Pregnancy weight gains, midwives, and nutrition
What do you think of the new suggestions that women who begin pregnancy obese gain absolutely no weight during their pregnancy?
As the article about this, linked above, points out, “[r]estrictions on weight in pregnancy are nothing new: throughout the 19th century and much of the 20th century, women were told to gain less than 20 pounds to reduce the risk of complications and Caesarean deliveries. The guidelines were relaxed in the 1970s and ’80s as Caesareans became safer and the risks to underweight babies were discovered. Rising rates of obesity are now leading experts to question that wisdom.”
Well, right away I’m not liking the way this entire subject smacks of paternalism on the part of the medical community. “The guidelines were relaxed”–really? Phew! Thank you, doctors! I think the whole subject of how much weight a woman “should” gain during pregnancy is a crazy one. Yes, my midwife in a very relaxed way asked me to weigh myself quasi-regularly–mainly because, she explained, a sudden gain of multiple pounds in a week or even less might signal a dangerous amount of fluid retention. But weight is clearly not the only–or even the primary–thing that should be tracked during prenatal care, and with the amount of pressure on non-pregnant women for their weight–and with society’s discomfort, even now, with a mother’s natural curves–I think the entire subject is fraught with problems.
Here’s another thing, though: The new study which encourages women to gain no weight is called Healthy Moms, and “[w]omen enrolled in the Healthy Moms trial will meet privately twice with a dietitian and participate in weekly support groups led by weight management specialists. They will be encouraged to follow a plan for eating low-fat food that emphasizes fruits, vegetables, whole grains, lean meat and low-fat dairy products.” Know what? That sounds a lot like good common sense, and a lot like the standard advice midwives give women. Midwives typically offer far more continuity of care, preventative care, and nutritional counseling than do OBs during prenatal visits, after all. Fruits, vegetables, whole grains, and good sources of protein are commonly recommended by midwives and should be the basis of all pregnant women’s diets–regardless of whether they’re trying to not gain weight, gain only a recommended amount of weight, control so-called gestational diabetes, or just be healthy for themselves and their babies!
Furthermore, the suggested guidelines in this case are potentially hazardous–and that “potentially” really is the issue. Basically, doctors don’t know what happens when overweight women gain no weight during pregnancy: “But the implications of severely restricting weight are not entirely known. [. . . . T]here are concerns. The major one is that women who are not gaining weight will burn fat for energy, producing acidic compounds called ketones, which could be harmful to the fetus. Studies in diabetic women and in animals have found that babies born to women who had more ketones in their blood had lower I.Q. scores than other babies.”
Really? Fabulous! Sounds great! Sign me up in the name of science! Well, the article continues: “What we don’t know is: Are there effects on the babies’ neurological development, or other adverse effects, from women not gaining weight?” Dr. Stotland said. “Some of these women may be losing fat mass, and the question is: Is losing fat mass during pregnancy, when you’re in a higher B.M.I. category, is that safe for the baby?”
I seriously hope, for the sake of the participants and their babies, that this study finds out it is.