The big baby thing? (Maybe paging Caryn?)

[angieb]

I had a growth ultrasound yesterday and DS2 was measuring 4 lbs 9 oz (30.5 wks), which seems crazy big to me. I'll take a big baby vs. an IUGR baby any day. They didn't tell me his percentile and I didn't catch it, but his measurements were easily 3 weeks ahead. (I easily passed my GD test, though I suspect my MFM may make me redo it on Monday when she sees this report.) DS was 7lbs 4 oz at 36 weeks, so not small by any means, either, but I don't think he ever measured this far ahead.

Monday I was spilling +1 on a dipstick test and gained 7 lbs between my morning and afternoon appointments. Doing a 24 hour urine today, and just feeling more swollen suddenly, only other concerning symptom is heartburn, my blood pressure has been fantastic like 100/60's. (But in my first pregnancy, I had a clear diptest and my blood pressure stayed mostly normal, I had gotten swollen and a huge jump in weight a few weeks prior to the upper right quadrant pain starting.)

Anyway, my doctors seem appropriately concerned, baby has good fluid levels and did well on his NST, we'll see how the 24 hour urine looks.

I was just wondering if you could explain the large/small baby connection and if you have any links/studies for that, (I'd rather not mess with the glucose test again if it's more likely to be pre-e related.)

Thanks.

[marilyn621]

I'm wondering about this as well. They didn't realize I was preeclamptic with my first but told me I was measuring too small. Baby came out at 8 lbs 2 oz (although I DD go three days past my due date) and this one is measuring almost 2 weeks ahead.

[sam10]

I found this thread re: big babies and PE

viewtopic.php?f=12&t=42876

How are you doing today? Have you received results of your 24-hour urine?

[angieb]

Thanks for the link!

Feeling normal, but definitely getting some swelling in my hands (they keep going numb) and face as well as my feet. Constant heartburn but it's not URQ pain. My blood pressure has been really good (like 100's/70's), 31 weeks today.

The lab said they may not have the results back to my doctor until this afternoon, so I figure I won't hear from them unless it's pretty bad, and I have an appointment Monday so not going to bother calling as long as my BP and everything else seems normal enough. I don't think they'd do bedrest or anything like that just for protein levels, and for all I know, they may still be well within normal.

[sam10]

The facial and hand swelling sounds concerning and it seems something is up. Did they do labs last time?

[angieb]

Yeah, they did labs (AST and ALT levels and I think uric acid or something) with the 24 hour urine. I'm not too worried about HELLP just yet, even though I have heartburn, I know it is definitely different from the URQ pain I had in my first pregnancy.

For me, it's hard to say how much is in my head and how much is trouble brewing, I'll be interested to find out my 24 hr results on Monday.

[jules2]

Hi

Hope it goes well on monday. The facial swelling is worrying for you though

I am now 31 weeks too, but my baby just appears to be average sized and all ok so very lucky here (so far....)

Best wishes

[caryn]

Sorry to be so late with this. I've actually been thinking hard about this idea after this study came out. Basically, it argues that the constraint on humans isn't the brain ----> pelvic outlet problem, but the problem of overburdening the maternal metabolism. Which I think handles preeclampsia *better* than the traditional obstetric dilemma explanation, since brains are energetically demanding things to grow.

So yes, in preeclampsia there's a known U-shaped curve if you plot baby weights for gestational age at delivery. That curve seems to be the consequence of a dispute between maternal and paternal genes over how much energy is provided by the placenta to the baby. (The obstetric dilemma would say that's because the kid would grow too big to fit out if we let it have as many calories as the dad thinks would be a good idea; this new hypothesis would say that's because the maternal metabolic rate can't go that high - we just can't put any more energy into growing that baby.) All placentas have varying degrees of depth of implantation and all preeclamptic placentas have varying strategies that they are using to compensate for the shallow depth. (For example, a lot of us only put on water weight and postpartum drop below our starting weights, because the placenta has used the strategy of cannibalizing our muscle tissue during gestation.)

On this view, some of the offspring are small for gestational age - probably because the placenta was very shallowly implanted, and the strategy of ramping up our metabolisms still didn't supply enough nutrients and oxygen to push that offspring into the middle of the curve. Some of the offpsring are large for gestational age - probably because the placenta was able to compensate with these other strategies, the kid grew bigger than average, and we hit our metabolic rate limit and delivered.

One strategy available to the placenta when it's shallowly implanted is inducing gestational hypertension, and another is inducing gestational diabetes, so even if the two are related, the glucose test will still give you useful information. Some shallowly implanted placentas *don't* turn into hypertension, just IUGR - presumably in those cases the paternal strategies are blocked by the mother. We're still working on this, though, because it's what they call "multifactorial and heterogeneous" - lots and lots of different genes and strategies in play. The theoretical architecture is nice for explanations since we can't generate an entirely empirical proximate cause yet.

How are you doing now?

[angieb]

Thanks for the explanation! Are you sure you aren't a scientist?

We are hanging in there, a little over 32 weeks, my 24 hour urine a couple weeks ago came back 700 mg so they gave me steroids just in case, but blood pressure is still doing very well and not really having any other signs of preeclampsia other than swelling (which is moderate, lately.) Baby is passing NST's easily, so right now we're just being watched closely and seeing what happens. My MFM made it sound like she might deliver just from spilling protein alone if we get in the 5000+ range, probably more because of my history.

[caryn]

I only brunch with scientists. Glad to hear you're still hanging in there!