Hold on to your cupcakes, big pregnant girls. A study that says fat women who gain little or no weight during pregnancy have better births is coming to an OB near you.
As if standing on the scale at each appointment isn’t tense enough, now the biggest of women will have to sit through a weight-loss lecture while suffering first-trimester nausea. Ugh.
A new study looked at 120,000 birth certificates in Missouri and divided obese moms into three categories from heavy to heaviest. In the least-heavy group, outcomes were best when the moms gained between 10 and 25 pounds. The middle group did best gaining zero to 10 pounds. The heaviest did best if they lost weight from conception to birth.
But what does “best outcomes” mean?
Well, when the least-heavy obese women lost weight, or when the heaviest obese women gained weight, they were found to have an increased risk of low birth-weight babies. Good to know. When the obese women gained little or no weight, or lost weight, they were shown to be at a lower risk for developing high blood pressure. Great.
All these obese women who gained/lost “optimally” also had a lower risk for delivery by cesarean section, the study concludes. Hmmm. This is where we need more information.
I’m sure the report is an accurate description of what happened – that the obese women in the study who gained too many pounds underwent more c-sections. The evidence I would like to see, though, is whether those c-sections were actually required. Overweight and obese women have long claimed there is a bias against them the medical community and that many doctors assume from the beginning that they will need a c-section. There is also some evidence that obese women have slightly longer labors, which might be another reason they wind up in surgery at almost twice the rate as the general pregnant population.
I can accept that there are increased health risks for overweight and obese people, particularly for hypertension and diabetes. But I also recognize the Western world equates right-sized bodies (especially those of women) with a sense of control and strength and priority that bumps up against a person’s morality. The last thing we want, especially from our mothers, is any hint of a loss of control, vulnerability, or moral weakness.
Doctors and nurses are people too, and any prejudices they may have against fat people outside of work get taken into work with them too. So was a vaginal delivery an obese Missouri mom’s reward for losing weight instead of gaining it? Was a c-section her fat friend’s punishment for letting herself go even more? If lower c-section rates are an argument for new weight-gain guidelines, I'd like to see strong arguments for sending the obese women into the OR in the first place. Being fat isn't a medical indication for c-section.
In my civilian life, I fall in the normal to just the other side of overweight gray area of the BMI charts. On my two tours of pregnancy duty, I gained more than 40 pounds, an amount the recommendations coming out of this study reserves only for the bird-boned and lithe (which I am not -- I am all muscle mass and excess emotional baggage). Neither of my caregivers showed concern during any of my weigh-ins and I felt good during all nine months both times. I can’t imagine being told to limit my weight gain to 15 or even 25 pounds, especially before taking my blood pressure and questioning my level of physical activity. I think I gained 15 pounds the minute I conceived.
How much did you or your partner gain during pregnancy? Anybody feel harassed by a doctor or midwife over weight gain or about being fat to begin with? Can you imagine anything more frustrating than being told to lose weight during pregnancy, especially if you’re feeling pretty good (and hungry)?
