Bigger is far from better when it comes to babies

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JaMichael Brown broke Texas records and made international headlines with his birth weight of 16 pounds. After a short stay in the intensive care unit to help him with breathing and high blood sugar, both mom and baby have a happy ending.

Not all large newborns or their mothers are that fortunate.

“Most people do not understand the implications of having a large baby,” says Dr. Renée Volny, obstetrician-gynecologist and former health policy fellow at The Satcher Health Leadership Institute in Atlanta. “Large babies are rejoiced in certain cultures without awareness of the potential health risks to both mother and baby.”

Babies born larger than 9 pounds 15 ounces have a much higher risk of complications. As many as 10 percent of newborn babies weigh-in above that at birth.

Like JaMichael, problems with breathing and controlling blood sugar are common among babies who weigh much more than expected, also called macrosomia. These babies can also have heart defects, slower development and increased risk of death during the first year of life.

Babies with macrosomia are more likely to suffer injuries from birth due to their size. An emergency during delivery called shoulder dystocia is most common.

With shoulder dystocia, the delivery is complicated because one of the baby’s shoulders is stuck against the pelvis and cannot come out easily. Sometimes, the umbilical cord can get compressed when the baby is in this position and decrease the amount of oxygen and blood to the baby. During these deliveries, the baby’s collarbone or other bones can break.

The mothers are at increased risk as well. Major lacerations or tears along the vagina or the urinary tract can occur. Having a newborn with macrosomia increases the need for Ceasarean section, involving the risks of major surgery. The mothers can also develop diabetes later on in life.

For unknown reasons, Hispanic women deliver heavier babies compared to white, black or Asian women. And, genetics also affect a baby’s height and weight.

However, macrosomia is most associated with mothers who gain large amounts of weight during pregnancy or gestational diabetes — a condition where the mother develops diabetes only while she is pregnant, and it resolves after delivery.The recommended weight gain is 25 to 35 pounds in women at a normal weight, 15 to 25 pounds for women who are overweight and only 11 to 20 pounds for women who are obese. However, women who are already obese are more likely to gain excessive amounts of weight during the pregnancy.

The problems from the mother’s weight gain are not limited to the first few years. An American Journal of Clinical Nutrition study showed that babies born to women who gained too much weight were almost 50 percent more likely to be overweight by age seven.

Whether a woman has diabetes before pregnancy or develops it during the pregnancy, controlling blood sugar with insulin is important. If blood sugar levels remain high, it is theorized that the baby is exposed to more sugar and, as a result, more calories, which leads to the increased weight gain.

“Although a woman has diabetes during her pregnancy, her baby is not doomed to being large,” says Volny. “If a fetus is measuring large early in pregnancy, it can be decelerated. Appropriate nutritional management and medications can make a difference in outcomes.”

Dr. Volny points out that maintaining a normal body weight from the beginning of the pregnancy is preferred over attempting to lose weight while pregnant. The outcome of the pregnancy can be improved by simple changes such as healthier eating habits.

Contrary to common belief, a pregnant woman is not “eating for two.” An additional 300 calories is what is needed to provide appropriate nutrition to the fetus. If the woman exercised before pregnancy, she may continue to do so if approved by her obstetrician.

Aiming to eat a balanced diet with appropriate portions and healthy snacks is preferred over satisfying cravings with sugary, high-calorie snacks. Small, healthy changes can help prevent excessive weight gain and its complications.

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