A little while ago, over on my personal journal, I put up a rant about the generalized inconsistency of gestational diabetes testing procedures. I'm lucky enough to have avoided a GD diagnosis, but because I am overweight and because my family does have a history of both GD and Type II diabetes (though the Type II seems to mostly be in the men), it was something that very much weighed on my mind until I got through the test.
Anyway, from the research I've done on the topic, the part that is particularly pissing me off is the assumption that a large baby is in and of itself, without any other confounding factors a medical problem. In the opinion of some doctors, any baby that comes out at or above the 90th percentile for size is BAD, regardless of whether or not there are any related health problems. I do understand that there is something called "pathological macrosomia" (body develops excessively large in proportion to head), which really IS a problem, but hello, I'm a large woman (leaving aside the weight issue for now, I'm also 5'11", which is somewhere at or above 90th percentile for a Caucasian woman) so why would it be a surprise or a sign that Something Is Horribly Wrong if I happen to give birth to a large baby (somewhere around 9 pounds or so)?
It seems like a lot of the treatment protocols for GD are less about keeping the mother's blood sugar balanced than they are about restricting her diet so "the baby doesn't get too big." WTF? Is it any wonder that eating disorders are so prevalent and that this culture has such a fucked-up relationship to food when doctors are ENCOURAGING mothers to put their UNBORN children on diets?!
For that matter, I'm not so fond of the percentile-based children's BMIs, for diagnosing a child as either overweight or underweight. Somebody has to occupy the percentiles involved, and I don't think that it's inherently unhealthy. I do think that poor nutrition is unhealthy. I do think that maintaining a weight either above or below what feels comfortable and natural (outside of ED-related distortion) is not the best idea. But if you define "overweight" as the 85th percentile or higher and then complain that "15% of kids are overweight"...well, that's just stupid. That's like complaining that 50% of kids score below the median on a standardized test.
The pregnancy aspect of it just infuriates me, though. I'm a large woman (partially because of the years of struggle with BED, and partially because I'm just meant to be big - I can't see myself as healthy or comfortable with a BMI much below 25, I think somewhere around 26-27 is going to be where I settle in the long run), but I am otherwise in *excellent* health by just about anything else that medical people use to measure - I'm not diabetic (gestationally or otherwise), my blood pressure and cholesterol are well within normal limits, and I eat my veggies and exercise, and I'm not doing anything stupid like drinking alcohol while pregnant. If overweight but otherwise healthy pregnant women are treated like disasters in the making, given that most of us do carry a fair amount of guilt about our size (especially when it's confounded by an ED, as it is in my case), and then we're continually harped on about making sure the baby "doesn't get too big" (which apparently happens to some overweight women even *without* a GD diagnosis), what kind of attitude does that set the poor mom-to-be up about how to feed her kids? I think that a lot of eating disorders *do* have their roots in the family's attitude about food - mine certainly does, and I'm pretty sure my cousin's does as well - so WHY are we starting this crap when the poor kid's still in utero? Grrrr.