Small baby, big mommy

I had an appointment with my regular OB today, because I did not see them for my 20 week appointment.  (I went to the high-risk OB.)  I found a few things troubling.

(1)    Baby’s small.  I’ve been saying this whole time that baby’s been measuring behind, and it did not really concern me because that was how it was from the beginning, and hubby and I think I ovulated a few days later than they are measuring.  Today my OB told me that my measurements from the high-risk OB showed baby measuring in the 30^th %.  (Apparently they use a variety of measurements to come up with that estimate, including some leg measurement, head measurement, etc.)  I was like, “oh, that’s no problem, we’re probably a few days behind.”  But then she said, “yea, even though your due date is May 10, they measured as though it were May 13, and you’re STILL in the 30^th percentile.”  Yuck!  But is that even bad?  I mean, it’s not like 30% is small.  (I understand they get worried when baby is measuring below the 10^th % or when baby’s growth falls behind.)  The high-risk OB didn’t even mention it, so maybe I have no reason at all to be concerned.  After the OB told me that, though, she suggested I could have another ultrasound at 28 weeks to check growth (the same offer the high-risk OB made), so I decided to take that appointment after all.  Let’s make sure this little man is not too little.  I can always change my mind.

(2)    I am gaining too much weight.  I mean, I knew that, but a (big) part of me thought, I’m so healthy—I exercise and (generally, outside of the holidays) eat well—and my husband and I have never had any problems with weight (and we have a skinny little kid!) so NBD if I put on 5-10lbs more than the “ideal.”  I mean, if I can brag for a minute, my husband and I looked like fitness models before I got pregnant!  (And he still does.)  But Dr. said the concern is not just mom having to lose an extra 5-10lbs after baby—some studies suggest that if mom gains too much weight it puts her baby at risk for obesity in later life.  UGH.  Then she showed me my weight gain chart and the basically vertical weight line (ie it shot up) from Thanksgiving to now.  She was like, “that’s the holidays.  You do not want to keep gaining like that.  Eat cheese or peanut butter.  Avoid carbs.”  But I love carbs!! 

Now, she admitted that many women with obese children are obese themselves, and that can have a genetic / environmental component (obviously).  But there is concern that when mom gains too much weight—even if she is otherwise generally healthy or in a healthy environment—that can set the kid up to be fat.

My doctor then measured me and said my tummy was measuring at 24 weeks pregnant—so AHEAD of where I should be.  Small baby, big tummy.  Dammit!

I decided to read a little more about this.  It does appear that there is real concern that if mom gains too much weight it can impact baby’s weight later in life and increase the risk of obesity:

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001521 (“The results showed that the amount of weight each mother gained in pregnancy predicted her children's BMI and the likelihood of her children being overweight or obese. For every additional kg the mother gained during pregnancy, the children's BMI increased by 0.022. The children of mothers who put on the most weight had a BMI that was on average 0.43 higher than the children whose mothers had put on the least weight…. This study shows that mothers who gain excessive weight during pregnancy increase the risk of their child becoming obese. This appears to be partly due to a direct effect on the developing baby.”).  This figure shows what appears to be a direct correlation between weight gained and child’s BMI: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001521

http://ajcn.nutrition.org/content/early/2017/09/06/ajcn.117.158683.abstract (“maternal weight across the childbearing period increases the risk of obesity in offspring during childhood, but high prepregnancy BMI has a stronger influence than either gestational weight gain or postpartum weight retention.”)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001295/ (“Mean (SD) gestational weight gain was 31.5 (11.2) pounds and offspring BMI z-score (BMI standardized for age and sex) was 0.15 (1.0) units; 6.5% of adolescents were obese (BMI greater than or equal to the 95th percentile). Gestational gain was linearly associated with adolescent adiposity: compared with 20–24 pounds, gain less than 10 pounds was associated with child BMI z-score 0.25 units lower (95% confidence interval [CI]: −0.47, −0.04), and gain greater than or equal to 45 pounds with BMI z-score 0.18 units higher (95% CI: 0.11, 0.25). Compared with women with adequate gain according to 1990 Institute of Medicine guidelines, women with excessive gain had children with higher BMI z-scores (0.14 units, 95% CI: 0.09, 0.18) and risk of obesity (odds ratio 1.42, 95% CI: 1.19, 1.70).”)

https://www.nature.com/articles/0803582 (“We found that high weight gain during pregnancy (⩾16 kg [35lbs]) was significantly associated with higher risk of overweight in Portuguese children.”)

http://onlinelibrary.wiley.com/doi/10.1111/ijpo.12163/full (“The results of this study suggest that ‘overnutrition’ in pregnancy independently affects child body composition throughout child development, particularly in non-Hispanic White respondents.”)

Even asthma is a risk, potentially due to “proinflammatory mechanisms”!

http://pediatrics.aappublications.org/content/pediatrics/early/2014/07/16/peds.2014-0439.full.pdf (“[Maternal obesity in pregnancy] and high [gestational weight gain – more than 42lbs] are associated with an elevated risk of childhood asthma; this finding may be particularly significant for mothers without asthma history. Prospective randomized trials of maternal weight management are needed.”)

I truly thought that discouraging too much weight gain during pregnancy (within reason) was just mom body shaming.  I had NO IDEA that it might actually hurt baby!!!  I gained around 35-40lbs with my first and he’s a healthy skinny little thing.  I started this pregnancy very thin (BMI 19.1) and about 10 lbs lighter than I was with him, so I assumed I would gain more.  I wasn’t super worried about weight gain but now I’m freaking out a little bit.  My question, of course, is if I am not supposed to gain too much weight when pregnant, WHY AM I SO HUNGRY???

More cheese, less donuts I guess.

[Before we go any further, yes what you’re reading is that I am both worried my baby is currently too small and that he will end up being too big.]

(3)    I might need an early induction.  This one potentially threw me for the biggest loop.  At the end of the appointment she made some comment about inducing labor at 39 weeks.  I was like, “what now?”  Then she told me that older (now defined as 35 and up) mothers are at an increased risk for stillbirth later in their pregnancies, and maybe their placentas may deteriorate faster than younger mothers.  (This risk of stillbirth issue is why my OB’s office was not going to let me go past 42 weeks with my son back when I was a youthful 33.)  She then said that to avoid this they recommend induction at 39 weeks.  She also said that induction when you’re already dilated with an open cervix is very different than if you’re tight as a drum, which is NOT FUN.  UGH!  

Just the other day my hubs and I were talking about my delivery (the first time we’ve discussed it) and he was like, “maybe home birth?”  I said, “nah, I’m more comfortable in a hospital.”  Now it sounds like I might not even have a choice.  BOOOOOOO.

Here’s an amazing article on the subject: https://evidencebasedbirth.com/advanced-maternal-age/

I have to think more about this.  Damn my old age.