The sad truth is that an estimated 1 in 4 people will experience pregnancy loss in their lifetime and whatever the reason that it happens, it’s not your fault.
Although pregnancy loss is becoming more talked about, the same isn’t true for people who experience loss with a higher BMI (BMI stands for Body Mass Index and is a bullshit calculation based on height and weight)
For those of us in fat bodies, the message we are given is still very raw and very blunt. Our bodies are the reason that we cannot maintain a healthy pregnancy and if we could only lose weight, then we would be able to have a healthy pregnancy.
Doctors will often take the “tough love” approach and tell people that losing weight is their only option and that they cannot access medical support, tests and treatment to help them maintain a healthy pregnancy until they’ve lost weight.
So what is the reality? Does the research support the idea that we need to lose weight in order to be able to have a healthy pregnancy?
In this post, I’m going to explore the research, the raw experience of dealing with pregnancy loss in a bigger body and some practical ways you can move through pregnancy loss and access the support that you need.
The terminology
Before we dive into the research, it’s important to note that pregnancy loss and miscarriage have defined criteria and the label that you are given will impact how your loss is dealt with within the medical field. Although I do not agree with the language used in the medical profession, it’s important to be aware of what each term means so that you can better understand what tests and treatment might be available to you when you are working with your healthcare team.
Chemical pregnancy/Early Pregnancy Loss – This is the term used to describe an early loss, normally up to around 5 weeks and before the foetus will be detected via ultrasound. Often you may only be aware of a chemical pregnancy due to the fact that your period is late or you’ve had a positive pregnancy test followed by a negative one a couple of weeks later.
Clinical Pregnancy Loss – A loss that occurs between 5/6 weeks up until 24 weeks.
Stillbirth – The term stillbirth is used when you experience pregnancy loss after 24 weeks gestation.
Recurrent Miscarriage – Recurrent miscarriage is used to describe the situation where you have had three miscarriages in a row. You should then be offered tests to investigate if they can find a cause for the losses. Sometimes a cause isn’t found.
We will go into more depth about what to do if you are experiencing recurrent miscarriage later in the article. One thing I want to make very clear now though – your weight is NOT a cause of recurrent miscarriage. If your doctor tells you this, then you can show them this document and ask them to treat look at the known and possible causes so you can access the treatment that you need.
The Research about miscarriage and BMI
Before we dive into the biomedical research around miscarriage and BMI, it’s important to frame the research. All scientific research is done by human beings, people who view the world through their own filters and their own bias. Science is not the ultimate truth, it’s the exploration of our world through our eyes. The majority of research done on fat people is done through the bias of “fat is unhealthy” and that assumption is never questioned.
Don’t get me wrong, I love science! I two degrees in science-related fields (Physical Sciences and Medical Physics) and I’ve worked within the healthcare sector for years, but science is limited by the people who are performing it.
Reading this research may be triggering, it was triggering for me and pregnancy loss is not part of my story. Please proceed with caution through this section and avoid it if you need to. I have also used the O-words throughout this section, in line with how the research is quoted.
“Maternal Obesity” edited by Matthew Gillman and Lucilla Poston, is a succinct view of how fat bodies are viewing in fertility and pregnancy medicine and one I regularly use to explore how the research explores fat bodies in this field.
In their research of early pregnancy loss, they found four studies that looked at early pregnancy loss and obesity, only two of which showed an association between BMI and early pregnancy loss. They lead with the study that shows the highest association, which showed that in a group of 383 women undergoing IVF/ICSI, the rate of early pregnancy loss was double for overweight or obese women when compared to lean women. In the next study looking at 2660 women, the data showed early pregnancy loss occurred in 4.8% of pregnancies for normal weight women, 5.4% for overweight women and 7.8% for obese women. However the two largest studies (here and here) representing 7696 IVF/ISCI cycles, showed no relationship between BMI and early pregnancy loss.
Looking at clinical pregnancy loss, a large meta-analysis showed that women with a BMI over 25 had a 67% greater chance of experiencing a miscarriage when compared with a woman with a normal BMI. This does not mean you have a 67% of having a miscarriage. It means that if 10% of women with a normal BMI have a miscarriage, their research suggests that 16.7% of women with a higher BMI will have a miscarriage. They also found a further 8 studies that had been undertaken since the meta-analysis, 3 of which found no evidence of a link and 2 of which showed a link with no statistical significance, leaving only 3 that actually showed a statistically significant link.
What this means is that the research is messy! There is no clear connection, some studies show a link, some do not. It is the researcher bias that leads to these links becoming “fact”.
There has been no mechanism found to explain the authors conclusions, however they suggest that glycemic control and insulin resistance may be important mechanism. Both these factors can occur in people of all sizes and both these factors can be supported without weight loss or dieting.
None of these studies take into consideration two other major factors that fat people face around their health. They are weight cycling and weight stigma. There is a lot of evidence to suggest that both these factors play a huge role in increasing fat people’s risks around their health in every area.
Weight cycling is the term used to describe what happens when we yo-yo diet. Our weight goes down and then our weight often goes back up. This cycle happens as often as we diet, going down and up. Research shows that this variation in weight does have a negative impact on our health and can explain increased risks in our health outcomes.
Weight stigma is the effects of the discrimination that fat people face. When we are judged and shamed by our healthcare professionals, this leads to a delay in tests, diagnosis and treatment for fat people. This delay has a measurable impact on our health.
Even if we take these increased risks at face value, they are not as high as is often expressed in the media and by our healthcare team. It’s important to know that the increased risks by be there so that you can fully consent to them but it is more than likely that you will be willing to accept these potential risks for the benefit of becoming a parent.
Although I believe that the majority of these risks are due to weight stigma and weight cycling, it’s really important to be informed so that you can consent fully.
Below are the absolute risks with the risk for someone in a smaller body for comparison from a couple of research papers.
|
Body Mass Index (kg/m2) |
Percentage of people with early miscarriage |
Percentage of people with late miscarriage |
Percentage of people with recurrent miscarriage |
|
19-24.9 |
10.5 |
2 |
0.1 |
|
Above 30 |
12.5 |
2 |
0.4 |
|
Body Mass Index (kg/m2) |
Percentage of people who experienced a stillborn |
|
18.5-24.9 |
0.16 |
|
Above 25 |
0.26 |
If you think you might be experiencing a pregnancy loss
If you are at all concerned about any symptoms that you are experiencing during pregnancy, immediately reach out to someone in your care team. If you are experiencing anything unusual, it doesn’t mean that something is wrong but it is essential that you get them checked out by your team as soon as possible.
Signs and symptoms that you may experience during a pregnancy loss include:
Pain – If you experience any kind of abdominal pain or shoulder pain during your pregnancy, contact your doctor immediately. Pain can be a normal part of the process but you should always get it checked out.
Bleeding – If you are bleeding during your pregnancy, it might not be anything to worry about, but again it’s something that needs to be checked as soon as possible. You may notice spotting when you wipe, or the bleeding may be heavier.
Around 16-24 weeks, you will begin to notice movements. The movements will change over time. If you ever notice a reduction in how often you are feeling the movements, contact your midwife immediately.
If you notice any of these symptoms contact someone on your healthcare team. That could be your doctor, your midwife or your consultant and inform them of the symptoms you are experiencing.
You may be advised to come in for a scan to investigate what is happening.
Unfortunately there is nothing you can do apart from rest and wait. If distraction helps, binge watch your favourite sitcom or throw yourself into a favourite hobby.
If you are worried about contacting your doctor or healthcare team for advice for any reason, find someone who can support you in accessing that support. Can your partner call the doctor for you? Do you have a close friend or family member who is able to call and/or go with you?
If you are experiencing a pregnancy loss
If you are experiencing a pregnancy loss right now, I am sending you so much love. No matter what stage of pregnancy you are at, this process can feel like grief.
Seek support. If you are able to, find someone who is able to support you in a non judgemental way. This could be your partner, a friend, a family member, a weight-neutral therapist or a coach like me (link to coaching page)
Get care for your healthcare team. When you are going through a pregnancy loss, this will look different depending upon what stage of pregnancy you are at. No matter what stage you are, you should still receive respectful and appropriate care from your doctors. They should absolutely not comment on your body or your ability to carry your baby. You should not be judged or made to feel ashamed in any way.
If you experience any type of negative comments from your doctor, I want you to know that it is nothing to do with you and everything to do with them and it is not acceptable. You may have some power in the situation or you may be capable of doing nothing.
Please just do what you are able to and have the energy for. This may be:
– immediately asking to see another doctor/nurse
– you or someone else you are with telling the person that what they said is not acceptable or appropriate and that they must refrain from saying anything else
- filing a complaint about the person later
Here is quick response you can use if you need it right now
“It is not ok for you to make that comment about my body/health. Please do not make any further comments like that”
Taking care of yourself after pregnancy loss
If you have recently experienced a miscarriage, I am sending you the biggest hug you can imagine. There is no right way to feel and there is no right way to process this. I’ve put together a collection of commonly asked questions that might help you move through the next few months with a little more ease. Take what you feel will be helpful for you and leave the rest.
How do I talk to my family and friends about my miscarriage?
It is a personal decision who you talk to about your loss. You can tell everyone or you can tell no-one. It’s ok to pick one or two people to share this with and not tell others. Your needs are the most important so decide who you tell based on what support you need right now.
It’s ok if you are afraid to tell people because you are worried about what they will think or say. In our society, we are conditioned to believe that being fat is unhealthy (Body Respect by Lindo Bacon is a great book to move away from this belief) and you might be worried that people will blame your weight and therefore you for your miscarriage.
Right now, your job is not to convince people that it wasn’t your fault you had a miscarriage. Your job is to look after yourself in the best way that you can and that includes taking really good care of your mental health.
Who can you talk to that you are not afraid will judge you and blame your body size? If there is no one you can think of, consider speaking to a fat positive professional like me or another HAES aligned professional.
Tips for your family and friends
If you have friends and family who you would like to support you but you are not sure what they will say, send them this link and ask them to read the below section:
If you have a friend or family member that has just experienced a miscarriage, right now they need your support. They have told you about their loss because they need you to help them pick up the pieces of their dreams and help them figure out how they can move forward with their lives again.
Now is not the time for advice. They don’t need you to tell them what they did wrong or what they can do in the future to stop this from happening again. They don’t need diet plans, or weight loss ideas or lifestyle advice.
Don’t tell them that, “it’s all going to be ok” and “at least you know you can get pregnant” or “you can try again soon”. None of these words will bring back the future that they thought they had.
What you can do is sit with them, listen to them, ask them what you can do to help.
You can say “I’m sorry this is such a shit situation”
You can bring them meals and snacks. You can send them thoughtful gifts.
You can text them and tell them you are thinking of them.
Right now they need your love and your support.
Supporting your mental health after a pregnancy loss
Acknowledge the grief
Experiencing any kind of pregnancy loss is a form of grief. No matter where you were in your pregnancy, not only did you lose your pregnancy, but you lost your future with your baby. You lost the day you thought you’d bring your baby home, the time you thought you’d spend together in the room you might have already decorated, every future memory you thought you’d make as a family. Even though you may have never met your baby, it’s ok to grieve all that you lost.
Be ok feeling ALL THE EMOTIONS.
Your feelings and emotions will change. They might change daily or even minute by minute. You might go from feeling sad to angry to frustrated to hopeless all in one breath and that’s ok.
You don’t have to bottle anything up. It’s ok to allow whatever emotions are there and to express them.
Honour your needs
In the same way that your emotions will change, your needs will change too. Sometimes you will need closeness and physical contact with your partner or another close friend. Sometimes you will need to be alone. Sometimes you will need the release of sobbing your heart out and sometimes you will need a big glass of wine/gin.
Honour those needs. Trust that you know what you need at any moment and go with it. Ask yourself regularly “what do I need now?” and make sure you are meeting those needs, even the most basic ones like going for a wee, having a drink or grabbing a snack.
What story are you telling yourself?
When you have healed a little and are ready to explore, dig into the stories that you are telling yourself about your experience with pregnancy loss. What are you making this experience mean about you?
Are you telling yourself that you will never be able to have a healthy pregnancy? Do you believe that you caused your miscarriage? Do you believe that it’s your body’s fault? Are you afraid to get pregnant again because you believe that you will have another miscarriage?
Think about which parts of these stories are based on facts and which parts are built from things that others have told you or that you have told yourself.
Acknowledging those beliefs is the biggest first step to changing them. What do you want to believe instead?
Dealing with pregnancy news after miscarriage
Getting the news that someone else is pregnant when you’ve suffered a loss is hard. You are not a bad person if you don’t immediately congratulate them and feel happy for them. It is completely normal to feel angry and jealous that they are pregnant, no matter whether it’s your best friend, sister or a colleague at work.
Get your needs met first. If you need to not be around that person for a while, that’s ok! Let them know (or ask your partner/close friend to let them know) that you are happy for them but you are struggling a bit right now and you’ll be back in touch when you are able to be.
Think about what you need and ask for it. Maybe you still want to spend time with that person and that’s ok to. Decide whether you want them to talk about their pregnancy or not and ask them to honour that boundary for you.
If it’s someone that you can’t avoid, like a work colleague or family member, think about how you can minimise contact with them if that’s what you need.
Supporting your physical health after a pregnancy loss
If you hold the belief that your weight is the reason that you had a miscarriage then your first thought will probably be that you need to go on a diet.
I’m not here to tell you that you can’t do that. It’s your body and that means that it’s 100% your choice what you do with it, but I want you to make decisions based on all of the information.
We know that diets don’t work. There is no evidence that shows any intentional weight loss plan working long term (long term is more than five years) Yes, weight loss plans will help you lose weight in the short term but the majority of people will then go on to regain the weight. If you are in a bigger body, I’m sure you’ve had this experience too.
The only sure results you’ll get on a weight loss plan is that it will mess up your relationship with food.
We are also making a huge assumption that being in a bigger body is the reason you experienced a pregnancy loss, therefore losing weight will fix the problem. We have talked about the research above and the huge problem with the research is that it does not take into account the experience of the people in the studies. I can guarantee that every single person in their study with a high BMI will have experienced periods of yo-yo dieting. They have also existed in our society where people in bigger bodies are told that every health issue they experience is due to being fat. This leads to people not receiving diagnoses and treatment for health conditions as quickly as their thinner counterparts – and means their health outcomes are worse.
You don’t have to throw yourself into a diet right now.
So what can you do?
We don’t know of any way of reducing your chances of having another miscarriage specifically.
But what you can do is look after yourself in the best way you can. This will look different for everyone but I always recommend that people:
- make sure they are getting enough rest
- make sure they are eating enough
- find a way to move their body in a way that feels good
If you want more specific advice, I work 1-1 with people to help them figure out what will work for them
When will I be ready to try again
Only you know the answer to this question. Sometimes you periods may take a little while to return to normal. Sometimes you need more time to process what happened. I know you feel like time is never on your side but you do not have to rush this. Take a big breath and trust that you will know when you are ready to try again.
Recurrent Miscarriage and BMI
Recurrent miscarriage is the term used when you experience three or more miscarriages in a row. This includes chemical pregnancies where you are only pregnant for a short time. Unfortunately you are not given the diagnosis recurrent miscarriage if you have a live birth between your miscarriages.
This term is important as you can normally only access support and additional tests once you’ve been diagnosed with recurrent miscarriage.
Sometimes a cause will be found and sometimes the tests will show nothing, but it’s helpful to rule these things out as some of them can be treated effectively
What help can you get
You may experience some resistance to getting these tests and the doctor may blame your weight for your recurrent miscarriage but whilst there has been shown to be a higher risk for people in bigger bodies (see research section above), that doesn’t mean that you should be denied testing.
The known causes of recurrent miscarriage from The Miscarriage Association in the UK are:
Antiphospholipid syndrome and other blood clotting conditions
Abnormal chromosomes
Cervical weakness
Other possible causes could be:
Abnormally-shaped uterus
PCOS
Infection
Immune problems
Diabetes
Thyroid conditions
Although weight is highlighted as a risk, it is not a known or possible cause of recurrent miscarriage. You should be able to access tests and treatment in the same way as anyone else.
You may need to learn to some skills in advocating for your body but it is your right to appropriate healthcare treatment
The one thing that I want you to takeaway from this post is that you are worthy of becoming a parent and you are worthy of receiving the care that you need in order for this to happen.
The evidence is mixed as to how being fat impacts the risk of pregnancy loss, but regardless of whether that risk exists or not and why it exists, you are a human being and you deserve to be supported with care and respect at the vulnerable time.
Additional resources
Jen’s @plusmommy miscarriage story
