Recurrent Miscarriages?

JBaker110

12 Posts
Reply Posted on: May 3, 2012 at 10:57am
Dr. Braverman,
I just recently had a late miscarriage on 4/16/2012 at 16 weeks, however, the baby measured via ultrasound around 14.5 weeks. This is my third miscarriage in 14 months. The first one was in January 2011 and the second was August 2011. I have had two live births; 2004 and 2008 (both girls and same father). I have PCOS with the only symptoms being overweight, 35-42 day cycles and polycystic ovaries on ultrasound. I presently take metformin and did during the first trimester of this last miscarriage (4/16/2012) and also took it in 2008 with my second daughter. I DID NOT take metformin with my 2011 miscarriages, which both ended prior to the 6 weeks mark and neither time was a heartbeat detected. They were complete miscarriages where my 16/14.5 week miscarriage was missed. I feel pretty confident that the PCOS is related to the early miscarriages. Where I am puzzled, is could PCOS been the culprit of the 14.5 week miscarriage? I stopped taking metformin (and baby aspirin) during the first trimester and then weeks later the miscarriage happened. Any suggestion on what tests should be taken to find out the cause? Or is it possible that this most recent miscarriage was a fluke? I did also have chromosome blood work done during this past pregnancy prior to the miscarriage and it all came back normal.
Jill Baker

Dr. Braverman

2027 Posts
RE: Recurrent Miscarriages? Posted on: May 3, 2012 at 11:11am
I think the losses were PCOS related but not due to your stopping the metormin once pregnant. There are most likely inflammatory or thrombophilic issues associated with the PCOS that need to be discovered and treated that should solve this problem. I would be happy to assist you with this. Feel free to call my office and schedule a consult with me.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

JBaker110

12 Posts
Reply RE: Recurrent Miscarriages? Posted on: May 3, 2012 at 2:40pm
What would the PCOS related inflammatory issues consist of? Infection?
Jill Baker

Dr. Braverman

2027 Posts
RE: Recurrent Miscarriages? Posted on: May 3, 2012 at 2:52pm
higher glucose breaks down to glycodan that can increase production of TNF from T cells, can also activate the clotting system through PAI-1 activation. No its not from infection but the immune system responds as if there were one.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

JBaker110

12 Posts
Reply RE: Recurrent Miscarriages? Posted on: May 3, 2012 at 3:30pm
So, it could be related to the insulin resistance portion of PCOS?
Jill Baker

Dr. Braverman

2027 Posts
RE: Recurrent Miscarriages? Posted on: May 3, 2012 at 9:31pm
yes that is usually the reason patients with PCOS end up seeing me.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.

JBaker110

12 Posts
Reply RE: Recurrent Miscarriages? Posted on: May 9, 2012 at 2:10pm
Is there a particular PCOS diet that you recommend for PCOS patients?
Jill Baker

Dr. Braverman

2027 Posts
RE: Recurrent Miscarriages? Posted on: May 11, 2012 at 7:03am
I refer my patients to this websie which is an excellent source to guide our PCOS patents with their diets. This is from living strong.


Moderate Carbohydrate Intake

Because of the underlying insulin resistance, a traditional low-fat, high-carbohydrate diet is definitely not the best approach with PCOS. The optimal carbohydrate intake needs to be individualized. Dr. Walter Futterweit, clinical professor of the Division of Endocrinology of the Mount Sinai School of Medicine, has been working with women with PCOS for over 25 years. He recommends a carbohydrate intake corresponding to 50 percent of the calories in women at a healthy weight, or 225 g for an 1,800-calorie diet, while women with weight problems should restrict their carbohydrates to 40 percent or less of their daily calories, or 150 to 180 g or less for a 1,500- to 1,800-calorie diet, respectively. The daily carbohydrate intake should never be lower than 40 g to prevent ketosis.Diabetes Food Chart Healthy diets and tips. Find diabetes food chart.BestHealthDiets.comSponsored LinksLow-Glycemic Carbohydrates

In addition to controlling carbohydrate intake, choosing high-quality carbohydrates is recommended in order to lower the levels of insulin. Low-glycemic-index carbohydrates are the best option. Since they are digested more slowly, they are released at a slower rate into the bloodstream and do not overstimulate insulin production. Legumes such as beans and lentils, nonstarchy vegetables, sweet potatoes, most fruits, stone-ground or sourdough bread, basmati rice, barley, oatmeal, quinoa and bulgur all have a low glycemic index and are therefore good foods to include in a PCOS diet.

Protein with Carbohydrates

To further reduce the impact of carbohydrate-containing foods on the insulin secretion, avoid eating carbohydrates on their own. It is better to pair carbohydrates with a source of protein, as recommended by dietitian Carol Brannon. For example, carbohydrate-rich foods such as fruits, crackers or bread could be paired with a protein source such as peanut butter, cheese or lean meat.

Healthy Fats

Saturated and trans fats are not good for patients with PCOS, as they contribute to insulin resistance. Instead, unsaturated fats, monounsaturated and omega-3 fats in particular, are recommended. These include olive oil, canola oil, nonhydrogenated margarine, nuts and seeds, nut butter, fish and flax seeds. These healthy fats improve the sensitivity of the body to insulin, in addition to optimizing blood cholesterol levels, which is especially important considering the higher risk of developing cardiovascular diseases in women with PCOS.

Healthy Weight

PCOS is characterized by insulin resistance. To compensate, the pancreas tries to secrete more and more insulin, which results in high levels of insulin, called hyperinsulinemia, in most women affected with PCOS. High concentrations of insulin promote fat storage, which explains why 60 percent of women with PCOS are overweight or obese, according to Pcosupport.org. Obgyn.net reports that a 5 percent weight loss can significantly improve PCOS-related symptoms and can be achieved by following a moderate-carbohydrate diet and reducing portion sizes.
Read more: http://www.livestrong.com/article/199992-recommended-diet-for-pcos/#ixzz1uZMM01eI
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.