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Adding a few pounds between pregnancies risky
Just 7 extra pounds increases hazards for mom and baby, large study finds
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Updated: 2:36 a.m. CT Sept 29, 2006
LONDON - Women who gain as little as 7 pounds between pregnancies can put themselves and their babies at medical risk, even if they don’t become overweight, suggests a provocative study of thousands of women.

Researchers found that gaining weight during that interval — not during the pregnancy itself — raised the risk of such complications as diabetes and high blood pressure during the second pregnancy, and even stillbirth.

Pregnant women with diabetes or high blood pressure are at risk of convulsions or organ damage, which in severe cases, can be fatal.

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The results provide new evidence that overweight or obese women who plan to become pregnant should lose weight, and that women with healthy weights should avoid packing on pounds before pregnancy, the researchers said.

The work was reported Thursday in the British medical journal, The Lancet, by Drs. Eduardo Villamor of the Harvard School of Public Health and Sven Cnattingius of the Karolinska Institute in Sweden. They examined records of more than 150,000 Swedish women who delivered two children between 1992 and 2001.

The researchers focused on body-mass index, or BMI, a calculation from a person’s height and weight. They examined the difference between the women’s BMI at the beginning of two consecutive pregnancies. And they examined the likelihood of complications such as high blood pressure, diabetes, the probability of a Caesarean delivery, and stillbirth in the second pregnancy.

Even applies to healthy BMIs
One striking finding was that the risk of complications rose even in women who did not end up overweight, Villamor said Thursday.

For instance, the authors offered the example of a 5-foot-5 woman who weighs 139 pounds before her first pregnancy. That would give her a healthy BMI of 23.

If she gained just 7 pounds before her second pregnancy, she’d move her BMI up a notch to 24, still considered healthy. But the new study suggests she would also raise her risk of becoming diabetic during the second pregnancy by about 30 percent.

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If she gained 13 pounds, raising her BMI by 2 units and making her overweight, her diabetes risk would double.

“Those are staggering numbers,” said Dr. Daniel Herron, associate professor of surgery at Mount Sinai Hospital in New York, who was not connected to the study.

“There’s long been a perception that being morbidly obese is associated with diabetes, but we may now be seeing this with relatively small weight increases too,” he said. “That’s news.”

Overall, the new study says gaining 1 or 2 BMI units increases the risk of diabetes and high blood pressure during pregnancy by up to 40 percent. Gaining 3 or more units raised the risk of a stillbirth by 63 percent.

Provocative results
“The results from this study are definitely provocative,” said Dr. Mario Merialdi, a reproductive health specialist at the World Health Organization, who had no ties to the study.

“It is the first study to lend support to a causal relationship between obesity and adverse outcomes,” he said, adding that while previous studies have been suggestive, none has provided the necessary evidence to show a link.


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Pregnancy Message Board: Are you concerned about between-pregnancy weight gain?



Villamor said he believed the Swedish study would apply to other, more diverse populations, although he said it’s important to confirm that.

Herron agreed: “I think that it does hold a lot of importance for American women as well.”



In an accompanying commentary in The Lancet, Aaron Caughey of the University of California in San Francisco, writes that “as with any groundbreaking study, these findings raise several questions that cannot be answered by the data alone.” One of the study’s limitations is that it could not address the reasons for weight gain, which may in turn be associated with some of the identified health problems.

Breastfeeding practices, Caughey suggests, might explain why some women gained weight between pregnancies and others didn’t. Women who breastfeed typically lose more weight than those who don’t.

Addressing this issue could allow doctors to spot women at risk of becoming obese between pregnancies. Further studies, including those with weight-loss interventions, experts say, are necessary to confirm a definitive link between obesity and pregnancy complications.

But Herron said women should not wait for later research before changing their behavior between pregnancies.

“For anyone who’s ever thought that gaining or losing 7 pounds didn’t make a difference, this should make them think twice,” he said.

They are talking about the mom who gains weight, not the baby. A woman can be gig and still give birth to a relatively small baby. Most BPI injuries are due to having big babies. Not due to the mom being big.
Marieke (LOBPI)

Yes, I agree that they're talking about the mothers gaining the weight. But, overweight and/or obese mothers are a risk factor for shoulder dystocia. As is gestational diabetes, which from this article, can be caused by gaining as little as 7 lbs.

Interesting article..

Cherie

Actually, it is not true that most BPIs occur because the baby is big. The vast majority of BPI babies are not macrosomic at birth. However, macrosomic babies have a higher statistical likelihood of sustaining a BPI, versus normal-sized babies. Maybe that is what you meant?
BPIs happen for a variety of reasons: mother's small pelvis, bad birth positioning or a doctor/midwife who doesn't do the right maneuvers, or does them incorrectly, when encountering SD. Gestational diabetes also does lead to bigger babies, but most competent doctors would monitor the baby's size and either take the baby early or C-section to avoid SD.

I had just gotten up this morning when I heard about this report on the news, so I got on the computer and seen it right away. I copied it for all you to see since I found it upsetting that Shoulder Dystocia was NOT included AGAIN in a large research about birth problems and their causes. I gained a lot of weight in my first pregnancy. My doctor said "Don't worry.....". And my Daughter was injured at birth. I had a second child by C-section and then 3 years ago I got pregnant again. They told me early on that I had Gestational Diabetes. They told me to get control over my sugars and weight gain or it could hurt me and my baby. I did! They couldn't have motivated me any better. I just think that since Maternal weight gain during the pregnancy is a risk factor in SD, it would have been great for the darn research to talk about Shoulder Dystocia. Then maybe some Mom's would be more AWARE of the dangers involved in delivery. I know I'm on my soapbox, and this is a goofy wish, but I want to wake up someday and see doctors on TV saying they were WRONG!, and announce to the world what causes BPI's and the effect the have on the families affected. Thanks for your time to read this, I know it is long. Sandi

SD occurs due to a large number of varying factors, baby size is not the only one and over half of bpi babies are not large. While maternal size is another factor (and morbidly obese women are at risk if they have C sections too, that isn't always the answer) I strongly feel that by focussing on the mother or baby size - which many of us on these boards pick up on - the doctors are again trying to shift the responsibility for bpi to factors outside their control or blaming the SD on physical factors.
Almost every person who posts here gave birth on their back, and most also had an epidural. These are the factors that appear in the majority of cases yet even on support websites the focus is on diabetes, baby size etc. We need a campaign similar to the onwe which did so much to reduce the incidence of Cot Death merely by putting babies to sleep on their backs. I'm not suggesting that if every mother gave birth in a sensible position (lying on your back is the WORST) and refused epidural we would wipe out bpi completely, but I think the incidence would drop dramatically.
SD and BPI ARE NOT the mother's fault through her size or her baby's size. The medical profession have a duty to tell us the real risks of the things that unfortunately are now considered normal such as epidural and back lying labor. They are the two easiest factors to control in a birth situation, unlike the maternal or fetal weight. Doctors are to blame and we also should inform ourselves. Epidural was once only used in extreme cases, when we as parents regard it as just a painkiller, we put ourselves and our baby in danger. The doctors should be telling us and we should research for ourselves too.
This research is yet another smokescreen. Spread the word to other expectant moms, check other positions out and refuse epidural. It's worth it.