April 2010


Being overweight isn’t good for pregnancy. We all “know” this, but a study in the British Journal of Obstetrics and Gynecology came out which looked at 23,000+ women in different countries.  They showed weight is an issue by itself.

We know obese and overweight women have a higher rate of pregnancy related gestational diabetes.  Gestational diabetes can lead to larger babies.  Larger babies are harder to deliver, causing more issues during delivery, including injury to the baby like shoulder dislocation.

So this study wanted to look at is it the weight? Or is it the gestational diabetes?

The women in the study all had oral glucose tolerance tests, height, and weight measurements.   Metzger and his colleagues looked at whether body mass index (BMI) influences pregnancy risks and fetal and newborn health unrelated to gestational diabetes.

Women with BMI of 42 or greater (severely obese) had triple the risk of an excessively large baby.  The risk of having a C section was doubled.  Preeclamisa risk was 14 times greater.

In an interview Metzger stated, “We’re pretty confident that treating gestational diabetes going forward is going to continue to be beneficial,” “We have much less evidence at this point as to how to neutralize or reduce the impact of overweight on pregnancy outcome.”  “What is becoming clear is that it’s probably a woman’s weight before she gets pregnant, rather than how much she gains during pregnancy, that’s important in determining risk.”

SOURCE: BJOG, online January 20, 2010.

Yes, yes.  I am a true believer in the benefits of breast feeding. 

I do not go into this starry eyed.  I know there is a cosmetic hit we breast feeding moms take (it is a lot of what I fix doing my mommy makeover work.)  But if you aren’t going to do it for your child’s health (less infections, etc), or for your health (lowers the rate of diabetes and heart risk), then do it for your country.

Medical costs are soaring.  The government is becoming increasingly involved in medicine.  I saw a recent study published in the news about how breastfeeding for six months could save 13 billion dollars. (!!)  You mean I can make a dent in America’s staggering spending by breastfeeding my baby?

Yes.

This is not new news.  In March 2001, a study of “The Economic Benefits of Breastfeeding: A Review and Analysis” was published for the USDA  (Food Assistance and Nutrition Report (FANRR13):

“A minimum of $3.6 billion would be saved if breastfeeding were increased from current levels (64 percent in-hospital, 29 percent at 6 months) to those recommended by the U.S. Surgeon General (75 and 50 percent). This figure is likely an underestimation of the total savings because it represents cost savings from the treatment of only three childhood illnesses: otitis media, gastroenteritis, and necrotizing enterocolitis. This report reviews breastfeeding trends and previous studies that assessed the economic benefits of breastfeeding”

http://www.ers.usda.gov/Publications/FANRR13/

The recent numbers are an extension of the original study, which only looked at three major illnesses, and wasn’t corrected for today’s economics. 

So.  Breastfeed- For your baby, for your health, and for your country.

I just got back from a playgroup. There was a mom who just had twins 6 months ago and has another child who is 2.  She had tried to do an intense exercise and diet program to get back into shape.  Here is a woman who has three kids within 2 years, the twins are boys, she is not sleeping through the night.  I was looking at her thinking, “You showered!” “Your shoes match!” “You aren’t wearing sweats!”  So I will repeat what I, the plastic surgeon and mother of three said to her:

Give yourself a break.

I know it is tough.  We see magazine articles of “how famous so and so actress lost her baby weight in three months!”  And there will be some lovely article about broiled chicken and fish and salad and yoga.  Or better yet, “I lost the weight just chasing after my kids.” Oh how lovely.  Here in the Bay Area there are many uber athletic thin women.  Some women I know look smaller when they are 9 months pregnant than the average American woman is non pregnant. 

Give yourself a break.

There are those genetically blessed women who “pop” right back into form quickly.  Yes, it isn’t all genes.  Keeping in shape while you are pregnant, not gaining more than the baby weight, not using pregnancy as carte blanche to try all the flavors of Ben and Jerrys … these all are important. 

But at six months out with a new baby, particularly if you have other children, and are breastfeeding/ working/ making dinners/ laundry/ cleaning up/ making lunches/ bathtimes/ buying diapers/ afterschool activities/ playgroups/ clean the house again…

There is a time and place for everything.  Sometime not so far away, your baby won’t be a baby.  He will be sleeping through the night.  YOU will be sleeping through the night.  I see the majority of my mommy makeover patients 2-3 years after their last child.  I think that timing is good.  It gives you time…. time to enjoy being a mother.  Time to breastfeed.  Time to give your body a chance to get back to normal.   Then you can work out.  Diet.  Exercise hard.  See where you can get to on your own.   

So give yourself a break.  Your baby won’t be a baby for long.  Savor every moment while you can.

I know this isn’t really about plastic surgery.  But being a working mom, I loved this study which looked at kids and obesity.  One of the questions raised in recent times is whether childhood obesity rates going up has something to do with more mothers having to work.  In 2000, the New York Times reported for the first time since the Census Bureau began tracking numbers, families in which both parents are working is the majority, including the traditional married with children group.  Here in the Bay Area we know most of us can’t afford our house without two working parents.  

This study out of Australia, to be published in the Journal of Social Science and Medicine, looked at 2500 children at two different points- ages 4/5 and again at 6/7.  There were three groups of moms: stay at home, full time working, and part time working. 

Findings (Dum ta dum dum drumroll): Mothers who worked part time were more likely to have healthier children than either of the other groups.  They found those children watched an hour less of TV per week and had a healthier lifestyle. 

Full time career women had higher rates of overweight children.  The thoughts were they had fewer home cooked meals and less time to encourage active, physical play.

Stay at home moms? Unclear why they were more likely to have overweight kids, but they postulated the part time working mom might balance work and family demands better. “They reschedule activities, sleep less, and allocate less time to personal care and leisure to ensure that time with children is protected.”

Regardless, it was good for me to read.  It is nice to know stay at home moms and full time working moms were in the same boat, and part time working moms fared the best.  So working isn’t the issue.  Balancing and scheduling well seems to be the ticket.

Ooooh.  Or perhaps this means we all need a day or two off a week.  As the study shows,  it is better for our kid’s health and weight….