Sex may not work, but sweeping the membranes might

Last week I wrote about a study that suggested sex doesn't get the contractions rolling. This week, however, a study was published that suggests there is something that might work. It's called sweeping or stripping the membranes. To do the procedure, your doctor or midwife will place 1 or 2 fingers through the opening of your cervix and separate the membranes of the amniotic sac from their attachment to the lower part of your uterus. The goal is to trigger a local release of prostaglandins, or the hormones responsible for softening the cervix and stimulating labor. The procedure can be uncomfortable, and often results in period-like cramping, irregular contractions, and sometimes bleeding. (Sex is looking pretty good right now even if it doesn't work, huh?)

In this research, the investigators reviewed 22 studies of nearly 3,000 women and examined labor outcomes. They found that women who had their membranes swept were more likely to give birth before 41 weeks gestation. Further, they found there were no differences in risks of infection for either mother or baby.

The authors concluded that the decision to sweep the membranes needs to be balanced with the discomfort of the procedure. Interestingly, they also suggest that routinely sweeping the membranes does not seem to produce important clinical benefits - although they aren't the ones who've been pregnant for 10 months. Ultimately, this is an important decision to discuss with your health care provider. Meantime, Barry White anyone?

Pregnancy weight gain - one size doesn't fit all

Most women know about the traditional weight gain recommendations for pregnancy: 25-35 pounds if you're normal weight (body mass index = 20-25), up to 10 pounds more if you started the pregnancy underweight (BMI <> 25). However, a new study published this week in Obstetrics & Gynecology suggests that these guidelines may be out of date, at least as far as obese women are concerned.

Investigators analyzed data from more than 120,000 obese women in Missouri to see how the weight they gained during pregnancy affected three outcomes: blood pressure, rate of cesarean sections, and the infant's birth weight. They found that 23% of obese women gained less than 15 pounds, 31% gained the recommended 15-25 pounds, and nearly 50% gained more than 25 pounds. The women who gained less weight during pregnancy had the best outcomes, including less pregnancy-induced high blood pressure and normal weight babies.

The researchers also calculated optimal ranges of weight gain during pregnancy based on pre-pregnancy BMI. Women with BMIs of 30-34.9 had the best outcomes when they gained between 10 and 25 pounds. These same women were more likely to have low birth-weight babies when they lost weight, but they had fewer other complications like high blood pressure and C-section deliveries. Women with a BMI of 35-39.9 did best when they gained less than 9 pounds. For women with a BMI of 40 or higher, losing up to 9 pounds produced the best outcomes.

As you can see, this study's findings contradict the current guidelines, which were established in 1990 when obesity wasn't so common. However the current guidelines may be no more. The Institute of Medicine plans to reevaluate its recommendations for weight gain during pregnancy to reflect more recent evidence about pregnancy and birth outcomes.

What does this mean for you? If you are obese and pregnant, or planning to become pregnant, talk to your doctor or midwife about the best weight gain - or weight loss - strategy. And remember, no matter what weight you are, it's important to eat a nutritious and well-rounded diet while pregnant and postpartum.

Weight Matters in Pregnancy: Part II

If my previous post on weight matters in pregnancy didn't convince you that starting your pregnancy obese can be bad for your baby, findings from a study published this week just might.

Researchers reviewed the birth outcomes of more than 4,000 women in eight states over a five-year period. They found that mothers who were obese (defined as a body mass index of 30 or greater) prior to pregnancy were significantly more likely to have infants with birth defects, including spina bifida, heart deformities, malformed rectums, hypospadias (abnormal opening of the urethra in males), short or missing limbs, hernias in the diaphragm, and abdominal wall defects. These researchers made sure that this was an obesity issue by not including infants whose birth defects had a known or suspected genetic cause and adjusting their calculations for women who took folic acid, which has been shown to reduce some birth defects.

I may sound like a broken record here, but the evidence continues to mount regarding the need to address overweight and obesity, especially among women of childbearing age. Additionally, given that: (1) Kentucky's rate of neural tube defects (such as spina bifida) is 1.5 times the national average; (2) birth defects are the leading cause of infant mortality in Kentucky; and (3) we already know that we're the fifth heaviest state in the nation, we've got some work to do if we want to meet our goals for improved birth outcomes in the Commonwealth.

Weight Matters in Pregnancy

Ask the average woman how much weight she should gain during pregnancy, and she'll probably respond 25-35 pounds. This Institute of Medicine guideline has been the practice for nearly 20 years. However, this recommendation is for normal weight women (i.e., body mass index [BMI] 18.5-24.9). The IOM also recommends that overweight and obese women limit their gestational weight gain according to their prepregnancy BMI.

A recent study, however, shows that many overweight and obese women are not limiting their weight gain during pregnancy, and this can have serious consequences for both the mother and newborn. In their study of over 7,500 women, researchers found that 64.3% of overweight and 52.9% of obese women gained more weight during pregnancy than recommended by the IOM for their BMI. Further, overweight and obese women were more likely to deliver by C-section and give birth to infants who were large for gestational age, with associated complications including the infant’s anterior shoulder becoming stuck above the pubic bones during delivery, birth canal lacerations, and fetal hypoglycemia (low blood sugar). Overweight/obese women also were less likely to initiate or continue breastfeeding beyond 10 weeks.

So if you are planning to become pregnant in the next year, take a look at your BMI. If you're above 25, talk to your doctor about steps to lose weight. Further, once you become pregnant, keep an eye on your diet and the scale. Pregnant women need only an additional 300 calories per day. By watching your weight before and during pregnancy, you'll not only improve your own health, but you'll also improve the health of your baby.