What Is Actually Complicating My Pregnancy

[contents: medical, tmi, fat hate, scare-mongering]

Before I get any further: YES, THE KID (AND I) ARE BOTH FINE.

Okay!

It's a really popular position to assume that all fat folks who get pregnant have high-risk pregnancies, and the resulting babies have tons of problems, and it's just oh my god terrible and WHY WOULD YOU GET PREGNANT IF YOU'RE FAT DON'T YOU KNOW YOU AND YOUR BABY WILL DIE. See also: pretty much any mainstream article about obesity and pregnancy published in the last ten-plus years, or so many entries on My OB Said What?! (seriously, that site needs major trigger warnings).

Except that position is not actually based in reality.

I'm not saying that there are no risks associated with (note: ASSOCIATED WITH) being fat during pregnancy. Fat pregnant folks are at higher risk of gestational diabetes and preeclampsia. The fetuses of fat pregnant people are at higher risk of being born large for gestational age, of having neural tube defects, etc. etc. etc.

What even the American College of Gynecologists doesn't tell you is that while yes, obesity is associated with higher risks (that is, we have no idea about what causes any of these), including things like OH MY GOD A FOUR-TIMES GREATER RISK of things... the actual, numerical risk is not actually that high. Not that you can tell from the ACOG paper, or indeed, many reports, because they don't actually include the baseline risk numbers.

The thing is, when you multiply a very small risk by four, the risk is STILL SMALL. And all of these things? Occur in very small numbers of pregnancies. Are they scary and bad? Absolutely. But even if your risk is elevated for them, that is far, so far, from a guarantee you'll get them. Even if you are "morbidly obese", your risk of any of these complications is less than 10% - in some cases, WAY less than 10%. For example, the CDC says that your risk of gestational diabetes is between 2-10%. (They also say here that it's between 2-5%, and that "some - but not all [people] with gestational diabetes are overweight before getting pregnant". Not even the CDC is telling you the fat causes gestational diabetes, y'all.) Is your risk higher than in folks that aren't fat? In some cases, yeah. Is it ever YOU WILL DIE AND SO WILL YOUR BABY high, as it's often presented? Not. Even. Close. Fact is, the vast majority of fat pregnant folks have perfect fine, healthy pregnancies, and give birth to perfectly fine, healthy babies. But that doesn't sell diets and papers and ads and shit.

These also aren't the only complications of pregnancy though. (And I have my theories about why they're what we hear about... namely, WE CAN LINK THEM TO THE FAT OMG). Last week, I was referred to a maternal-fetal medicine specialist. Not because of my weight, thank fuck, because it really isn't complicating my pregnancy. I mentioned here that there was a finding at my midpoint ultrasound just before Thanksgiving that resulted in a referral. The finding wasn't about The Kid - The Kid looks fine, is measuring spot on for the due date, is extremely active, everything seems to be going well. The finding was that my cervix was a bit on the short side.

(Here is where I spent an hour trying to find how common a short cervix is in pregnancy, and found no good answers. Basically, judging by this study and a few others, at least 95% of all pregnant folks do NOT have a short cervix. It's actually pretty hard to find baseline risk information for any condition. So frustrating.)

Having a short cervix around this point in the pregnancy is associated with a higher risk of delivering early, and the shorter your cervix is, the higher the risk. I'm not in the highest risk category, but my cervix was short enough to up my risk, so I was referred to a specialist to be evaluated and see what, if any, treatment would be necessary. So I got a second ultrasound in a week, which again confirmed that The Kid looks just fine. The ultrasound was pretty entertaining. I'm pretty sure The Kid was napping when it started. Then after a minute or two of wand-on-belly, I started seeing hand-waving and kicking... and was kicked pretty constantly the rest of the day. Thank you for expressing your opinion, Kid. But the ultrasound also confirmed that yeah, my cervix is a little short.

No one is really sure why some cervixes are short. Theories include natural variation, inflammation, previous cervical trauma, and more. (Nobody links it to OMG THE FAT, SORRY HATERS.) There's also a difference between just a short cervix and what is called an incompetent cervix (and isn't that just a lovely health term). Some people will tell you that any cervix sufficiently short is incompetent, while others will say no, there has to be early dilation. Like many health topics, it can get somewhat confusing, but long story short, HAH, my cervix is just short, not incompetent.

I also mentioned earlier this week that I'd been all over Cochrane, checking to see what the actual risk was and what the treatment plans were. Cochrane kindly confirmed my assessment (higher than usual, but not panic time), and that of the two treatments (cervical cerclage, which is literally stitching the cervix closed, and progesterone supplementation), for people like me, who just have a short cervix, no signs of pre-term labor, and no history of pre-term delivery, progesterone is the way to go. It's associated with better outcomes all around, including reducing the rates of pre-term birth and neonatal complications. As I mentioned previously, the specialist I saw was on the same page as me - thank FUCK for doctors that read and understand research. And thank FUCK for doctors that love when their patients read the research. And a final, super-hearty thank FUCK for doctors who don't engage in fat shaming - my weight came up exactly ZERO times in this appointment, which is exactly how it should have been.

So I am now on supplemental progesterone. I go back in about a week for another special ultrasound to check my cervix, and so long as it hasn't gotten worse, then I get to go back in a month or so. Is it considered a complication? Yes (but technically, so is my well-controlled hypothyroidism ALSO NOT CAUSED BY FAT, THANKS HATERS). Is it a big one? No, and I'm thankful for it. I just have to take some additional meds and see another doctor once in a while, and that's okay for me.