Pregnant with PCOS? 4 Ways to Reduce Your Risk of Gestational Diabetes
One of the primary goals I have for my pregnant patients with PCOS is to reduce the risk of developing gestational diabetes (GDM). GDM is a condition in which a person without diabetes develops high blood sugar levels during pregnancy. Women with PCOS are at an increased risk of developing GDM because many have pre-existing insulin resistance.
Screening for GDM doesn’t happen until weeks 24-28 of pregnancy but we know that implementing strategies early on in pregnancy is essential to reduce the risk of developing this condition. Diet and lifestyle changes and even specific supplements have been found to reduce the risk of developing GDM and can also help treat GDM If it has been diagnosed.
Let’s talk about 4 strategies I recommend for reducing the risk of GDM in patients who have PCOS.
Always work closely with your healthcare provider to tailor these recommendations to your individual needs and circumstances for a healthy and safe pregnancy.
Focus on Sleep
Sleep is one of the cornerstones of health no matter what the age or stage of life, but research highlights a heightened significance in pregnancy, especially for women with PCOS. Poor sleep quality or insufficient sleep can impair insulin sensitivity and disrupt the body's ability to regulate blood sugar levels effectively1. Sleep deprivation can also increase oxidative stress, systemic inflammation and activate the HPA axis (stress response)1.
Pregnant women should aim for 8-9 hours of restful sleep each night to help reduce the risk of GDM1. If total sleep time overnight doesn’t hit this goal, napping seems to also reduce the risk1!
Keep Your Body Moving
Many of my patients are hesitant to keep exercising when they find out they are pregnant, however, research supports regular physical activity during pregnancy to improve insulin sensitivity and studies indicate that women who begin exercising early in pregnancy and meet the recommended guidelines have a significantly reduced risk—by up to 34%2.
Exercise in both the 1st and 2nd trimester can reduce GDM risk, but starting earlier, ideally before the 15th week, is particularly important and more effective at reducing risk3,4.
Exercise in pregnancy has also been found to reduce the risk of several other important health outcomes including supporting healthy blood pressure, reducing excessive weight gain, reducing the risk of c-sections and the risk of having a large baby5,6.
The American College of Obstetricians and Gynecologists (ACOG) recommends at least 150 minutes of moderate-intensity activity per week during pregnancy*. Ideally, this movement should be spread over at least 3 days of exercise and patients should avoid more than 2 consecutive days of rest.
Always consult with your healthcare provider before starting any new exercise regimen to ensure it is safe for you.
Consider Myo-inositol Supplementation
Myo-inositol is one of the most well-researched supplements when it comes to supporting PCOS. It plays a role in cellular signalling, particularly in insulin signalling pathways. Many of my patients are on myo-inositol while trying to conceive as it has been found to support regular ovulation and egg quality.
We also have research that continuing myo-inositol in pregnancy can reduce the risk of GDM and safety is well established7,8. Additionally, research has found that myo-inositol reduces the risk of pre-eclampsia and decreases the incidence of pre-term births7. A typical dosage recommendation is 2 grams twice daily.
Consult with a healthcare provider before starting any supplement to ensure it is appropriate and safe for you.
Manage Blood Sugar Through Diet
Diet can play a pivotal role in managing PCOS in general but also can significantly impact the risk of developing GDM. Many of the foundational dietary strategies that support PCOS can be applied here.
A diet rich in fibre, lean proteins, healthy fats, and low-glycemic index (GI) carbohydrates helps maintain stable blood sugar levels9. Avoiding processed foods, high glycemic index carbohydrates, sugary snacks, and beverages can also reduce the risk of GDM.
Interestingly, studies have shown that higher cereal intake is associated with an increased risk of GDM, whereas a higher intake of vegetables and leafy greens is linked to a reduced risk. Additionally, higher red meat consumption has been found to increase the risk of GDM10.
Always work closely with your healthcare provider to tailor these recommendations to your individual needs and circumstances for a healthy and safe pregnancy.
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References:
Rawal S, Hinkle SN, Zhu Y, Albert PS, Zhang C. A longitudinal study of sleep duration in pregnancy and subsequent risk of gestational diabetes: findings from a prospective, multiracial cohort. Am J Obstet Gynecol. 2017;216(4):399.e1-399.e8. doi:10.1016/j.ajog.2016.11.1051
Paulsen CP, Bandak E, Edemann-Callesen H, Juhl CB, Händel MN. The Effects of Exercise during Pregnancy on Gestational Diabetes Mellitus, Preeclampsia, and Spontaneous Abortion among Healthy Women—A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2023; 20(12):6069. https://doi.org/10.3390/ijerph20126069
Xie W, Zhang L, Cheng J, Wang Y, Kang H, Gao Y. Physical activity during pregnancy and therisk of gestational diabetes mellitus: a systematic review and dose-response meta-analysis.BMC Public Health. 2024;24(1):594. Published 2024 Feb 23. doi:10.1186/s12889-024-18131-7
Martínez-Vizcaíno V, Sanabria-Martínez G, Fernández-Rodríguez R, et al. Exercise duringpregnancy for preventing gestational diabetes mellitus and hypertensive disorders: An umbrellareview of randomised controlled trials and an updated meta-analysis. BJOG. 2023;130(3):264-275. doi:10.1111/1471-0528.17304
Huifen Z, Yaping X, Meijing Z, et al. Effects of moderate-intensity resistance exercise on blood glucose and pregnancy outcome in patients with gestational diabetes mellitus: A randomized controlled trial. J Diabetes Complications.
Li X, Luo R, Qiao B, Ou H. Exercise Intervention Improves Blood Glucose Levels and Adverse Pregnancy Outcomes in GDM Patients: A Meta-Analysis. Comput Math Methods Med. 2022;2022:9287737. Published 2022 Sep 22. doi:10.1155/2022/9287737
Li, C. & Shi, H. (2024). Inositol supplementation for the prevention and treatment of gestational diabetes mellitus: a meta-analysis of randomized controlled trials. Archives of Gynecology and Obstetrics, 309(5), 1959–1969. https://doi.org/10.1007/s00404-023-07100-x
Motuhifonuaa, S. K., Lina, L., Alsweiler, J., Crawford, T. J. & Crowther, C. A. (2023). Antenatal dietary supplementation with myo‐inositol for preventing gestational diabetes. Cochrane Database of Systematic Reviews, 2023(2), CD011507. https://doi.org/10.1002/14651858.cd011507.pub3
Facchinetti F, Vijai V, Petrella E, Gambigliani Zoccoli S, Pignatti L, Di Cerbo L, Neri I. Food glycemic index changes in overweight/obese pregnant women enrolled in a lifestyle program: a randomized controlled trial. Am J Obstet Gynecol MFM. 2019 Aug;1(3):100030. doi: 10.1016/j.ajogmf.2019.100030. Epub 2019 Aug 5. PMID: 33345794.
Sahariah, S., Potdar, R., Gandhi, M., Kehoe, S., Brown, N., Sane, H., Coakley, P., Marley-Zagar, E., Chopra, H., Shivshankaran, D., Cox, V., Jackson, A., Margetts, B., & Fall, C. (2016). A Daily Snack Containing Leafy Green Vegetables, Fruit, and Milk before and during Pregnancy Prevents Gestational Diabetes in a Randomized, Controlled Trial in Mumbai, India1234. The Journal of Nutrition, 146, 1453S - 1460S. https://doi.org/10.3945/jn.115.223461.