More weighty responsibilities for women: pre-pregnancy BMI and medical shaming

There’s a new study out this week with results on links between pre-pregnancy BMI and infant mortality.  Researchers examined 6.4 million singleton (as opposed to twin or multiple) births and more than 36,000 infant deaths in 38 US states.  What they were looking for was the relationships among pre-pregnancy weight of women, weight gain during pregnancy, and infant mortality (up to the first year of life).  So what did they find?

It depends on who you ask.

If you ask me (a person who waded through the article, which is chock-full of loads of pretty complex data), it paints a complex picture of the state of womens’ health in the US.  In terms of pre-pregnancy weights, low BMIs (<18.5) confer increased risk of some types of infant deaths and higher BMIs(>40) confer increased risk for other types of infant deaths (the researchers distinguished between infant deaths in the first month and in the subsequent eleven months).  Also, infant mortality rates are MUCH higher for non-white women giving birth according to this study.  Everyone in public health knows this, but it bears repeating, as it’s a horrific reminder of the state of racially-based health inequality.  For my money, THAT should be the headline in the press coverage.  But it’s not.

Another result of the study concerns weight gain during pregnancy.  According to the tables, gaining less weight than recommended confers increased risk of infant mortality in almost all BMI categories.  And, gaining more weight than recommended confers increased risk in only the lowest and highest BMI categories.  So the picture is complex, because biology is complicated.

If you look at the press coverage, though, you get a different story.  In this news story you get the following headline:

Even before pregnancy, your health matters:  Mom’s obesity linked to higher risk of baby’s death

The stories in the news are doing four things that I object to:

1.They are (as usual) distorting the scientific results for the purposes of sensational headlines.

2.  They are using inflammatory language– talking about “Mom’s obesity”, referring to women who are in fact not even pregnant.

3. They are sending a message that women who are NOT pregnant, but of child-bearing age, have the responsibility for potential risks to future children and obligation to lose weight (which, as we all know, is nigh unto impossible) to mitigate those potential risks.

4. The researchers, in their discussion, write that their results should encourage more public health campaigns to promote pre-pregnancy weight loss, as if public health weight loss campaigns have ever had any effectiveness at all.  This kind of tone deafness to the intractability of body weight management by medical means doesn’t surprise me, but it is tiresome and once again weight stigmatizing, targeting women.

We’ve heard this type of story recently, in the Centers for Disease Control report released last month stating flatly that women of childbearing age who consume alcohol and don’t use birth control are risking their future babies’ health.  This report provoked articulate responses like this one (by Fit is a Feminist issue guest blogger Rebecca; really worth a read).

As I said above, science is complicated.  This study suggests complicated relationships between pre-pregnancy body weights and infant mortality.  But distortion and fat shaming and freighting women with unbearable burdens should play no role in the dissemination and response to complicated science.

Sigh.  Have a nice day…




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