September is PCOS Awareness Month
We've talked about how PCOS and insulin resistance can affect lactation and milk production before but let's explore this a bit more.
There is a disproportionate incidence of diabetes among ethnic groups.
Prevalence of diagnosed diabetes was highest among American Indians/Alaska Natives (14.7%), people of Hispanic origin (12.5%), and non-Hispanic blacks (11.7%), followed by non-Hispanic Asians (9.2%) and non-Hispanic whites (7.5%).
This, of course, is not the only disparity found in lactation among different ethnic groups. The disparities run deep and are shown throughout a lifetime. These outcomes are affected by systemic racism and poor access to timely, high-quality healthcare in areas with higher populations of black and brown people in the US - and ultimately these combined increase allostatic load. There is not a simple solution for the combination of societal racism, poverty, and trauma which lead to poorer health outcomes, however, as lactation supporters we do play a role in improving chestfeeding exclusivity and duration by using our knowledge and skills to address some of the most important factors which lead to precocious weaning.
However, insulin resistance plays an important role in the physiological barriers to successful feeding as well as the perception or expectation of failure.
PCOS is a syndrome and the combination of symptoms is unique in each case, making identification more challenging. Many people never receive a formal diagnosis. Symptoms can include:
•Raised levels of insulin (that can lead to excessive weight gain) •Raised levels of androgens hormones (that can lead to acne and growth of unwanted hair) •Irregular menses, ovarian cysts •Increased risk of developing diabetes •Underdevelopment of breast glandular tissue – not size
Medical conditions related to insulin resistance create additional challenges to lactation. Insulin resistance may delay Lactogenesis II – which is the milk transition from colostrum to mature milk and copious volume increase – this may be delayed by up to a week.
Some people with IR may never make enough milk to meet all the needs of their infant because of the role insulin plays in milk production and glandular growth during pregnancy, however, we do not know in advance that a person with diabetes will have insufficient supply. Our focus should be on best practices to support these parents in the optimal outcomes for milk production and healthy infant feeding. We can do this by supporting nutrition which does not focus on weight alone, through offering medication therapy if indicated during pregnancy, by increasing access to lactation care both in-patient and after discharge, and increasing access to human donor milk for supplementation.
As providers we can also learn more about non-medication supports for managing milk supply which can include: • Frequent milk removal using hands-techniques • Learning about which herbs to use or avoid • Avoiding pacifiers and bottles, instead focusing on skin-to-skin and using at breast supplement tools • The use of donor milk until milk production is established • Frequent visits with an IBCLC in the first week after delivery • Supporting in-home care • Using Peer Support programs to encourage parents and monitor the need for medical intervention With support, education, and provider support parents with PCOS can chestfeed successfully!