SUN-170 - Got Milk?: Exploring Developmental Origins of PCOS through Human Milk Biology

Polycystic ovary syndrome (PCOS) is a common heritable reproductive endocrine disorder associated with adverse reproductive outcomes and long-term metabolic risk, including infertility and type 2 diabetes mellitus. Evidence suggests that PCOS may originate during the critical developmental windows of fetal and early postnatal life. Nutrition during infancy, particularly from human milk, plays a key role in early metabolic programming. Altered human milk composition has been reported in mothers with gestational diabetes and obesity, including higher leptin, insulin, carbohydrate, and fat content. However, little is known about human milk composition among women with PCOS or its influence on infant metabolic outcomes.

This study examined whether human milk macronutrient composition, hormone content, and lactation patterns differed between mothers with PCOS and control mothers. Human milk samples were collected from 28 mothers with PCOS and 45 control mothers and then analyzed for macronutrients (protein, carbohydrate, fat, energy), glucose, insulin, and leptin. Breastfeeding practices were assessed using validated questionnaires.

Maternal age and BMI did not differ between groups. Birth weight and sum of skinfolds at 3 months of life were similar between daughters of PCOS and control mothers. Milk from mothers with PCOS had lower total carbohydrate content (7.86±0.44 vs 8.096±0.24, g/100 mL, P=0.002), while lactose content did not differ (P=0.47). Human milk insulin concentrations were higher in mothers with PCOS compared with controls (18.93±10.98 vs 14.01±8.05, mU/L, P=0.02), as were whole-milk leptin levels (182.6±92.81 vs 129.5±48.4, ng/mL, P=0.01). Milk fat and protein content did not differ between groups. Mothers with PCOS showed a nonsignificant trend toward shorter breastfeeding sessions and longer intervals between milk expression.

Compared with controls, human milk from mothers with PCOS is characterized by lower carbohydrate but similar lactose content, suggesting differences in human milk oligosaccharides. Elevated insulin and leptin levels parallel previous findings on gestational diabetes and obesity. The metabolic significance of these differences remains unclear, as infant adiposity did not differ at 3 months of life. Ongoing analyses include measurement of steroid hormones and endocrine-disrupting chemicals as well as longitudinal assessment of infant growth and adiposity at 12 and 24 months of life.

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