Monday, June 23, 2008

High Cholesterol Equals Cesareans in Fat Women?

Ah, medicine. Want to hear the latest excuse for the high c-section rate in fat women?

It's because we all have high cholesterol, dontcha know, and high cholesterol might impede the ability of the uterus to contract efficiently!! So therefore, let's give all fat women statin drugs in pregnancy and that'll lower the c-section rate!!

I swear, ya just can't make these things up.

This was based on a couple of studies recently that supposedly found that obese women's uteri "have poorer contractility." The researchers concluded that this may be why labor in obese women went slower and they had more cesareans. They hypothesized that high cholesterol levels might impede the contractility and that might be why the cesarean rate in women of size is higher.

Oh puleeeeeze. This is ridiculous and objectionable on SO many levels.

First of all, all fat women do NOT have high cholesterol at all. The fact that they assume we all do is symbolic of the usual assumptions researchers make about obesity and fat people, and how it impacts their ability to reach reasonable and sound conclusions. Some do, some don't. Especially during childbearing years, many fat women have perfectly normal cholesterol levels.

Second, did they do any studies to see if the fat women who delivered vaginally had better cholesterol levels than the ones who had cesareans? Did they study thin women with high cholesterol and see if they had more cesareans or slower labors? Nope. As always, it's all just based on ASSUMPTIONS about fat people and not on any real detailed study or logical questioning of their theories.

And of course, they are already pre-marketing this idea to the media aggressively without having yet proven their case or the safety of their proposed solution. Disgraceful.

Third, please note that the part of the study done on fat women's uteri, showing "poor contractility," was done on women having planned cesareans with no labor. How again does this prove how they might have labored in real life? They took samples of the uteri before labor even started, and then did some lab tests on them, testing "contractility" in the lab.

Sorry, this is hardly indicative of real-life labor and birth, and since they did pre-emptive cesareans on these women whose samples were tested, how can they prove that these in vitro "contractility" tests really have any relationship to how labor would have gone had these women been allowed to go into labor? There is just no way that this proves conclusively that there is something wrong with fat women's uteri.

Furthermore, they did not look for any other causes. Studies show that fat women tend to have longer menstrual cycles and longer pregnancies. IF the study indeed were able to reliably show poorer contractility in obese women's uteri (and IF they were able to then show that this were reliably predictive of how they might do in labor), it might simply show that their uteri were just not ripe and ready for labor yet, not an underlying defect in ability to contract.

Remember, planned cesareans like the ones in this study are usually done at 38 or 39 weeks, and if the obese group would normally tend to go into spontaneous labor closer to 42 or more weeks, doing such an early cesarean would not reliably show whether their uteri were "less contractile." Rather, it would suggest that these obese women were simply not even close to spontaneous labor yet and therefore less responsive to stimulants.

Finally and MOST importantly, the spate of news stories recently about this dubious study and follow-ups suggesting that perhaps putting fat pregnant women on statins might lower their cesarean rate were just plain irresponsible.

Statins are CONTRAINDICATED in pregnancy; they are category "X" and may cause birth defects. Cholesterol and lipids play a very important role in fetal development. There is a reason why a pregnant woman's cholesterol rises during pregnancy; the baby needs it for development. Artificially lowering these levels may have devastating effects on the baby.

Critics would respond that they are "only" suggesting putting fat women on statins in the last few weeks or so of pregnancy, so therefore there would be no risk of birth defects. But if these drugs can be so dangerous in early pregnancy, who knows what kind of harm they might cause late in pregnancy as well? There are other harms that can be caused to babies besides birth defects during organogenesis.

No one knows for sure what critical roles cholesterol and lipids play during late pregnancy. Pregnant women's cholesterol levels rise through pregnancy, suggesting that it has an important biological role even in the end of pregnancy. Putting women on statins at the end of pregnancy may be just as harmful as at the beginning of pregnancy, just perhaps with more subtle problems than birth defects.

What it boils down to is that they are proposing using fat women's babies as lab rats to experiment on. This is UNACCEPTABLE.

There is completely insufficient evidence to support that high cholesterol is the "cause" of the high cesarean rate in fat women, and the safety of statins in pregnancy at ANY stage is highly questionable. To suggest treatment with statins for anyone during any stage of pregnancy is completely speculative and based on BAD science.

Furthermore, to be running stories in the media even suggesting statin use in fat pregnant women at this point in the research is highly irresponsible. It smacks of a few researchers looking for a "hook" to gain name recognition and funding for research, rather than serious and responsible scientists pursuing a legitimate investigation.

You can read more about the story in much more detail at Sandy's Junkfood Science site here. She does an excellent job of dissecting the original studies and their conclusions, and of showing just how important cholesterol can be to fetal development.

It is time for researchers to stop jumping to conclusions about fat women and pregnancy, time for them to examine their own faulty assumptions about obesity and how this distorts their research, time for them to stop using fat women's babies as lab rats for their own personal theories, and time for researchers to stop prematurely "spinning" the media on preliminary research in order to get name recognition and research funding.

Shame on these researchers. SHAME. And shame on the media outlets that picked up and ran with this story without questioning it further.

1 comment:

kris said...

you know something else that scares me are all those women out there that unquestionably trust their caregivers and will just take the pills if given. and the caregivers, (i use this term loosely) who will jump on this bandwagon just b/c it's put o/ in front of them, just like they did when the AMA said homebirth should be outlawed w/o even looking at the statistics and w/o any evidence or studies to prove any of their accusations.