I have read with interest the recent “Clinical Opinion” in your February issue authored by Phelan and generally agree with her statements. However, the article is incomplete, not current, and did not comment on the first randomized clinical trial evaluating the perinatal outcomes in obese pregnant women. That controlled trial, with appropriate power, studied behavior interventions which included asking patients to keep a daily food diary, monitoring their food intake, and placing these obese women on a well-balanced, nutritionally appropriate diet.

As suggested in her article, behavioral targets set by physicians is a laudable goal. The “teachable moment” for weight control is the active involvement of the practitioner by encouraging and reinforcing healthy eating habits in obese women; before, during, and after pregnancy. Contrary to the recommendations in the “Clinical Opinion” that one should adhere to the revised Institute of Medicine (IOM) guidelines, Artal et al questioned the new guidelines and recommended that gestational weight gain should be more individualized, especially in obese women.

The aforementioned randomized clinical trial did find that maternal-fetal outcomes of women in the study (monitored) group who gained little or no weight had perinatal outcomes that were equal to or better than those who gained substantial weight. Therefore, practitioners should seize the opportunity to monitor weight during the antenatal period to better serve their patients.

Thank you for allowing me to voice my opinions regarding this article.