The position, published in the May issue of the Journal of the American Dietetic Association, represents the associations' official stance on obesity, reproduction and pregnancy outcomes:

Given the detrimental influence of maternal overweight and obesity on reproductive and pregnancy outcomes for the mother and child, it is the position of the American Dietetic Association and the American Society for Nutrition that all overweight and obese women of reproductive age should receive counseling prior to pregnancy, during pregnancy and in the interconceptional period on the roles of diet and physical activity in reproductive health, in order to ameliorate these adverse outcomes.

The joint ADA/ASN position and accompanying paper were Anna Maria Siega-Riz, PhD, RD, LDN, assistant professor of maternal and child health at the University of North Carolina; and Janet C. King, PhD, senior scientist at Children's Hospital and Research Center, Oakland, Calif.

An estimated 33 percent of U.S. women are obese, according to the authors, who write that a long-term goal of health professionals must be to reduce the number of women who become pregnant while obese. They add that the effect of a woman's nutritional status prior to pregnancy is an issue of great public health importance.

"Among obese women, who already have aberrations in glucose and lipid metabolism, the further adjustments induced by hormonal changes in pregnancy create a metabolic milieu that enhances the risk for metabolic disorders such as gestational diabetes mellitus and preeclampsia," according to the position paper.

Infants born to obese mothers have "a higher prevalence of congenital anomalies than do offspring of normal-weight women, suggesting that maternal (obesity) alters development in the sensitive embryonic period." The authors note neural tube defects such as spina bifida and anencephaly are about twice as common among children of obese women. "Other birth defects more frequent in offspring of obese women include oral clefts, heart anomalies, hydrocephaly and abdominal wall abnormalities."

Objectives of the new ADA/ASN position are to provide guidance to nutrition professionals in becoming aware of risks and possible complications of excess weight and obesity for fertility, course of pregnancy, birth outcomes and short and long-term maternal and child health; and to commit ADA and ASN to identifying gaps in scientific research needed to improve knowledge of risks and complications and develop effective strategies "that can be implemented before and during pregnancy as well as during the interconceptional period," the authors write.

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