US Babies Get Smaller, Puzzling Scientists-- Sorry if this has already been posted! - Page 2

[belltree]

Originally Posted by rachelsmama

Aren't there a lot of women whose doctors change the "due date" late in pregnancy based on size estimated by ultrasound? If there's been an increase in how often that happens couldn't that explain the results?

I thought about that as well. My due date was adjusted, although I knew my ovulation and conceptions dates. My guy arrived 10 days early. Officially he is listed as 2 days past due date. But I know better.

Also, I have met a ton of woman, that go to their first prenatal visit to confirm that they are pregnant and to be told how far along they are. It seems to me that there are a ton of women out there who just don't pay attention to their bodies.

[AlexisT]

I'm not sure that it's inductions and C sections that are having such a big effect. Most of them are done at 37 weeks plus, and babies don't really gain much weight at that point. My 38 weeker was 8 lbs 2 oz (I was sectioned for severe preeclampsia, and she was not ready to go). That's a good size baby by any measure. This is why even ACOG doesn't recommend elective induction for macrosomia. It doesn't help, because you'd have to section at something like 36 weeks to make a real difference. Sections at 39 weeks mean a difference of a few ounces. Not much at all.

How much have premature births increased? That would cause a much bigger effect.

First trimester u/s has been shown to be accurate, and many women DON'T know when they got pregnant. Not everyone plans their pregnancies. Third trimester scans are not accurate and in fact ACOG says dating should not be changed based on them. Which isn't to say it never happens, but it's not considered good practice.

[nia82]

Babies gain a lot the last weeks, I forget good sources that I read when I was preggers, but here from eHow:

"During the last month of the final trimester of pregnancy the baby will gain between a quarter and a half pound per week, until she is born weighing between 6 and 8 lbs."

My DS weighed 5lb 10oz at 36+6. He weighed 9lb plus at his "real due date". He would have been a lot bigger if born on time and not that early (preterm labor though, no intervention did this to us).

[Storm Bride]

Originally Posted by AlexisT

I'm not sure that it's inductions and C sections that are having such a big effect. Most of them are done at 37 weeks plus, and babies don't really gain much weight at that point. My 38 weeker was 8 lbs 2 oz (I was sectioned for severe preeclampsia, and she was not ready to go). That's a good size baby by any measure.

Yes, but she'd have probably gained at least a few more ounces in two more weeks. If large numbers of women with babies on the "big" end of the spectrum are having their babies even two weeks early, and losing those few ounces, that will affect the average newborn size.

This is why even ACOG doesn't recommend elective induction for macrosomia. It doesn't help, because you'd have to section at something like 36 weeks to make a real difference.

Are you sure that's why? I thought they had concluded that macrosomia doesn't really require intervention. (I'm willing to admit I may be wrong, as "less intervention" isn't exactly a popular concept with ACOG.)

First trimester u/s has been shown to be accurate, and many women DON'T know when they got pregnant.

Shown by whom? Many women don't know, but many women do, and those women are still told they're wrong, if the u/s disagrees.

Not everyone plans their pregnancies. Third trimester scans are not accurate and in fact ACOG says dating should not be changed based on them. Which isn't to say it never happens, but it's not considered good practice.

I've had my dates changed by ultrasound, and it wasn't accurate, and it wasn't a third trimester ultrasound. I've only ever had third trimester ultrasound on the L&D ward, to check position, and to check for a (missing) heartbeat.

[Gladiolus]

I have a bit of a different thought on this just due to personal experience - I'm not a scientist.

With my first, I ate A LOT of processed foods - including a lot of white sugar, white flour, etc. I started the pregnancy in a normal weight range, gained 60lbs, had 6lb 14 oz DD - born on her due date.
My second pregnancy, I started off overweight since I didn't lose the weight but not obese. I gained 20 lbs, DS was 8 lbs 14 oz, born 15 minutes before his due date (I have some naturally on-time kids!). I cut out the processed foods, watched my daily protein grams (shot for 80-100)- ate much better than the first.
I also lost the weight in the end by cutting processed foods out of my diet.

Maybe babies are smaller due to the inductions (which makes perfect sense!) but also maybe the "standard american diet" of the modern, busy woman is lacking the things that babies really thrive on... just a thought.

[Storm Bride]

Originally Posted by Gladiolus

Maybe babies are smaller due to the inductions (which makes perfect sense!) but also maybe the "standard american diet" of the modern, busy woman is lacking the things that babies really thrive on... just a thought.

I could see that, except that the SAD has been crap for a long, long time. This is a new trend.

[miriam]

Originally Posted by rachelsmama

Aren't there a lot of women whose doctors change the "due date" late in pregnancy based on size estimated by ultrasound? If there's been an increase in how often that happens couldn't that explain the results?

Ultrasound is accurate for gestational age and size up to 20 weeks. After 20 weeks, heredity takes over. Doctors change the dates, in my experience, for their own convenience.

I have no proof of this, but I have talked to women who suffered a trauma during their pregnancy and the baby seems to have stopped growing and is many weeks late. My proof is anecdotal, so it is just my own personal observation.

It doesn't help, because you'd have to section at something like 36 weeks to make a real difference. Sections at 39 weeks mean a difference of a few ounces. Not much at all.

It does make a difference to the baby. Size and weight are not the only factors here. The L/S ratio and surfactant levels in the lungs show how ready the baby is for breathing air when it is born. Hyaline membrane disease and RDS are still killers of pre-mature babies, and delivering babies early through ERCS or induction or failed induction is not a good start in life.

But doctors never learn. In the summer of 1963, President Kennedy and his wife, Jackie, lost their fourth child, a son, to RDS, and yes, he was a c/sec. That was 47 years ago, and the same thing happens everyday in maternity wards across the country.

"Patrick Kennedy's death from hyaline membrane disease or respiratory distress syndrome, helped spark new public awareness of the disease and further research. The disease has an overall mortality of less than 15%—and is much less fatal among mildly to moderately premature infants as of 2004. Treatment modalities are now widely available in developed countries, such as continuous positive airway pressure (CPAP), pulmonary surfactant replacement, and improved respirator technology, that either did not exist or were unavailable in 1963." (70 words)

I suppose since doctors feel there is an 85% chance of a mildly premature baby to survive, most OBs feel safe enough about delivering them early.

[AllyRae]

Originally Posted by Gladiolus

I have a bit of a different thought on this just due to personal experience - I'm not a scientist.

With my first, I ate A LOT of processed foods - including a lot of white sugar, white flour, etc. I started the pregnancy in a normal weight range, gained 60lbs, had 6lb 14 oz DD - born on her due date.
My second pregnancy, I started off overweight since I didn't lose the weight but not obese. I gained 20 lbs, DS was 8 lbs 14 oz, born 15 minutes before his due date (I have some naturally on-time kids!). I cut out the processed foods, watched my daily protein grams (shot for 80-100)- ate much better than the first.
I also lost the weight in the end by cutting processed foods out of my diet.

Maybe babies are smaller due to the inductions (which makes perfect sense!) but also maybe the "standard american diet" of the modern, busy woman is lacking the things that babies really thrive on... just a thought.

Huh. Very very interesting... My first was born 6 lbs 15 oz at 40 weeks. With that pregnancy, it was 2003, I didn't know better and ate the SAD. Processed foods, white flour, etc.

My second (2005) was 7 lbs 10 oz at 41 weeks...my diet was somewhat better...gluten free, more protein, but still processed with fast food, etc.

(My 3rd was adopted so that's why I'm skipping her).

My 4th (2009) was 7 lbs 2 oz at *36 weeks*...I was gluten free, very little processed food, almost all organic diet, whole foods vitamins, lots of protein, in general a fairly healthy diet. Even though she was born early (c-section due to a high risk of blood clots and stillbirth), she was born with the highest apgars and would have been my largest if she would have been full term. And my diet was definitely better with her...

[AllyRae]

Originally Posted by miriam

I suppose since doctors feel there is an 85% chance of a mildly premature baby to survive, most OBs feel safe enough about delivering them early.

Do you mind citing that statistic? I'm pretty sure it's a 95%+ chance of survival at 35-37 weeks. Or are you citing survival without any complications at all?

[lunarlady]

When I read the statistic, my first thought was that they are saving more preme babies lives. When you look back even 15 years ago, those tiny premes that are just 2 lbs didn't often survive, but now, I think they have a fighting chance. One of our friends has a 6 year old that was born at 26 weeks, just 1 lb, 9 oz. She survived. It truely is a miricle, but I wonder because I think for a long time, those early babies died so soon after birth that they might not have been counted as live births. It doesn't take very many tiny babies to swing the average a few ounces smaller. Or is the study only measuring "at term" births?

[Delicateflower]

Originally Posted by lunarlady

When I read the statistic, my first thought was that they are saving more preme babies lives. When you look back even 15 years ago, those tiny premes that are just 2 lbs didn't often survive, but now, I think they have a fighting chance. One of our friends has a 6 year old that was born at 26 weeks, just 1 lb, 9 oz. She survived. It truely is a miricle, but I wonder because I think for a long time, those early babies died so soon after birth that they might not have been counted as live births. It doesn't take very many tiny babies to swing the average a few ounces smaller. Or is the study only measuring "at term" births?

Yes, the study only included term births.

Originally Posted by Storm Bride

That's easy. They're confusing their data with reality. It's not uncommon. She says inductions and c-sections aren't to blame...but she doesn't have the data she needs to reach that conclusion. If she's using birth certificates, and the certificates don't show induction, then she's most likely assuming that she has data that she doesn't (ie. nothing says "induced", therefore ind

Your reasoning doesn't make sense. How would someone look at 37 million birth certificates, and if none of them state they were cesarean births, assume cesarean births are imaginary?

it's unfortunate the OP didn't link to the article, because they did discuss inductions and length of pregnancies.

Moreover, babies' length at birth suggests even full-term pregnancies are 2.5 days shorter than they used to be. That can't account for all the weight change, and Oken couldn't find a full explanation from the birth certificates she studied.

Oken excluded premature babies, as well as twins or other multiples, from her study. (Obese mothers also are at higher risk of having a preemie.) Yes, there are more scheduled cesarean sections or induced labors now, but her analysis concluded that wasn't to blame.

But that's not clear as induction often isn't listed on birth certificates, and the study found a drop in babies born at 40 or 41 weeks gestation, noted Dr. Joann Petrini, an adviser to the March of Dimes.

[miriam]

Originally Posted by AllyRae

Do you mind citing that statistic? I'm pretty sure it's a 95%+ chance of survival at 35-37 weeks. Or are you citing survival without any complications at all?

I am sorry.

That statistic is from Wiki page for Patrick Bouvier Kennedy. I know that wiki is not considered scholarly research, but sometimes there is a citation for a statement. There was no backup citation for this information. I apologize. I wonder how that number was arrived at also.

I was a premature infant born in the 1950s at home and I healthy and still here. I am not blind; I know that was a problem with the excessive O-2 used at the time which was Standard Practice.

The Dionne Quintuplets were born at home prematurely and they did survive infancy; I believe two are still living.

Therefore prematurity has been handled outside of the medical model for a while.

Even the practice of kangaroo carein Columbia, a practice in which mothers carry their premature baby attached to their breasts, matched the 85% rate that we have in the US.