PCOS Pregnancy: My Bump Journey

I’m sitting here reflecting on my pregnancy journey and writing this 8 week postpartum… yes, time flys and I realised even more so once bringing a baby into this world. I had every intention to write this in my final weeks of pregnancy or at least in my first few weeks postpartum but I’m coming to realise that my to-do list is never ending as a mama and I’ve been putting things off to simply spend time being in the moment with our little one.

Our journey’s to falling pregnant, being pregnant and transition into motherhood are all so different. I loved being pregnant and was very blessed to have, dare I say, a fairly “easy” pregnancy, well at least one that was low risk and without complications. But for many women this isn’t the case. Falling pregnant can be so very difficult, pregnancy can be incredibly hard physically and emotionally. And the transition into motherhood is a whole other thing!

You can read more about my PCOS fertility journey and preconception care here.

Many times throughout my pregnancy people would ask how I was going and sometimes I felt almost guilty for replying “great!”. Sure I experienced every kind of emotion throughout my pregnancy but for the most part it was beautiful and I felt amazing (aside from first trimester fatigue and nausea). I completely acknowledge that not everyone has this experience and for many pregnancy can be incredibly challenging and hard both physically and emotionally. If you are pregnant or planning to fall pregnant, try not to have any expectations of what it may look like for you.

TRIMESTER 1:

I first found out I was pregnant while I was still studying nutrition. It was mid-trimester of my final trimester of clinical studies. We were in lockdown in Melbourne at the time so I was doing online consults 2 days per week as well as working part time 3 days a week (in an essential healthcare service - at a natural medicine clinic). My husband and I were so excited when we found out, but it was also a little bit of a shock. We just never expected to fall pregnant so quickly considering my history of PCOS (although to be fair, I had reversed my PCOS years prior and continue healthy lifestyle practices to support my health).

I started feeling fatigued and nauseas from about week 6 of pregnancy (so 1 week after I found out). It made my final few weeks of juggling uni and work quite hard as I felt like every day I was just “surviving” and getting through the day. My energy was really low and I found very quickly that my usual weight training sessions were feeling really challenging. I still felt fine exercising but I reduced the intensity to how I was feeling on the day, and took a few extra rest days here and there if I wasn’t feeling up to it. I always ensured I ate pre and post workout throughout pregnancy and included a serve of carbohydrates to ensure my body had available energy, as the placenta has high glucose requirements.

I had morning sickness pretty much constantly daily. It wasn’t intense but I generally felt “off” all day and had no appetite for food. I know a lot of women who have cravings during the first trimester or just feel like eating bland food like crackers or plain toast, but I didn’t even feel like that. Not eating made me feel worse, more fatigued and more nauseas so I had to force myself to eat everyday. Not fun, especially for someone who loves food and normally has a great appetite! For the most part, I ate what I normally would because I figured if I didn’t feel like eating but needed to, I might as well make it nourishing. I thought I’d share some of my tips for managing morning sickness that I used, and what I have recommended to my clients.

TIPS FOR MANAGING MORNING SICKNESS:

• It sounds simple but keep hydrated. If you have been vomiting you likely need to replace electrolytes as well as water, so include some unsweetened coconut water, bone broth, hydralyte, or if you can tolerate it a squeeze of lemon or orange juice and pinch of salt in a glass of water.

• Eating something dry and bland first thing in the morning, like some wholegrain or rice crackers or a piece of toast

• Swap large meals for smaller more frequent meals and snacks throughout the day – hunger and an empty stomach may increase nausea

• Have some ginger which is known for its anti-nausea properties – a hot cup of tea or water with fresh sliced ginger stepped for 5 mins is worth a try

• Chamomile and peppermint tea may also help combat nausea

• Slow cooked meats may be easier to digest and reduces the strong smell of meat if this is an aversion for you

• Opt for high protein snacks rather than sugary snacks – cheese, nuts, yogurt, eggs or veggie frittatas, protein smoothies

• Take your supplements with food rather than on an empty stomach. Some popular over-the-counter pregnancy supplements are known to increase nausea in some women due to the forms of nutrients used

• Severe morning sickness may benefit from additional supplementation with vitamin B6, but this needs to be under the guidance of a healthcare practitioner

Remember its ok to avoid foods that make you feel nauseas, its ok if you’re finding you can’t eat as much or you have aversions to many healthy foods you once enjoyed. It will pass. Just try your best to include as much nutrient dense food that you can stomach. Making some simple swaps can help increase the nutrient density of your diet, for example:

• Swap rice for quinoa or buckwheat, which have a higher nutrient profile

• Swap regular flour for oats, buckwheat or quinoa flour in protein pancakes and homemade muffins and cookies

• If bread is all you can stomach, opt for a quality grainy or seedy sourdough

• If you can stomach a smoothie sneak in some veg like frozen zucchini or cauliflower (which makes it like an icecream consistency) or spinach

• Nutritional yeast provides protein, vitamins B1, B2, B6 and B12, and adds a cheesy flavour to rice and pasta dishes

TRIMESTER 2:

My second trimester was over the Christmas and summer holidays and it felt like it went by so quickly. Getting to finally share our news with family and friends was so exciting and we were so grateful for all the love we received. Seeing my body start to change now was incredible. I surprised myself in that I never worried about my body changing or gaining weight. It was doing something amazing and I actually felt more connected to my feminine energy than ever before.

It wasn’t until early in the 2nd trimester I started questioning the model of healthcare we were receiving (up until this point we had been seeing a GP and they had booked me as a public patient at our closest hospital but I wasn’t able to get an appointment until 25 weeks and only over the phone). I had no idea that other models of care existed for pregnancy and birth until I happened to notice a private midwifery group just doors down from the gym I went to. Whilst it does come at a cost, we decided on having a private midwife for continuity of care throughout pregnancy, birth and 6 weeks postpartum. After researching and meeting with them it felt like my whole outlook on pregnancy and birth changed and I went from fearing birth to feeling empowered about birth because I felt informed, began understanding how natural physiological childbirth happens, and we discussed and planned for labour and birth preferences in our regular appointments. I know this isn’t an option for everyone (and of course may not even suit your needs) but was the right choice for us.

As quickly as my nausea and fatigued began, it seemed to disappear around week 14 and I quickly felt far more energetic and back to my normal self. I had graduated from uni by then, and continued to work part time. In the new year I expanded my business from nutrition coaching and recipe development to online Clinical Nutrition consultations. Life was busy even though we were in and out of lockdown, so I was grateful my energy had returned and I kind of just went about life as normal whilst our baby was growing inside me.

My appetite returned in a HUGE way and I found I was always hungry and always eating. Our body requires an additional approx. 300 calories in the 2nd trimester (the equivalent of an additional snack such as a bowl of yogurt, berries and nuts, or increase in main meal portion sizes). Clearly my body needed it! I continued eating as I normally would, nourishing my body with lots of whole foods for micronutrients, ensuring I was eating macronutrient balanced meals to reach my needs for protein, carbs, fibre and fats, as well as included a little treat here and there. Just honouring my hunger levels day by day.

I continued weight training and found I had plenty of energy for exercise. I saw an Exercise Physiologist for safe training modifications and continued seeing my Osteopath to keep my body functioning well and to avoid injury. I reduced the weight I was lifting to around 70% below my usual and modified any exercises that weren’t safe and didn’t feel right for me (for example by week 16 you shouldn’t do any exercises laying on your back as it may restrict blood flow - but seek advice from a qualified trainer/physio on what is suitable for you as everyone is different). My Exercise Physiologist suggested to try swimming for low impact cardio to build up more endurance for childbirth - suggesting it was like preparing my body for a marathon! I’d never really swam before but ended up loving my weekly swim sessions. I started off slow but found I quickly built up my lap speed (with total poor technique I might add!) and being in the water took the weight off a growing belly.

TRIMESTER 3:

We booked a babymoon holiday early in my third trimester to Byron Bay and QLD (it ended up being cut a little short thanks to lockdowns again). It was such a beautiful restful time, enjoying and celebrating our last months together before we welcomed our baby boy into the world. It gave me the opportunity to relax and unwind and start to slow down which I was finding my body was craving.

By around 32 weeks I was finding working part time plus in my business really tiring especially as I was working evenings. I had every intention to continue this until 38 weeks against the advice of both my midwife and husband, but ended my part time job at 34 weeks and just continued working in my business until due date. As much as I love work and could have pushed through, I really wanted to honour how I was feeling and energetically and emotionally I wanted to turn inward a little, slow down and prepare my body and mind for childbirth. I began “preparing” for birth by also listening to birth stories on podcasts (Australian Birth Stories and Positive Birth Australia), talking to mama family and friends, and I read a beautiful book called ‘Birth from Within’ by Pam England. I also had an Energy Therapy session with Steph Warburton to release an energy and emotions before childbirth and mama-hood.

Training wise, I still felt great and continued swimming and weight training, modified to be safe for pregnancy and reducing the weights to around 50-60% of my usual. I decided to stop training at 38 weeks and just continue walking daily. The aim was to allow my muscles to relax and avoid injury due to the high levels of the hormones relaxin and progesterone which loosen the ligaments and joints, particularly around the pelvis area. I didn’t experience any low back or pelvic girdle pain (so common in pregnancy) until around week 38 after going on a long walk. I found from then on I could only walk max 30 minutes a day to avoid any pain, but otherwise felt physically really good with a huge belly!

Nutrition wise I continued to eat the same with another slight increase in calories. I didn’t actually track my calories, simply added an extra snack in or had slightly larger meal portions depending on my hunger levels. From the 3rd trimester, our body requires an extra approx. 450 calories (an additional small meal, or 2 small snacks, or larger meal portion sizes) per day compared to pre pregnancy as this is when the baby lays down its energy stores by gaining weight in preparation for birth. I never worried about how much weight I would gain in pregnancy but instead focused on eating as well as I could, listening to my body’s needs and trusting my body. In the end I put on about 12kgs. I really do feel for me that keeping active and eating well throughout pregnancy helped me to feel great.

In the final month I started prepping freezer friendly meals and snacks for postpartum. I shared this including some freezer friendly meal ideas over on Instagram here as well as provide my mama-to-be clients with a mini eBook of postpartum recipes.

CAFFEINE & PREGNANCY:

Prior to falling pregnant I had reduced my coffee intake to 1 per day most of the time, and continued to have no more than 1 per day during pregnancy. Research suggests over consumption of caffeine may lead to delayed conception, increased risk of miscarriage, low birth weight and preterm births.

The current guidelines in Australia recommend pregnant women reduce their caffeine intake to max 200mg daily. This is the equivalent of 1-2 cups of coffee (single shot espresso ranges from 70-145mg - keep in mind some cafes serve a double shot in a regular coffee; 1 tsp instant coffee approx. 60-80mg), or 2 mugs of tea. Chocolate also contains caffeine, ranging from approx. 10mg per 50g milk chocolate, and 40mg per 50g dark chocolate. Something to keep in mind is that clearance of caffeine slows in pregnancy, taking 1.5-3.5x longer to completely clear from the body.

SUPPLEMENTS:

I often get asked about supplements I took during pregnancy and what I recommend, so I’ll share what I was taking (I don’t have any affiliation with brands, just sharing general nutrients/supplements here). Although I will say I recommend working with a qualified healthcare practitioner that understands pregnancy supplementation requirements and can prescribe you what is going to be best suited to you. I recommend starting supplementation at least 3 months prior to conceiving where possible, or as soon as possible.

Natal multivitamin - I started my natal multivitamin about 6 months prior to falling pregnant, and took this throughout pregnancy and postpartum. Natal multivitamins contain folic acid or folate, crucial role in the development of the neural tube, DNA synthesis and cell development, whilst deficiency can increase the risk of preeclampsia in pregnancy. Different forms of supplemental folate are available and this is worth discussing with a qualified Nutritionist as some forms are not tolerated by those with MTHFR gene variations. I opted for these high quality practitioner products as they contain nutrients in bioavailable forms and at preferable levels compared to some over the counter brands (which may increase nausea and digestive discomfort in a lot of women).

Choline - My natal vitamin also contained some of the required choline, which is missing in most over-the-counter supplements. Choline is essential for neural tube development and higher intakes have been shown to improve cognitive function in babies as well as placenta function – reducing inflammation and improving transport of nutrients across the placenta. Eggs are a great source of choline, so I recommend eating them throughout pregnancy (fully cooked through).

Omega-3 fish oils/DHA - I opted for a fish oil with higher levels of DHA which is essential for brain and eye development, as well as reduces the risk of preterm birth, and peri and postnatal depression in mothers. I recommend a quality fish oil from trusted brands that test for mercury. Also store your fish oils in the fridge to avoid the oils being heat or light damaged and going rancid.

Vitamin D - I also took vitamin D to maintain my levels and keep up with the higher requirements during pregnancy. Vitamin D plays one of the most varied roles including metabolism, inflammation, immune function, bone development, and gene expression (meaning it can switch on and off genes). Low levels of vitamin D during pregnancy is also associated with pregnancy complications such as preeclampsia and gestational diabetes. I tested my levels prior to and during pregnancy to ensure my vitamin D levels and adjusted my dose accordingly.

Iron - I held off on taking an iron supplementation until mid-way through my second trimester as my levels were optimal. I took an iron that included the co-factors for red blood cell production to avoid anaemia. However I find the majority of women have low iron stores leading into pregnancy and require supplementation much earlier to avoid iron deficiency anaemia. Iron requirements increase significantly during the second half of pregnancy to 27mg per day, which is difficult to achieve through the diet. By the 2nd and 3rd trimester, stored iron (ferritin) declines rapidly both from the increase in blood volume and transfer to the placenta. Iron should be taken at least 2 hours away from coffee or tea and these inhibit absorption.

Zinc - I tested my zinc levels and opted for additional zinc supplementation in the final trimester as my levels were borderline low. Zinc deficiency can impair immunity, prolong labour, increase the risk of preterm and post term births, postpartum haemorrhage, low birth weight and pregnancy induced hypertension. Zinc and iron should be taken at least 2 hours apart as they compete for absorption.

Probiotics - There is evidence that specific strains of probiotics taken in the 3rd trimester and during breastfeeding reduce the risk of mastitis, colic, asthma and allergies in newborns and may even improve infant behaviour. I opted to take a probiotic during the final trimester and postpartum which was strain specific for infant as well as for a healthy vaginal microbiome. I also included prebiotic and probiotic foods to maintain optimal gut health during pregnancy.

Magnesium - Magnesium promotes relaxation, improves sleep, reduces stress, and improves stress tolerance. It is also essential for carbohydrate metabolism and insulin sensitivity, which is important in pregnancy as naturally we become more insulin resistant during pregnancy so that the body has more circulating glucose available for the placenta. Magnesium is a supplement I take consistently and continued this throughout pregnancy and postpartum.

I hope you found this information and hearing about my experience helpful or insightful in some way. Remember that every single pregnancy is different (I’m trying not to have expectations for the next one as who knows what it will be like!) If you have any questions about my experience or any information I shared, please feel free to reach out at [email protected]

Tris x