Friday, May 29, 2009

Yes, I've seen the new Institute of Medicine guidelines on how much weight "obese" women are supposed to gain (or more accurately, not gain) during pregnancy. (See Yahoo "health" news.) Wanted to reassure you all that I will be commenting on it soon.

But first I have to put top priority on some mom stuff, some end-of-the-school-year activities and big events that need my more immediate attention, and then I'll get to this. Sometimes blogging has to take a back seat to real life, but wanted to reassure you that I'm aware of this story and have plans to discuss it.

In the meantime, feel free to talk among yourselves about the new guidelines. What do you think of them, how do they make you feel, what are your concerns, are they realistic, what do you think the practical application of the guidelines will be in clinical practice?

I'll publish comments frequently until I have time to blog more fully about this, but in the meantime, let's start some dialogue on the topic.

What do you think about the new IOM guidelines?

20 comments:

MJK said...

Love how they use the old "packing on the pounds" cliche. *sigh*

And of course part of it is their definitions of "overweight" and "obese." When I got pregnant I was at the weight I've been for the last two years, fairly stable, what I consider to be the right weight for me - but the holy BMI charts would put me firmly at overweight.
At 36 weeks pregnant I'm on track for about a 35 lb weight gain. As far as I'm concerned that means I've done it exactly the way I was supposed to.
And can I say that if you practice intuitive eating it's pretty darn easy to tell when you're not eating properly? I've been getting lazy these last few weeks and my protein consumption had dropped down from what it had been. Boy did I notice. And if I don't remember my calcium supplements my leg cramps start to get crazy.

jamiesnyder said...

While I'm sure there need to be some "standards" for weight gain during pregnancy, such as recording weight gain and keeping track of it because rapid weight gain can be just as damaging as rapid weight loss.
What I do NOT agree with, however, is the article's underlying tone on how many overweight/obese women are being "noncompliant."

Carolyn said...

Riiiiiggghttt. . . .we just need to be "educated". Has science done any studies on the affect it has on babies to be born to mothers who dieted down to their ideal weight before conceiving?

Anonymous said...

What a load of statistical crap. Weight loss in general is hard enough, if not impossible and during pregnancy all bets are off. Our bodies know what we want and need. I actually had a net loss during pregnancy but quickly went back to my normal weight.

I do think women should be weighed early in pregnancy to make sure they are not loosing weight. Weight loss due to nausea or other problems can have devastating consequences and it does need to be addressed.

I found the "teachable moment" idea to be pedantic, patronizing and just plain stupid. Do they think any person in America who is not living in a cave has not heard about the "obesity crisis"? Do they not realize that normal, under and over weight women have been on many diets and feel the pressure to be thin? What do they expect to happen during that teachable moment? Do they really think a woman will thank them? Will the woman say.."Thanks so much, I have not heard in the media about all the awful things associated with obesity. As an American woman, I have felt nothing but happiness and confidence with my body. Although I enjoy being overweight and know my body is idealized and loved by all, I will immediately go on a diet and loose weight because the health establishment has advised me that diets are easy and have long lasting results."

Did this person take a stupid pill or is she that out of touch with reality?

JennyRose

Shotgun Mary said...

I was absolutely horrified. Every single thing you read tells you not to restrict calories during pregnancy, but thats exactly what these new guidelines suggest. I want to see the data that says that sort of restriction is a)healthy for mom and baby and b) improves non-iatrogenic outcomes. That thin people have less c-sections has very little to do with their physical condition and more to do with the fact that doctors just section them less often.

I am considered "obese" by national guidelines. Nevermind all of the BMI silliness and that I'm physically fit. During my recent pregnancy I gained 30 lbs-ish, which is now over the limit. If I would have had my baby in a hospital #1 I would have been considered a higher risk for having a c-section (that burns me anyhow, a c-section isn't an accident or organic event, they're handed out to you) #2, having gained the weight I did there would have been concern about a big baby #3, my rise in blood pressure, even in the absence of any other indicators of pathology, would have certainly earned me an early induction. Thankfully, I had my baby at home and at 40w2d I gave birth without any medical intervention to a 6lb 5oz baby girl. She would have been nicu material if she would have been forced out earlier. I am tired of all of these seemingly arbitrary guidelines based off of "C" grade evidence that are driving women to the operating room in droves. It has to stop.

Anonymous said...

My name is Zenneia McLendon and I work for The National Academies. I noticed your interest in the National Academies recent report, “Weight Gain During Pregnancy: Reexamining the Guidelines”. This report responds to the need for a reexamination of the 1990 Institute of Medicine guidelines for weight gain during pregnancy. We are delighted that you will be informing your readers of this report and we wanted to inform you that the report is available to read and download for free online at http://bit.ly/preg. As followers of Well Rounded Mama, we know that your readers are interested in topics related to motherhood and women’s health we believe that this publication would be of interest to them.

We also have a widget available for this report for you to post on your site, the widget will give your visitors direct access to our resources; to grab the widget go to http://bit.ly/preg2 and copy the code snippet in the box.

I hope you and your readers find these resources useful. Feel free to contact me with any questions or concerns.

Best,
Zenneia McLendon
Online Outreach & Promotions Specialist

Jen Anderson said...

Well, first I hurt my eyes from rolling them so much when I read that the average pregnant woman is gaining FIVE WHOLE POUNDS over the recommendations. 'Scuse me while I clutch my pearls and faint.

And the example they use of the woman who has only gained 2 pounds by week 24, by giving up soda is just infuriating, because anyone who gives up soda is likely to drop 10 pounds of water weight from the sodium, so that's not really a valid example.

But what really infuriates me is how they're calling this a teachable moment. I am turning 38 next week and am trying to get pregnant. Teachable moments are for children, not adults!

The new guidelines just make me even more worried that I won't be able to find a midwife or GYN in my area (and who takes my insurance) who won't harp on my weight to the exclusion of more important health issues.

Deidra said...

Wow.

That article is crap.

In my opinion, isn't the healthiest weight gain the one the body dictates? Every woman and every pregnancy is different. Studies show this, and my own observations of friends and families show this.

And, I'm really disappointing with their "example." A woman had started gaining weight for years, made no mention of going to a doctor during that whole time, only when she was pregnant. In a lot of people, weight gain is a f-ing -symptom- of developing diabetes, not a cause!! and isn't gestational diabetes usually something that doesn't come around until after the first couple of months? of course now that her diabetes is actually being treated her body isn't putting on as much weight! She'd be losing weight if she wasn't pregnant so it's evening out!

Goodness Gracious. And cutting out all beverages but water? I had a couple of friends that by the time the third trimester came around they had to drink high calorie drinks (think replacing skim milk with whole cream and some ensure) just to get enough calories to function since the baby was squishing their stomach so much they could barely eat any solids!

wellroundedtype2 said...

I don't know how women are supposed to limit their weight gain, or control it, for that matter. It seems to me that women's bodies in pregnancy do what they need to do. If they have to adjust the guidelines, why not focus on the inputs, ie intake of fruits, vegetables, fiber, water, lean protein, whole grains, rather than the output, over which none of us has much control. The comments at the NY Times Well blog (which use up too many Sanity Watchers points to be of use) include many women who say they gained lots more weight than the guidelines recommend and had healthy outcomes as well as returned to their pre-pregnancy weight.

I worry that this will result in poor care for fat women, and medium-sized women, and that more low birthweight and preterm babies will result.

And, encouraging women to lose weight prior to becoming pregnant, well, the unintended consequences of that will be increased weight gain during pregnancy (if these women eat as much as they need to for a healthy pregnancy and healthy baby), and women delaying getting pregnant so that these women will end up with fewer options (and poorer outcomes) when they do decide to become pregnant.

I hope there are practitioners who reject the guidelines, but I worry for those who do.

Brief story here: I didn't feel ready to have a baby until I was in my early 30s. I bought all the hype about how being obese (and having diabetes) was going to lead to an unhealthy baby, etc. I went to a perinatalogist who was really wonderful, reassured me that in fact a healthy pregnancy was possible at my size, with well-controlled diabetes. He said that while weighing less would be good, without losing weight I could safely get pregnant and have a healthy pregnancy.
Without him, I would never have felt confident that I could safely become pregnant. I might have delayed the decision to get pregnant "until I lost weight" -- which would have meant I wouldn't ever have had children. So this, in essence, functions as a form of sterilization of fat women.
I worry that there won't be practitioners out there like him anymore.

Lady said...

Just ONCE, I'd like to see anyone in the obstetrics field place a higher focus on proper nutrition than on weight gain in pregnancy. Just once.
My blood is boiling too much to form a more coherent thought than that right now.

Piffle said...

I think that when Moms who try to follow these guidelines end up with stillborn, premature, and underweight babies; it will be blamed on their fat, and not on their attempts to lose or not gain weight. It infuriates me that women are being given such bad information. Gah!

Sandy has some info on the protective effects of fat on babies

http://junkfoodscience.blogspot.com/2009/01/obesity-paradox-17-fat-women-and-risks.html

And another source:
http://www.ncbi.nlm.nih.gov/pubmed/12730491

And another:

http://jn.nutrition.org/cgi/content/abstract/129/5/988

Other things that occur to me off-hand:

1. Pregnancy is a risky time for getting the 'flu, and getting it badly :

http://junkfoodscience.blogspot.com/2009/01/obesity-paradox-17-fat-women-and-risks.html

Calorie restriction may also be a risk factor for getting the 'flu:

http://cr.timtyler.org/contraindications/index.php

So... they want to encourage people who are already at high risk from 'flu to increase that risk. Completely irresponsible. It irks me that the 'flu, just plain 'flu, is so underrated as a serious disease. It kills tens of thousands of people in the US every year.

2. Babies of women with very low caloric intakes (on the order needed to keep many fat people from gaining weight) also risk addiction and schizophrenia:

http://www.medicalnewstoday.com/articles/95254.php

3. Such babies also have epigenetic differences that we don't know the consequences for:

http://www.blisstree.com/geneticsandhealth/maternal-starvation-has-lasting-effect-on-fetus-dna/


And all of these outcomes, you betcha; willl be blamed on the mother's fat rather than her attempts at attaining the "recommended weight gain". We all know that many many fat women gain on as little as 1200 calories a day. It's absurd to think that to meet some arbitrary goal they'd be encouraged to restrict calories during pregnancy.

*explodes in flames*

Also, apologies for this long and link filled post. There are some real hot button issues for me...

womantowomancbe said...

I was going to say what Lady said -- what about *nutrition*, rather than just pounds or calories? I know people who can eat garbage and maintain a thin weight -- but it doesn't mean that they're healthy; and I know people who eat right and are "overweight" -- but it doesn't mean that they're unhealthy.

Also, isn't there some study that shows that calorie restriction during pregnancy is bad for the baby? And that the pregnancy diets of the 50s and 60s (which, frankly, is what this sounds like, just no diuretics to force women to gain less than 15 lb.) caused harm in their babies -- some of which may be registering as the epidemic of bad health that we have today?! Sure, babies tend to be larger now than they were a generation or two ago -- because we're eating normally, not trying to starve ourselves while growing a baby!

My sister lost weight during both of her pregnancies, because she stopped eating crap and drinking lots of soft drinks, and started eating good food. Her total weight gain in each pregnancy was about the size of each baby -- 8-9 lb. -- but that's because she lost the unhealthy eating that was causing her to pack on the pounds.

Nutrition, folks -- nutrition! JUST ONCE I'd like to see them focus on what foods and what nutrients people eat, instead of just the number of calories. You can eat a little mac-n-cheese and not gain weight, and eat tons of salad and gain weight, but that doesn't prove that enriched bleached flour with fake cheese is better for you than lettuce, carrots, etc.

Ok, gonna step off my soap box or two. :-)

-Kathy

Anonymous said...

I saw the article on Medscape and was bothered by the fact that it wasn't broken down clearly, I have an overweight friend who was NOT gaining on the 1990 schedule and probably would have fit the new standard nicely, One of the OB's was hounding her about poor weightgain but when she saw another his tack was totally different, he told her as long as she had a healthy diet he didn't care how much weight she gained.

She had a healthy big baby boy, sadly via c-section that can most likely be pinned on her failure to attend childbirth classes. (I don't know all the gory details)

The Shadow said...

This brings up such hurtful memories...

The year before I got pregnant with my son I was homeless. I went from the 205 pounds I had been at pretty steadily for years to 175. After I was housed again, I still didn't have much to eat, so I didn't gain any weight.
I got pregnant and lost 10 pounds from severe, nearly disabling nausea. I had no health care for some time because I had to navigate a horrific bureaucracy to get into the charity clinic. Then I applied for WIC because even after the horrible nausea faded I only could manage enough food for 2 meals a day. By then I had gained 15 pounds, at about 5 months along (no, I had no prenatal care for five months.)
So the WIC lady asks what I weighed before pregnancy then told me since I had already been overweight, I'd gained as much as I was allowed to gain, then looked at me expectantly as if I should agree to go four months of the baby's most rapid growth without gaining an ounce. I don't remember what I said to her but I remember she didn't like it. Then she went on to her chart of what I ought to be eating and asked how many meals I was eating a day. When I told her two, she looked surprised and asked why only two. "BECAUSE I HAVE NO MONEY FOR FOOD" I almost yelled. She looked at me like I was totally lying and I saw her write on my chart that he suspected I would be "non compliant". I went home in tears, hysterical at being told if I gained any more weight I was an evil, bad mother endangering my child.
I gained 62 pounds during my pregnancy, a good chunk of it during the last few weeks when I went overdue and swelled up from toxemia (which they let go untreated until I almost died). Then I lost 32 pounds (since it was mostly water) in the next week or so, bringing me back to... 205. Exactly what I had weighed before I became homeless.
So all that weight loss right before I got pregnant that they probably would have recommended I lose since they now say fat chicks shouldn't get pregnant? That was all I gained back. Go figure.

Anonymous said...

The whole idea of restricting weight gain for pregnant women really worries me. I was born in the late 70s, and they basically knew from the start my mom was likely to have problems due to some health issues she had, so her doctor basically told her - If you're hungry, eat. Try to make it good quality food to make sure you're getting a good range of nutrition, but EAT. Do not worry about how much you're gaining.

I honestly believe that his advice is part of why I'm here. I was born 7 and a bit weeks premature. I was tiny - but basically completely healthy. I spent exactly an hour in an incubator in the nicu before they decided I was fine and kicked me out to the normal nursery.

My mom gained about 60lb over the course of being pregnant - most of which came off again after just on it's own - if she'd limited her intake it probably would have slowed my development (since the baby can't develop if there's limited resources to grow WITH) and I really wonder if I would've had major health problems.

Obviously, this is anecdotal and hardly scientific proof, but it really does make me wonder.

Marleina said...

I'm new here, and loving it. :)

Anyway, a bunch of about dieting have shown that most diets just set your body up to think you're starving and take every bit of nutrition it can out of what you do eat. This later leads to your body reacting the same way when you stop the diet, and you gain back what you lost because your body is desperately trying to maintain what it had. SO - women who lose weight before getting pregnant most likely end up putting all that back on, PLUS what they normally would have gained.

I'm a 'well-rounded' mama myself (go figure). I started out with my first pregnancy at 268 pounds. At the end I weighed in at 286. Gain of 18 pounds, and my baby, born at 38.5 weeks, weighed in at 10 lbs 4oz. I had no gestational diabetes, boy did they prove that again and again when my ultrasounds kept showing a big baby - Oh, big baby - let's test you for gestational diabetes AGAIN even though you've passed with flying colors the last three times.... no matter than I'm 5'7" and my husband is 6'4"... no reason for that baby to be above average! I almost laughed when my 5'3" 100 lb pregnant friend who only eats whole and organic foods was discovered to have gestational diabetes... by the same office that gave me a hard time! With my next pregnancy, a midwife sent me to a diabetes clinic at 12 weeks gestation - because my previous baby had been so large. I went, and ended up following a modified gestational diabetes diet for my pregnancy - I was nursing for the first half. I gained 17 pounds. My daughter was born at 41 weeks 6 days - at 10 lbs 15 oz. Definitely lost weight that time around, too. Can you imagine if I had followed it to the letter?

I think it's really a sad state of affairs when yet again the medical profession and researchers focus on a woman's weight as the main indicator of her health. Let's forget about the percentage of issues related to 'obese' mothers in comparison to the percentage of issues in iatrogenic prematurity, maternal morbidity, cost of healthcare and effect on future pregnancies due to obstetricians (and some midwives) being induction and c-section happy. How much money is wasted in healthcare every year because most hospitals won't allow a VBAC? Do people realize that the guidelines for VBAC and Cesarean are written by the ACOG, the very people who make money from performing c-sections??

*off my soap box*
The world needs to realize that pushing this weight gain limit on women has the potential for causing way more problems with malnutrition, low birth weight, etc. than backing off and teaching nutrition = to EVERYone.

Jen Anderson said...

Just wanted to draw your attention to a relevant post on the NY Times' Well blog:
http://well.blogs.nytimes.com/2009/06/02/starving-for-twoa/?hp

sezuan said...

When I got pregnant, I was a bubbly, healthy 220 lbs. At 5"7, this made me obese, but I had excellent blood pressure, I ate very healthily, and was in all around excellent shape.

four months in, and I had lost 20+ lbs. I was nauseaous, vomiting -- it seemed that everytime I found something I could keep down -- water, smoothies ( NO solids, they hurt too much coming up), It would become a trigger and I would wind up throwing it up. It was a terrible time, and it lasted until about a month ago, when I was finally given SOME reprieve. Though I did get the (intolerable,unacceptable,downright HURTFUL) praise from aquaintances ("you look so skinny!"), I was blessed that both WIC and my OB GYN were goading me to eat-eat-eat; despite being obese. When I went into WIC, the nurse asked me how much I thought I was supposed to gain and I said "15 lbs." She tsk tsked at me and said that I needed to gain more like 25 to have a healthy baby. My doctor is more liberal, he said 30-35 was fine but that I shouldn't worry -- excellent blood pressure, good fetal heartbeat, strong kicks.

I've finally, at 22 weeks, managed to put on five lbs, and it's made me very happy.

I'm not anxious about loosing my baby weight, my delivery, or my chances at having a healthy baby because my heath care providers have made a point of making sure that I know that it's acceptable, responsible and entierly good for me, an obese woman, to gain weight.

As a twenty year old woman with her first baby, whose only experience with the
medical profession was --"I dont care how much you can run/how good your blood pressure and sugar is, your a walking death sentance!", my pregnancy has been refreshing and empowering. If these new guidelines deprive women of this experience, it would be a shame.

Tami said...

I lost 40 lbs in my most recent pregnancy, my weight after the baby was born was 40 lbs less than my pre-pregnancy weight. I ate well, I watched my blood sugar and blood pressure, and was in good shape. However, my midwife dropped me at 36 weeks because she was afriad I was going to have a big baby. She cited my "poor nutrition" as part of her reasoning, because I admitted to an occasional bowl of ice cream. (who loses 40 lbs while pigging out on junk? I sure don't!!) The baby came at 41 weeks, with a different midwife attending, weighing 9lbs, nearly 2 lbs smaller than her older sister, and my next-to-smallest baby so far. Since then my weight has been stable (despite efforts to continue losing weight--I anticipate it will be hard to lose weight until I wean this baby, then I hope it comes off a little more easily). But my pregnancy weight loss was not due to an effort to lose weight. I did watch my nutrition more carefully because I was concerned about my blood sugar and blood pressure, and I made better food choices, but I did not limit portions at all. That's just how my body reacted in this pregnancy. To force a woman to gain or not gain during pregnancy is ridiculous.

Mrs. Bee said...

Not on this subject, so please forgive me, I just found your site and man, I am ever so glad! See, I am one of those over-endowed, fat mama's. I was recently diagnosed with PCOS. I have had 3 babies, however, they are miracles more then anything as I generally do not get a period and have always been told it was cause I was fat.... I was not fat with my first and I was just a bit overweight with my 2nd. I was fat with my 3rd. My husband and I stopped trying several years ago for another cause, I just was not loosing weight. Got into a whole depression cycle... Anyways, long story short, while loosing some of this weight would be ideal, I think we might go ahead and just start trying to have us another baby. I am on 31 and he 40. Young enough to have more.....
I am sure I said more then what is needed, but just wanted to say THANK you!!!!!