Weight, Fertility, & Pregnancy Loss: What You Need to Know

by | Authenticity, Parenthood, Personal Journey | 0 comments

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Episode 60. Today’s topic delves into something I feel strongly about and have thought about sharing for a while now. I’ve decided to share now for a few reasons:

  1. I believe stories are incredibly powerful and just sharing facts ain’t going to cut it with this incredibly important topic.
  2. I’ve finally created a bit of time and space in my life to research the topic and form some coherent thoughts.
  3. I have many different privileges that afford me the opportunity to share this story, without as much fear of painful backlash as some other women might face. And that’s messed up.

That said, this topic is hard to write and talk about. It still brings up grief and sadness that I frankly still often want to avoid. But it feels incredibly important, because stories and support are what helped me get through this immensely difficult experience. As a woman, I feel compelled to speak out for many reasons that I will explain further below (that is, this is related to health and well-being and your relationship to food and your body, and not just a random story about my experience).

“If we can let go of the shame and focus on the root cause, maybe then we could start making some headway.”

– Dr. Sumer Ledet

This episode includes the following:

  • My personal experience with miscarriage and grief
  • An overview of some of the stats about miscarriage and how weight is typically discussed in this arena of health (and how this applies to most other health arenas)
  • How correlation is different from causation and why we need to be super aware of this as we interpret research studies, and interact with medical providers
  • What you need to know to empower yourself or your loved ones as you move towards taking great care of yourself on this incredibly vulnerable journey that is trying to conceive and have the family you want (or again, this example pretty much relates to most health related concerns that are blamed on weight)

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Welcome! I’m so glad to have you. You might be wondering what this blog and podcast are all about.

We relate everything in this podcast back to motivation, but not the hustle and grind kind. Truly sustainable motivation that keeps you feeling energetic and engaged in your life for the long haul. We talk about why “I’m just not motivated” is a myth, and why the TYPE of motivation you have is so important to fully understand. If you are ready to learn about motivation and respecting your body in an effective way so that you can live a life you truly love, you are in the right place.

Check out the Foundational Episodes of the Motivation Made Easy Podcast here!

Do you ever worry that you are wasting your life?

I definitely did. In fact, I wrote that in my journal many years ago when I was in the middle of the diet-binge roller coaster ride.

  • I woke up every day thinking about food, my body, and what I would eat that day to “be healthy”
  • The notebooks I had filled with calories and points could fill up a spare bedroom
  • Social events and vacations immediately prompted the thought “they will notice I gained weight” or “I need to lose weight by then”
  • Deep down I knew I wasn’t living life the way I wanted to, but I didn’t know how to pull myself out of it.

If this is you, I want you to imagine what it would feel like to feel empowered in your body and proud of your choices on a consistent basis. I promise you, it isn’t too late.

Dieting steals our motivation. It makes us ineffective. It keeps us spinning our wheels in a system that was never built to work.

If you are ready take the first step to motivating yourself with what matters to you, download my free Cultivate Powerful Motivation guide (which is quite beautifully designed if I do say so myself), and walk through the 3 simple steps to cultivate motivation that works for YOU in 15 minutes or less. You will get a simple formula to write ONE SENTENCE you can use to motivate yourself on a daily basis.

You can write it on your bathroom mirror, put on the background of your phone, or just read it and repeat it in your mind.

Look, I know how much it hurts to live a life worrying you are missing out, not stepping into the person you were truly meant to be, vibrant, passionate, curious, vulnerable, and brave.

You can listen to the podcast all day, but taking that first step, putting pen the paper (or typing on your phone) is required for true change. It’s time to start living my friend.

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Our Pregnancy Loss Story

I don’t really want to tell this story. Not because I’m ashamed, but because even though I’ve processed the pain a great deal, it’s still incredibly intense and painful at times when I think about it in any focused way.

And yet, I feel compelled to. Because as immense as my pain is about our miscarriage, I had the privilege of going through that pain without the additional stress and strain of body shame, weight-biased medical information, or professionals or people implying, either directly or indirectly (or behind my back) that it was somehow my fault, something I could have prevented if I’d just “been healthier”.

This Career Girl Never Wanted Something so Viscerally

We were so lucky. We wanted a family and we got to have one.

When it came time to try for a second kiddo, my good friend was already recently pregnant. So if I got pregnant soon, we could be pregnant together and have kids of similar ages! I was excited, but incredibly anxious. It felt like pressure.

In my experience, entering the trying to conceive phase feels almost impossible to do without a degree of anxiety and pressure. And for me, it was palpable.

For more detail about the events leading to our miscarriage, please listen to the podcast episode.

What Does This Have to Do With Body Shame and Weight Bias?

So why am I sharing this here? And why so much detail? But I need us to reflect on some things. I am a white woman who has size privilege. I have immense privilege in my healthcare access and I still got bounced around. This experience was immensely painful for myself, my husband, and the family who knew about it. At one point, I talked to a good friend’s sister who was a physician to get a second opinion on the safety and risks/benefits of the D & C. Again, privilege.

And you know what else? The reason I’m sharing this here, is I got to experience this pain without the added stress or guilt of feeling like my body size or eating or movement habits had any role to play. Because of my body size, that was never implied.

And I know full well that if there was any indication by anyone that I might have done something or somehow been at fault here, I 100% would have blamed myself and had a harder time moving through the grief.

I’m NOT Suggesting that Many Women’s Health Physician’s Overtly Blame Women for Pregnancy Loss

Now to be clear here, I don’t think that it’s common for obstetrician’s to necessarily imply that miscarriages are caused by body size. At least, I hope that is rare. Though I wouldn’t be surprised to hear that has happened, it’s not something I’ve heard often.

But I do think the implication is there for many women. I’ve heard so many stories of weight bias in medicine and pregnancy care, it’s incredibly upsetting. I’ve heard things like:

  • Nurse says to newly pregnant mom (whose BMI is around 30): “we need to get you in RIGHT AWAY for your glucose test” and makes them to the intensive version of the test versus the standard version despite no other risk factors for gestational diabetes beyond body size
  • Comments like “better be careful” when mom gains 3 lbs in a week, without even checking the chart to see that she had lost weight the previous week (frankly, this comment is egregious no matter what the weight change was)

Research on Miscarriage, Fertility, and Weight

So what does the data say about miscarriage and weight?

As always, with research we have to look at the body mass index, even though there are many issues with this measure as a measure of individual health.

Like most health conditions, you don’t have to look far to find studies stating that obesity or being of higher weight is ASSOCIATED with poor health outcomes, and miscarriage and fertility concerns is one of these outcomes. A quick google search will tell you in no uncertain terms that having a BMI in the obese range is associated with higher risk of miscarriage. Sadly, much of the language used, even in peer-reviewed research appears to attempt to suggest a causal relationship. For example, using terms like the “impact” of obesity on miscarriage, fertility, etc.

The reality is, that correlation does not imply causation. Let me explain.

Sleeping With Shoes on Causes Headache?

I forget where I first saw this example, so my apologies to that person for not being able to remember it to give credit where credit is due. But one of my favorite examples of this concept is the idea that people who wake up with a headache (aka a hangover) have a higher risk of having slept with their shoes on. So do we assume wearing shoes to bed causes a headache?

We do not!

The “third” or “confounding variable” here is the fact that people falling asleep with shoes on are more likely to have consumed a lot of alcohol and that is very likely what’s causing their headache. That variable in this case explains the association completely, as we have no reason to think wearing shoes would cause a headache (unless I guess these were really tight shoes and restricted your blood flow or something).

The Data on Miscarriage

There is still a lot of misconceptions about miscarriage. One survey in 2013 of men and women found that 15% of respondents indicated that they or their partner had at least one miscarriage. However, 55% of respondents believed that miscarriage occurred in less than 5% of all pregnancies (Bardos et al., 2016).

In reality, miscarriage is the most common complication of pregnancy in the US, and occurs in 15-20% of clinically recognized pregnancies (Katz et al. 2012).

Most miscarriages (60%) are due to aneuploidy or the presence of one or more extra chromosomes or the absence of one or more chromosomes (Bardos et al., 2016).

The Correlation between Weight and Miscarriage

As noted above, there are several studies that note a correlation between weight and miscarriage, but as I put myself in someone’s shoes trying to navigate this research, I’m saddened by the fact that most of the online articles indicate a strong causal relationship, when the data just don’t support that.

The reality, from what I can find is that there is an association between women with a weight in the obese range (BMI over 30) and an increase risk of miscarriage. One relatively large study found a risk of miscarriage for women with a BMI in the normal range to be 10.7%, and those in the obese range to be 13.6%. I couldn’t find the data for the overweight range from this study.

But as we’ve talked about, there are many things that could be causing this, much of which that might have to do with weight (e.g., shame and weight bias and associated chronic stress), and some that may have nothing at all to do with it whatsoever.

Interestingly, a study by Zl et al., 2012 found that when they compared 467 women with recurrent pregnancy loss to 413 women without this history, there were no significant differences in BMI or average age, however, fasting insulin level was significantly higher in the group of women with recurrent miscarriage.

Looking at Root Causes, Not Weight

As we covered in my interview with Joanna Pustilnik, MS, RD on PCOS, insulin resistance is relevant, but can occur at any weight, and the standard advice to cut out carbs and lose weight is incredibly misguided at best, and can really harmful at worst.

See that post for suggestions that may be helpful to reduce inflammation, and remember that these guidelines can be followed in a flexible way, and a focus on weight loss is not needed and often incredibly counterproductive.

Take Home Messages about Weight, Miscarriage Risk, and Your Body

I debated sharing this story at all. I debated sharing it more succinctly. Less detail. Just be like “I had a miscarriage and that’s it.” But I felt that the details about the medical uncertainty, and waiting the pain were relevant.

Experiencing pregnancy loss is incredibly painful. And sadly, has always been and likely always will be incredibly common due to aneuploidy.

And yet, my grief experience would pale in comparison to someone having to experience that grief while also blaming herself. Blaming her body. NO ONE DESERVES THAT ADDITIONAL PAIN. That is what we in psychology call complicated grief.

That’s when grief and sadness becomes amplified, like the person who blames themselves for the death of another, who takes responsibility for it versus just the pure raw pain of grief that no one can change.

Here’s the thing: You deserve good quality information and health care that empowers you, shows you what is right with your body, and how to maximize and move towards optimal health and well-being. You deserve empathy and informed choice conversations around fertility. And other areas of health, of course.

There is a lot of uncertainty about miscarriage and no one can engineer out of it. The attempting to conceive journey is immensely vulnerable and I see zero way around that.

But please remember that if you or a loved one has a miscarriage, the odds are highest that it was spontaneous and would have occurred no matter what. It’s just a hard reality of how our bodies function to create human life.

You and your body deserve loving care, respect, and great treatment. You deserve to marvel at all it does for you and take steps to support what it might want to do in the future, be that birthing a child, writing a book, or caring for a loved one.

As women, frankly as people, we need to understand that science and research is biased towards the “smaller is better and healthier” weight-centric paradigm. It’s hard to go anywhere in the medical field without seeing the weight bias that is rampant, and women’s health isn’t an exception (of course there are providers who are exceptions!) And not only is it cruel and hurtful, it isn’t evidence-based medicine. It isn’t person centered and it always over emphasizes the role of weight and behavior in health outcomes, and minimizes the role of un-addressed factors.

We need more women to understand this data so that they can empower themselves against a weight-focused healthcare system, and surround themselves with people and providers who help them work with their body and not against it.

  1. Miscarriage or pregnancy loss is common across all body sizes. The most common reason for this is aneuploidy (the presence or absence of one or more extra chromosomes or the (Bardos et al., 2016).
  2. Correlation between weight and miscarriage occurs in some studies and weight ranges but does NOT imply that weight is the cause. Focusing on weight and weight loss rarely leads to better health outcomes and the shame and stress this causes is almost always counterproductive for optimal health (and therefore optimal pregnancy and fertility outcomes).
  3. We need more weight inclusive healthcare providers. Women will very often look for any excuse to blame themselves. We need to make sure they know it isn’t their fault, and focus on things they can control (like allowing themselves to process the grief without shame and guilt, and focusing on actual health promoting behaviors, versus weight loss). Healthcare providers rarely get this training, share this episode, or this previous episode where Dr. Jillian Murphy breaks down really well why the Health at Every Size movement is incredibly evidence-based.
  4. Finding a healthcare team that helps empower you is key. I cannot stress the importance of this enough. We don’t all have this privilege to easily find weight inclusive healthcare providers (E.g., providers who will help you de-emphasize weight and focus on root cause resolution and factors in our control), however, keep trying. Even though much of the healthcare system is broken, the more we ask for what we need, the more providers will need to meet that demand. Whether your team includes physicians, midwives, doulas, chiropractors, or physical therapists, try to seek out individuals who help you feel safe and trust your intuition when it doesn’t.

If you are struggling with infertility and/or pregnancy or infant loss, or miscarriages, I see you

Even typing this out and thinking about reading it makes me tear up. This is one of the most painful experiences I’ve been through in my life, and also one of the most influential. Thinking about it, as hard as it is, reminds me of what matters and fuels me to do work that matters to me.

After my miscarriage, I talked to my husband about making sure I left healthcare and did the work in the world I felt called to do (this blog and podcast, being one). The grief was immense, and maybe it’s me making meaning but it felt helpful.

If you are in pain, I see you, your experience is valid, and I hope you aren’t going through it alone.

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Disclaimer: This blog and podcast is for informational and educational purposes only. It is not a substitute for individual professional advice or treatment, including medical or mental health advice. It does not constitute a provider patient relationship.

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Credit: This blog post was written by Dr. Shawn Hondorp and edited by Julia Ledbetter.

References

Bardos, J et. al., (2016). A national survey on public perceptions of miscarriage. Obstetrics & Gynecology 125(6), 1313-1320. doi: 10.1097/AOG.0000000000000859

Boots, C., & Stephenson, M.D. (2011). Does obesity increase the risk of miscarriage in spontaneous conception: a systematic review. Seminars in Reproductive Medicine 29(6), 507-513. DOI: 10.1055/s-0031-1293204

Katz VL. Spontaneous and recurrent abortion: etiology, diagnosis, treatment. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, editors. Comprehensive Gynecology. 6. Philadelphia (PA): Elsevier Mosby; 2012. pp. 335–359.

Wang Y, Zhao H, Li Y, et al. (2012). Relationship between recurrent miscarriage and insulin resistance: a meta analysis. Gynecologic and Obstetric Investigation 72(4), 245-251. DOI: 10.1159/000325165. PMID: 21952420.

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