Big Babies

I have a lot of fears in this pregnancy. The biggest one is obviously the baby not being OK. Nothing else really matters compared to that. But in the back of my mind there is also a strong nagging concern about the size of the baby, and it’s all because I’ve grown up hearing the sweeping generalisation that “women with diabetes have big, fat babies”.

“Big Baby Syndrome”, more correctly called macrosomia, is defined most commonly as a baby weighing more than 4 – 4.5kg at birth regardless of gestation. Large for Gestational age is similarly defined but, as the name suggests, takes in to account the gestation of the pregnancy. A large baby is defined as one that lies above the 90th centile for that gestation.

Macrosomia is also the number one cited risk associated with a diabetic pregnancy. It’s the first thing that people will mention and often the only thing that they know about having a baby as a person with diabetes. The risks from macrosomia relate mainly to delivery. Premature labour is more common if the baby is large for gestational age. Vaginal birth may be more difficult, with an increased risk of shoulder dystocia and fetal distress, leading to a higher chance of instrumental assistance or caesarean section. Fortunately in the majority of cases everything turns out fine. It’s rare that a complication such as shoulder dystocia will lead to peri-natal death of either the mother or baby. It is obviously a tragedy if it happens, one that doesn’t bear thinking about, but it’s not what makes me fearful of birthing a big, fat baby.

I’m simply afraid that people will judge me and my diabetes control, or lack thereof, if I happen to have a child that is larger than average. For women with diabetes, the size of their baby at birth can feel like a judgement. A branding statement of how well they took care of themselves.

The fact is, though, that whilst diabetes – both pre-existing and (especially) gestational – is the biggest single cause of macrosomia, many healthy women also have big babies. There are many contributing factors – genetics, the baby’s gender, race and precise gestational age at birth. But as soon as your maternity record is marked with diabetes, these factors get overlooked. You may have looked after your diabetes in the very best way possible, done all that you could and achieved near-normal blood glucose levels, but the immediate assumption will be that failings in the management of your chronic health condition are the cause of the size of your baby even if, in fact, you were destined to have a larger child for other reasons.

Furthermore, whilst larger babies born to non-diabetic mothers will tend to be declared to be “bonny” and “a good size” and regarded as healthy, larger babies born to mothers will diabetes will be deemed to have been put at risk by their mothers before they were even born. This is despite good emerging evidence that low birth weight actually carries more potential for future health problems than normal or higher birth weight.

Sadly, for diabetic women everywhere, having a big baby has become synonymous with “failure”. I’m no exception. I know that I’ve worked hard and can’t do better. My A1c has been sub 6 since pre-conception, falling in to the fours in the second trimester. The best numbers of my life. An A1c in the fours is “normal” (for which read non-diabetic). Yet if I have a big baby, I’ll feel guilty. I’ll feel like I didn’t do a good enough job. And I’ll feel like my baby’s weight is a scarlet letter on my birth record.

I wish that I could change my tendency to worry too much what other people think of me, and instead just focus on myself and all the positives. But more than that I wish I could banish this notion of failure. But I know that won’t be easy. I know that I’ll continue to experience recurrent dreams of my baby tipping the 12lb scale, and I’ll continue to rehearse a little speech justifying my baby’s birth weight should that dream happen to become reality. Because really a healthy baby is a healthy baby, and weight is not the only measure of that.