Weight, exercise, and pregnancy (TW: fucked up attitudes about weight; incompetent medical care)
If you have ever been pregnant, you are probably familiar with the relentless push at pregnant people to "maintain a healthy lifestyle."
Intertwined with amazingly fucked up discussion of how "THIS IS THE ONLY TIME IN YOUR WHOLE LIFE IT IS OKAY TO GAIN WEIGHT FOR ANY REASON," pregnancy websites, books, etc. repeatedly enjoin pregnant women to exercise, to start exercising now if they aren't already, to make sure that EVERY BITE OF FOOD is nutritionally optimal for the fetus--forget about nausea, which is near-constant for some women, or the fact that the fetus will suck the freaking marrow out of your bones before it starts going malnourished.
But what I mainly want to address here is the constant recommendation to exercise. When I got pregnant, I was quite active; the day before I got the positive home test, in fact, I had biked 24 hilly miles in fairly warm conditions with my spouse. I was doing weights ~3 times a week.
When I spoke to my OB's nurse (this was before I realized that she was basically useless for all purposes), I was given the conflicting instructions to "keep active" and to never let my heart rate go above 140, which is basically what happens when I climb the four flights of stairs to the campus gym cardio room. After a lot of arguing, I was finally presented with the completely different litmus test of talking--if you can speak comfortably, you're not working "too hard" for pregnancy. (This is no different from the appropriate cardio exertion test for non-pregnant people, actually--you should not be able to sing, but you should be able to speak conversationally.)
At this point, I was doing a lot of research on PubMed, having realized that my OB's nurse was not a good source of evidence-based medical advice. At first, I found little information--an extremely small case study (seriously, like six people) of "elite athletes" that seemed to confirm my initial suspicion that active people can stay active with few or no problems, but not much else.
But then, I found a very LARGE study using the Danish National Birth Cohort (hooray for socialized medicine), and the results surprised the hell out of me.
Up to 18 weeks gestation (16 weeks after conception), cardio exercise in ANY AMOUNT increases the risk of miscarriage.
"High-impact" exercise (e.g. jogging) is particularly bad, but the effect is basically just dose-dependent: the more cardio in which a pregnant person engages, the higher the risk of miscarriage climbs. A person engaging in 75 minutes to 4 hours of cardio per week, for instant, has a miscarriage risk about double that of a person engaging in less than 75 minutes of weekly cardio. At 4.5 hours or more of cardio per week (what I was doing before I got pregnant), the risk climbs to ~3 times the risk of a person doing less than 75 minutes.
After 18 weeks, the risk disappears--but that's really close to the midpoint of pregnancy.
Source: "Leisure time physical exercise during pregnancy and the risk of miscarriage: a study within the Danish National Birth Cohort," published in BJOG: An International Journal of Obstetrics and Gynaecology, November 2007; abstract on PubMed here; full article available FREE here.
When I told a good friend who had her baby about this last year, she was shocked. From the very beginning of her pregnancy, healthcare professionals were constantly pushing her to exercise regularly. I suspect the fact that she is considered "obese" by BMI (I'm not going to get into the total uselessness of BMI as a measure of ANYTHING here, but I know) contributed to this; I have certainly been told to "stay active," but haven't been directly admonished by my doctors very much.
Gaining "excess" weight during pregnancy (more than 35 pounds for women with a "normal" BMI, but again--BMI, terrible measure, WHY ARE WE ACTING LIKE IT MEANS SOMETHING?) is considered a risk factor for gestational diabetes--but it's not clear to me that it's a causal factor rather than a correlate. And the bottom line is, if you gain "excess" weight but DON'T HAVE GESTATIONAL DIABETES, then you don't have gestational diabetes. As with non-pregnant people, the weight itself is not a health problem.
I am 12 weeks pregnant and have gained about 10 pounds. I'm actually surprised that no one at my OB's office has chewed me out yet, since all the books say you should gain "1-5 pounds" in the first trimester, and I've got another two weeks before I'm officially in the second. I was actually tested for GD at 11 weeks, because my mother had it with all three of her pregnancies and now has Type 2. My test came back totally normal; I'll be retested between 24-28 weeks, the normal time frame for that test.
Honestly, I'm not terribly worried that I will develop it, because I'm not eating many simple carbs, which is the main issue for diabetes--or, really, I should say that if I DO develop it, it won't mean much in the way of dietary changes, because I already eat whole-grain everything and not much sugar. I am definitely eating a lot of salty, fatty foods and spaghetti, because they reliably sound good with my constant, barely medically controlled nausea. I'm not worried about it, and I sure as hell don't feel guilty about eating food that sounds good and feels good in my stomach. I'm the one who made sure I got the early test, just in case; I'm doing what I reasonably can.
I'm also walking a lot--or I was, until the heat indices in southern Wisconsin started going over 105 on a daily basis. I'm sure that a lot of my weight gain can be attributed to the combination of giving up more intense cardio and changing my eating habits to accommodate how I feel right now, and it just really pisses me off that there's this huge deal made about how terrible it would be for a person to gain more than five pounds in the first trimester.
On top of that, while many OBs do give the "140 bpm" rule (which IS really useless; the talk test is much more individualized and meaningful), there is still this constant pressure on pregnant people to exercise, clearly fueled by cultural fatphobia and also clearly medically indefensible.
Last week I was at the doctor's office for something totally unrelated to my pregnancy (I had an ear infection), and the PA who treated me insisted that I HAD TO BE WEIGHED, after I politely declined, because "oh no, if you have rapid weight gain going on it's a sign of pre-eclampsia." Which is pretty much bullshit. A) Pre-eclampsia is almost never a problem before 20 weeks, and B) my blood pressure, which is one of the major measures by which pre-eclampsia is diagnosed, was EXTREMELY good when it was taken at that same appointment. What pisses me off the most is that in the moment I didn't refuse--I let myself be bullied to satisfy a healthcare pro's fatphobic idea of appropriate care, rather than what I know to be a reasonable standard. Ugh.
So there you have it. Fatphobia is a major issue in the standard medical care that pregnant people receive in the US. This probably doesn't come as a surprise, but I hope this can be helpful to other people who are now or may become pregnant.
