PCOS and Breastfeeding

Some individuals with PCOS may experience low milk supply when breastfeeding in the early post-partum period after giving birth.[1],[2]

During the first and second trimesters of pregnancy, changes occur in the structure of the breast to support breastfeeding (also known as mammogenesis, these changes can also be induced by hormonal treatments):

If conception occurs, the corpus luteum, a collection of cells formed on the ovary, doesn’t break down immediately but instead releases progesterone for the first c. 12 weeks of pregnancy;[3],[4]
The placenta, a temporary organ that connects your baby to the uterus, begins to form 7-10 days after conception, and starts to take over progesterone production from the corpus luteum after the first trimester;[5]
The level of progesterone, the hormone that prepares the lining of the uterus for a fertilized egg, continue to rise throughout pregnancy;[6]
Progesterone performs several functions in pregnancy including working with prolactin, the hormone responsible for lactation or producing milk,[7] to develop alveoli, small hollow ducts lined with milk-secreting cells, into milk-secreting lobules, groups of alveoli that connect to the nipple;[8],[9],[10]
As a result, the fatty and supportive tissue that normally makes up most of the volume of the breast is replaced by glandular tissue changing the size, texture and feeling of “fullness” of the breast[11] (note that the size of the breasts is not related to the ability to produce sufficient milk for the infant)[12];
During early pregnancy, Montgomery Tubercles, the small bumps on the nipples may get more pronounced, preparing to secrete an oily fluid that protects the skin of the nipple and areola during pregnancy with a scent that attracts the baby to the breast;[13],[14] and
In addition, there is an increase in blood flow to the breasts and the veins can become more visible through the skin.[15]

During the second trimester of pregnancy, the breasts start to produce colostrum, a thick yellowish liquid that rich in nutrients, antibodies and antioxidants (the first stage of lactogenesis):[16],[17],[18]

The alveoli cells take proteins and sugars from the blood and turn them into colostrum (high levels of progesterone and estrogen, the hormone that plays a number of key roles in our reproductive health,[19] prevent the action of prolactin to produce milk at this stage);[20],[21]
In addition, the nipples may get larger and more pronounced; and
At the same time, increasing levels of progesterone and estrogen cause an increase in the secretion of melanin, the substance responsible for the color of your eyes, skin and hair,[22] causing a darkening of the nipples[23] (some hypothesize that this makes it easier for the newborn, with poor eyesight, to find their source of food).

Within 2-3 days of giving birth, the breasts start to produce transitional milk as it gradually transitions from colostrum to mature milk (the second stage of lactogenesis):

During the third stage of labor, typically within 30-60 minutes within giving birth if via vaginal birth, the placenta is delivered;[24]
With the removal of the placenta, levels of progesterone and estrogen drop dramatically;[25] and
The drop in progesterone and estrogen allows prolactin to stimulate milk secretion within the mammary glands.[26]

Roughly 14 days after giving birth, the breasts start to produce mature milk, a bluish-white liquid that is thinner than colostrum.[27] The color of breast milk can also be affected by diet and medications.[28]

Expression of milk from the nipples is triggered by a release of oxytocin, one of the four “feel good hormones”, from the pituitary gland: [29],[30],[31]

The baby’s suckling action stimulates the release of oxytocin[32] and this same reaction can be triggered by hearing the baby cry or just thinking about the baby;[33]
This triggers the “oxytocin reflex” where the myoepithelial cells that line the surface of the alveoli contract;
This contraction makes the milk that has collected in the alveoli flow along and fill the ducts in the nipple.

Note that oxytocin plays a key role in labor and delivery as it triggers uterine contractions.[34] Oxytocin is an unusual hormone as it is self-reinforcing, i.e., the release of oxytocin leads to actions which stimulate the production of more oxytocin.

PCOS is believed to affect milk supply in a number of ways:

Elevated levels of gestational dehydroepiandrosterone-sulphate (DHEA-S),[35] a type of androgen or male sex hormone produced within the adrenal glands at the top of each kidney,[36] increases the levels of estrogens in the placenta, temporarily interfering with the transition from colostrum to milk; and
Insulin resistance, where cells in your muscles, fat and liver don’t respond well to insulin,[37] interferes with the conversion of sugar in the blood into milk as part of lactogenesis.

PCOS could also affect an individual’s ability to breastfeed in a number of other ways, including:

Increased prevalence of diabetes or gestational diabetes, associated with a 2.6x increased risk of low milk supply;[38]
Higher rates of obesity, caused by insulin resistance of other factors, associated with lower rates of breastfeeding initiation and duration;[39]
Higher rates of pregnancy complications and corresponding risk of caesarean or more traumatic birth experiences are associated with delayed and lower milk production;[40]
Higher rates of post-partum and other forms of depression are linked with feeling unsatisfied with breastfeeding and experiencing breastfeeding problems;[41]
Higher rates of thyroid issues such as hypothyroidism and hyperthyroidism,[42] with hypothyroidism associated with low quality and volume of milk[43] whereas hyperthyroidism is associated with high milk volumes and both can affect mood;[44] and
For individuals with fertility challenges or who have, through choice, given birth later in life, higher maternal age is associated with delayed milk production and reduced milk volume.[45]

Risk factors for challenges with breastfeeding include:[46]

Advanced maternal age;
Use of fertility treatment;
History of breast surgery or damage to the breast;
Maternal underlying chronic health issues, for example, breast cancer, HIV, tuberculosis, depression or endocrine disorders;
Maternal anemia or iron deficiency;[47]
Absence of, gaps in or poor prenatal care;
Poor prior experience with breastfeeding;
Lack of social support;
At-home stressors such as domestic violence;
Caesarian delivery, stressful vaginal delivery, use of forceps/suctioning or use of pain medication or anesthesia during delivery;
Post-partum hemorrhage, or excessive bleeding after delivery;[48]
Use of hormonal contraceptives postpartum;
Return to work within 6 months of giving birth;
Multiple births, prematurity or small/large for gestational age;
Meconium aspiration, where newborns experience difficulties breathing because their first bowel movement has been breathed in;[49]
Neonatal jaundice, above normal weight loss or lower than expected fetal bowel/bladder activity after birth; and
Neonatal care or delay/absence of skin-to-skin contact (“kangaroo care”) post delivery.

Reviewed by Jenny Lynn Walding, Certified Lactation Counselor and CEO Founder of milkmade

PARTNER SPOTLIGHT

milkmade is a lactation flow meter that accurately gauges breastmilk output, answering the question, “Am I making enough milk to sustain my baby?” milkmade promotes lactation longevity, facilitates user benchmarks, provides early indicators into potential complications, empowers breast and chestfeeders, and reduces anxiety through data.

Reviewed by Jenny Lynn Walding, Certified Lactation Counselor and CEO Founder of milkmade

PARTNER SPOTLIGHT

Sources

[12] https://wicbreastfeeding.fns.usda.gov/breast-and-nipple-size-and-shape.

PCOS and Breastfeeding