Fat Friday (Sunday): Fat Pregnancy in the Media

There has been a lot of media attention surrounding the negative effects of obesity on pregnancy this week. First, an article came out from the Daily Mirror about a study that was done out of King’s College London. That led to an article about low birth weights from fat mums in the Times and in the Telegraph. The BBC busted out with a doozie, including a nice side bar summery of the risks obesity has newborns:

"PREGNANCY RISKS FOR OBESE WOMEN
Small babies
Large babies
Pre-eclampsia
Diabetes
Premature births
Stillbirth
Instrumental deliveries
Postpartum haemorrhage
Caesareans"

The problem with studies, and the articles that are spewed through out the media once they are released (and especially when they come with a press release as part of their scientific publication), is that headlines are read and that is all. The Daily Mirror is a tabloid magazine. They publish articles with titles such as “Deathly Peril to Fat Mums”. The article states that obese mothers are at a higher risk for pre-eclampsia, premature and underweight babies. That is right… UNDERWEIGHT. Which is a much different story than the ones I have read that say fat women need to watch out because they have fat babies they can’t push out. The thing is, although this study did find these statistics, they also used women from another study that had targeted women considered a high risk for pre-eclampsia.

NHS:

“It reports results from a subgroup of women who were originally involved in another study (a randomised controlled trial) examining the effects of vitamin supplementation on risk of pre-eclampsia in women at risk of the condition.”

“To set the context for their study, the researchers report that maternal obesity carries well established risks of complications, including for gestational diabetes (high blood glucose during pregnancy), pre-eclampsia (high blood pressure during pregnancy), high birth weight babies and stillbirths.

However, it is not known how maternal obesity specifically affects women who are pregnant for the first time. In this study, the researchers were able to explore what the risk of poor pregnancy outcomes was in obese women who were pregnant for the first time.”

According to Plus Size Pregnancy they have no proof that losing weight counter acts these findings. They just assume that it will.

The big deal, in my opinion, is the fact that there was no control group for the study. These women were already high risk for pre-eclampsia and they were only compared to each other. The NHS states:

“The findings of the study are difficult to interpret because of the lack of a comparison group. In a study questioning whether obesity is a risk factor for something, it is usual to have a non-obese comparison group. Equally, in a study questioning whether first-time pregnancy in obese women is more risky than other pregnancies, it is usual to see first-time mothers compared with mothers with one or more previous pregnancies.” (highlighting added)

And then, The New York Times puts out this: Obesity During Pregnancy Linked to Infant Birth Defects

The article begins:

“Obese women are more likely to have babies with rare but serious birth defects, including spina bifida and other neural tube defects, and to a lesser degree heart anomalies, cleft palate and hydrocephaly, a new study confirms.”

Then:

“Dr. Laura Riley, medical director of labor and delivery at Massachusetts General Hospital in Boston, said she was skeptical of the findings regarding babies of overweight women. She pointed out that pre-pregnancy weight is often self-reported in studies, adding, “People lie about their weight.” If obese women underestimated their pre-pregnancy weight in their reports, they may have inadvertently been included in the category of overweight rather than obese mothers, skewing the results, she said.”

“This confirms what we know and certainly tells us the association between obesity and neural tube defects is real,” said Dr. Riley, adding that she routinely advises her obese patients to lose weight or consider bariatric surgery before becoming pregnant.”

This is where you lose me completely. It is better to consider bariatric surgury before becoming pregnant?!! What?!!

As JFS sites:

“The Mayo Clinic reported in 2000 that 20% to 25% of gastric bypass patients develop life-threatening complications, but the recent Lap-Band U.S. clinical trials done to earn FDA approval reported 89% of patients had at least one adverse event, one-third of them severe. Complications from lap bands are more likely to require surgery to correct and the bands result in so much more vomiting, they are known as “surgical-induced” bulimia among medical professionals. While many consumers believe the newer, less invasive laparoscopic bypasses and lap-band procedures (which tighten a constrictive band around the stomach to make it smaller) are safer, they merely have their own “unique set of complications,” according to surgeons Shanu N. Kothari, M.D., and Harvey J. Sugerman, M.D. writing in Healthy Weight Journal. Ulcerations and the bands eroding into the stomach can happen and usually are why the bands are not reversible or removable. A September 2003 and an August 2005 Blue Cross-Blue Shield TEC Assessment scientific review of the evidence on the newer procedures concluded they had also “not demonstrated improved net health outcomes.”

For an amazing review of some fact/ fiction on the risks of bariatric surgery check out this link. It is a short article and one that I have sent to friends pondering The Band (they got them anyway).

So yes, we know the media sensationalizes everything. Fat isn’t going to be any different. The reason why this is pertinent to me is because I am on a pregnancy forum where I belong to a sub group of fat soon-to-be mums. Each time one of these articles comes out a barrage of women freaked out that they are mutating their kid, killing their kid, going to have a fat kid, going to have a underweight kid, or their kid will be disabled all because they are fat. There are women crying and talking about the diets their doctors still have them on to lose weight while they are pregnant. Others who cry because their doctor says they won’t be able to get pregnant because they are too fat. Some write in desperation because the people performing the scans tease them when they can’t get a good angle of the baby through the fat on her belly. How many of these women are going to have more stress at the time of birth? How many are going to be worried that they are going to be judged for how well they perform? How many are going to have increased amounts of adrenaline causing a slowing of the final stages of birth and therefore increasing the need for a cesarean?

“The obesity-related medical research that gets most grant funding is that which supports the war on obesity — and that is very different from caring about fat people and supporting research devoted to improving medical care and health outcomes for the obese.” JFS