods. These helps you know your cycle length. You are more prone to certain complication with few cycles. So the high risk ones are easily identified.

Do not consume extra calories:

Since the BMR is generally low, you need fewer calories - eat 300 extra calories/day during the second trimester. Eat 500 extra calories/day during the third trimester. Avoid any weight gain in first trimester. Avoid extra and fast weight gain.

Do not neglect your check-ups:

Do not ignore your symptoms. A lot of treatment options are available. Take your treatment like pills and metformin without skipping as skipping them can bring more hormonal imbalance and hypoglycemic attacks, respectively. Do not skip your consultants’ appointments. Do not skip your consultants advice

All the best for your pregnancy.