What it's Really Like...to have hypothyroidism when you are pregnant or breastfeeding
Did you know that hypothyroidism (underactive thyroid causing slow metabolism) is the most common of all thyroid disorders and affects around 6-10% of women?
Because the thyroid is responsible for secreting hormones that regulate so many crucial metabolic processes including growth and energy expenditure, there's never a time when ensuring this is in check is as important as it would be during pregnancy and post-natally.
However you'll read in this great article written by Kristy Manners (an Accredited Practicing Paediatric and Maternity Dietitian giving breastfeeding counselling support) from Growth Spectrum that it even took her some time to 'connect the dots' between what living with hypothyroidism and becoming a mum really meant for her and she has some other great learnings that we we hope sharing will help others!
You would think as a health professional (Dietitian and Paramedic) that I would have been on top of my first pregnancy. Maybe it’s because I was away from our over informative and news driven society (working in the field over in Somalia)…maybe it’s because I was an older first time mum and more relaxed about things….maybe it’s because I thought I knew all that I needed to know given that I work and specialise in mother and child health and nutrition. In any case, it wasn’t until I was about 10-13 weeks pregnant, that I “remembered” that I had hypothyroidism and joined the dots of how it could affect my unborn child if my hormones were not kept in check!
What happens to the thyroid gland during pregnancy?
For those of you who don’t know much about the complex thyroid organ, the thyroid hormones increase 50% during pregnancy, particularly in the first trimester, until the baby is able to produce their own thyroid hormones. Iodine levels are also increased 50% and can also affect thyroid function, playing an important role in the metabolism in the body. Lack of iodine in pregnancy is common and is one of the largest preventable contributors to cretinism and intellectual disability in children globally.
They say that it is extremely important during the first trimester….right…well I was nearly approaching the second trimester when I realised I hadn’t had my levels checked since before my pregnancy! So that brought on a bit of panic that I had affected the brain development of my child! As I was in a country where laboratory results were not so precise, I had to do my own readjustment to compensate for the increased need for thyroxine by my baby (please don’t follow me though…always monitor it with your doctor!). Two and half years post partum…I must have done something alright as we have a perfectly healthy child ;)
However, during my pregnancy, despite being fit and doing a significant amount of exercise (probably too much!), I managed to put on 18kg during the pregnancy. Looking back on things now, I wish I had monitored my thyroxine levels a lot more closely, and if anything, tried to push them to the upper normal limits, as this could have affected my weight gain and perhaps the birth weight of my large 4.1kg baby. As a result, I had a long and complicated labour, resulting in a number of prolapse/incontinence/infection issues. This probably didn’t help my start to breastfeeding – the stress, the infection, not having skin to skin in the first hour due to being taken to NICU for short while, him having jaundice and under UV lights for 5 days – therefore limiting skin to skin time……but again it wasn’t until I started studying to become a lactation consultant that the light bulb moment came on again about my thyroid and the impact it can have on breastmilk supply.
How hypothyriodism can affect breastfeeding
I succumbed to the vicious cycle of formula top ups with breastfeeding as my child was not gaining weight nor getting over his jaundice very quickly. I was breastfeeding and expressing up to 1hr -1.5hrs each feed, started on motilium and taking fenugreek like it was no tomorrow. Again another light bulb moment in my lactation consulting study was that fenugreek can actually have the opposite effect in those suffering with hypothyroidism….but by then my child was nearly 2yrs old and I’d stopped breastfeeding at around 10 mths post partum, something that I had wanted to continue for longer. It was definitely a lot of …..”if only I knew moments”. If we are blessed to have another child, as most mums, I want things to be different in my breastfeeding journey.
These are some of the things I would look at:
- To check I’m getting enough iodine and selenium as pregnancy and thyroid conditions could affect levels during pregnancy but also postpartum thyroid levels which may impact breastfeeding (see a Maternal/Women’s Health Dietitian for this)
- Have a full thyroid panel blood test done regularly ie. monthly (TSH, Total T4, Free T4, Free T3, Reverse T3, Thyroid antibodies)
- Start expressing milk in pregnancy after week 36 to make sure I had some colostrum ready in case my child had jaundice again or some other issue taking them away from me for treatment
- Consider milk banks or donor milk and store some milk
- Do as much skin to skin as possible…go naked if I have to!
- Demand feed and not stick to scheduled feeds
- Invest in a double electric hospital grade pump and a hand pump as some mums express more with different methods
- Consult an IBCLC lactation consultant for latch and feeding issues
- Consider what herbal treatments may affect my thyroid (see a functional medicine/naturopath)
- Try Yummy Mummy’s biscuits and teas!