Well, here’s some research that can’t possibly be misconstrued: a new study published in The Lancet has documented an association between the amount of weight a mother gains during her pregnancy and the birth weight of her infant. Since birth weight can be used to predict adult BMI, cue the ZOMG! Obesity! commentary. “For babies, studies are just now beginning to show that the effects of tipping the scales at birth may linger throughout life. Many experts suggest that excessive nutrition in pregnancy creates an abnormal uterine environment that permanently changes the baby’s brain, pancreas, fat tissue and other biological systems, said a co-author of the study, Dr. David Ludwig.”
(A note: some of what follows may be triggering for people who have experiences with eating disorders.)
And, of course, since the womb is a baby’s first environment, this is one more thing that pregnant women can be policed on. “As more and more Americans struggle with obesity, the role of early prevention is key [and] early prevention may also extend to the development of the fetus,” said Dr. Jennifer Wu, an obstetrician/gynecologist. William Callaghan, acting chief of the maternal and infant health branch of the CDC added The Lancet paper “just adds more fuel to the fire that [managing weight gain] is an absolutely critical part of preconception care and prenatal care.” Of course, the doctors both go on to mention the importance of good nutrition and and exercise, serving once again to conflate weight with health.
When I was pregnant with A, I became highly attuned to the ever growing list of things I was and was not supposed to be doing. There were the obvious things (drinking alcohol, smoking cigarettes, using various controlled substances), and the less obvious things (not eating cold cuts). But the list went on and on and on. Restrictions on fish, cheese, processed foods, sprouts, spinach, caffeine, sugar substitutes, hot tubs, any activity where I might fall down, sleeping position, you name it. And every time I casually mentioned that I would give anything for a blue cheese burger and a beer, I would get a very stern “But the baby! You don’t want to risk it!” response.
I see a role here for practitioners to engage with their patients about eating habits, in no small part because pregnancy is enormously taxing on your body and it’s good to make sure you’re getting enough vitamins and drinking enough water. (I’m actually surprised that this isn’t already a part of what practitioners talk about with patients.) However, I do not recommend the strategy one of the midwives took with me early on in my pregnancy, which was to lecture me about my BMI and losing weight. (Keep in mind here that I’m on active duty: my job requires working out 5 days a week, passing regular fitness assessments, and maintaining either a specified weight or body fat percentage.) Ultimately, I gained very little weight during my pregnancy, and lost it all rapidly after delivery owing to some truly horrific medical complications from the delivery. When my daughter was two weeks old, I went back in for follow up and mentioned that I was really worried about how much weight I’d lost. In two weeks, I’d lost all of the weight I gained during the pregnancy plus another 10 pounds. The doctor laughed. “Oh, women don’t normally worry that they’ve lost weight after a pregnancy.” I glared. “I don’t care about that. I’m asking because I am worried. Losing thirty pounds in two weeks isn’t normal, even if you’ve just had a baby.” “Oh, well, I think you’re fine from a health point of view, but let us know if you keep losing weight. You’re really lucky.” In case anyone was wondering, being hospitalized for eight days and having hideous medical complications makes a girl feel really lucky that at least she lost weight.
I’ve got concerns about two different ways this could go. First, there’s even more pressure on women than there was before about losing weight, dieting, and the moralizing and guilt that follows. It’ll just be amplified when it comes to pregnancy: “Well, it’s fine if you want to be selfish and overweight, but think of your baby! Dooming a child to a life of being overweight!” We already live in a world where the word policed doesn’t just mean social pressure and stigma for some women for conduct during pregnancy: it means criminal prosecution. This has the potential to become just one more thing where pregnant women are judged, shamed, and guilted about not providing a perfect uterine environment. (As though there is such a thing and that women are able to control it like that. Environmental exposures, anyone?)
The study’s authors conclude “In view of the apparent association between birthweight and adult weight, obesity prevention efforts targeted at women during pregnancy might be beneficial for offspring.” Well, yes, it might, if done in a way that’s constructive, understanding of the fact that significant and sustained weight loss is not a realistic goal, and focuses on good eating habits as part of a healthy pregnancy. But I’m not particularly optimistic that’s how it’ll shake down. You’re likely to wind up with people saying truly asinine things like “The idea that a big baby is a healthy baby, and a crying baby is probably a hungry baby who should be fed, are things we really need to rethink,” Dr. Birch said. Spoken like someone who’s never had an infant.
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