Weighty Matters

Obese Women Gain Too Much Weight During Pregnancy, Study Says

Oh, Lord. Keeping up with the ACOG theme of women being too old and fat to deliver normally, this headline really chapped my hide. Yes, obesity has health risks, and ideally we'd all begin pregnancy in perfect physical form, but really, Dr. Artal, is pregnancy really one of the leading contributors to the obesity epidemic? Women should try to limit their weight gain during pregnancy because they're too lazy to lose it postpartum?

The article harps on the fact that the current guidelines for weight gain in pregnancy state that overweight women ought to gain at least 15 pounds. Considering that that would barely cover baby, amniotic fluid, and breast growth, that hardly seems excessive. I find this especially ironic considering that the obstetrical community, with few exceptions, rarely offers anything in the way of substantive nutritional guidelines to women in its care. Those that do often offer such gems as, "Eat lots of peanut butter!" (Actual quote.) I do have a client whose OB employs a dietician on his staff, and I give major props to him.

In the words of Anne Frye, "Our culture has a tremendous loathing of large, especially fat, women." Her sensible advice is that women of size should cut out junk foods and refined carbohydrates, consume plenty of high-quality protein, vegetables, and whole grains, and walk or swim daily. Doesn't that seem more reasonable?

This attention to the weight gained by obese mothers seems, to me, to be yet another example of a reductive approach to maternity care by the medical community. Instead of "how can we help this person have the healthiest pregnancy and birth possible, given factors X, Y, and Z?" we see more of a "shame the patient who dared conceive outside our guidelines!" If nothing else, it's not an attitude that is likely to win a woman (who likely already agrees that she ought to lose weight) over to the idea of weight loss goals in the postpartum period. I'm not even going to delve into the fact that a high BMI does NOT equal an unhealthy or uneducated patient -- and neither is a low BMI evidence of a healthy, active person!

The sad thing, to me, is that focusing on one part of a woman's health and taking such an alarmist attitude towards it squanders, in my opinion, an opportunity to begin a lifelong dialogue about taking steps to improve one's health, make better choices, and embrace pregnancy as a time to implement positive, permanent health improvements. Remember, folks, this is the same community that used to advise women to smoke during pregnancy to ensure a small baby...

Elizabeth's Anti-Eclampsia Salad

Pre-eclampsia (aka pre-eclamptic toxemia, toxemia, or pregnancy-induced hypertension) is a disorder of the liver and kidneys that affects around 5% of pregnant women. Signs include elevated blood pressure plus protein in the urine and fluid retention. (Elevated blood pressure by itself does not mean you have pre-eclampsia, and is actually normal at the end of pregnancy, along with swollen feet and ankles -- talk to your midwife if you're concerned.)

Left untreated, pre-eclampsia can cause severe headaches, problems with your kidneys and liver, and it can interfere with placental function. In extreme cases, it can lead to seizures, changing the diagnosis to eclampsia.

Causes and Risk Factors
The exact cause is unknown, but:

• Thinner-than-normal blood vessels in the placenta caused by an inappropriate reaction of the uterus to the placenta may be a factor.
• Pre-existing conditions such as diabetes, kidney disease, high blood pressure, being in your teens or over the age of 40 may also increase risk.
• The risk of pre-eclampsia is highest in a woman's first pregnancy, but if she is pregnant with a new partner, her chances are about the same as if it were her first pregnancy.

While its cause is up for debate, many midwives believe there is a very strong link between nutrition, especially adequate protein intake, and pre-eclampsia. The work of Dr. Tom Brewer focused on this link, and he recommended 80-100 grams of protein each day. And so, dear friends, here's a little something I started making during my first pregnancy. Salads are inherently flexible, and the ingredients listed below can load you up with as much as 40 grams of protein in a single meal -- good for you and your baby regardless of your feelings on the link between pre-eclampsia and protein.

Bon appetit!

Elizabeth's Anti-Eclampsia Salad
Mixed dark greens (mustard + Romaine is a good combo)
One hard-boiled egg, sliced or chopped
Cold chicken (preferred) or Quorn/Bocca chicken, sliced
1/3 cup low-fat cottage cheese
Dried cranberries (unsweetened)
Whichever fruits and veggies you like, such as carrots, bell peppers, tomatoes, avocado
Unsalted sunflower seeds
Walnuts
Dressing (I highly recommend walnut oil and a tasty vinegar)

Variations/Optional:
Leftover cooked quinoa, cous cous, or lentils
Orange slices (great for boosting iron absorption!)

More information, research and theories on pre-eclampsia.

Fill your belly, feed your baby: the importance of nutrition in pregnancy

What if there were a way to decrease complications of pregnancy and birth like pre-eclampsia, anemia, and hemmorhage? If you could be free of common pregnancy ailments like morning sickness, heartburn, muscle cramps, even itchy skin and swollen ankles? What if you could feel full of vitality throughout your pregnancy and beyond, helping to assure an abundant supply of breastmilk for your baby during the exhausting post-partum newborn days? And if you could do all of these things with absolutely no risks or side effects for your baby, other than being born healthy and plump? If I told you that this was as big of a factor in determining a healthy pregnancy as your genetic disposition, except that you only you can provide these healthy advantages and are in complete control of them, would you be interested? Eating well provides all of this and more for you and your baby throughout pregnancy and beyond. Yet all many care providers tell pregnant women about nutrition is “Just eat a good diet and you’ll be fine.”

Do we know what a “good diet” is? In our culture of fad diets, quick fixes and fast food, where do we find the resources to help us reap the rewards of eating for two? In our society of Western medicine, nutrition is overlooked even though it is often the most obvious solution to our health problems. We have dozens of pharmaceutical remedies for lowering cholesterol and preventing heart attacks, but how many people on these drugs could benefit just as much if not more by altering their diet and exercising? How many of us suffering from chronic pain rely on the constant use of analgesics instead of working to discover the source of our pain? In the midwifery model of care, nutrition is the foundation of a healthy pregnancy, used to prevent problems and complications of pregnancy and birth rather than attempting to treat them after they arise.

What we eat directly affects all of our body systems. Quite literally, we are what we eat. Our body is constantly rebuilding and repairing itself, and it uses the nutrients from food to do this important work. Especially in early pregnancy, what you eat directly affects the life your body is building and supporting. Growing a baby also means growing a placenta, membranes, and drastically increasing your own blood supply. This is all powered by the food you eat. Your baby needs the most iron, protein, and calcium in the last eight to twelve weeks of pregnancy, so it is never too late to improve nutritional status. Certain vitamins have been identified as playing huge roles in preventing problems for the baby, such as folic acid, which taken preconception and in early pregnancy can reduce the risk of devastating neural tube defects by as much as two thirds. Mothers who are at risk for developing hypertension benefit from calcium supplementation. These are just two examples of what scientific studies have proven to be true about nutritional remedies, and new compounds are constantly being discovered in food. A good diet could prove to have benefits we don’t even know about yet.

We do know that the days of limiting weight gain and attempting to grow small babies in hopes of easier deliveries are gone. The vast majority of modern women are unaffected by rickets, a skeletal disease which led women to have difficulties in childbirth due to misshapen pelvises. Today, we understand that women rarely grow a baby that they cannot birth, and that the pelvis is much more flexible than we once imagined. Women often imagine that it is easier to deliver a smaller baby than a large one, but the largest part of the baby, the head, varies in size only slightly between a 5 pound baby and a 10 pound one. Babies lose weight during the first few days after birth while waiting for the mother’s milk to come in, so it is imperative that they have some extra ounces to lose. Extra fat helps cushion the baby down the tight squeeze of the birth canal. Your baby is also building the store of iron she will draw upon for the first six months of life. Babies need their mothers to fill their bellies with yummy, nutritious food! Mothers also need to put on extra fat in preparation for breastfeeding. There is no need to worry about pounds gained from healthy food, these will be pounds used in producing milk.

Every pregnant woman needs a treat sometimes, and eating should be fun and pleasureable in addition to being healthy. The purpose of encouraging expectant mothers to eat well is not to create anxiety or promote analyzing every bite of food. If you're in Albuquerque and are interested in learning more about pregnancy nutrition, please join us for a class on the last Monday of every month from 6-8pm at the ABQ Birth Network, 123 Wellesley SE. Check http://www.albuquerquebirthnetwork.org/ for more details and information on other classes.