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Docs Should Talk About Weight

The report noted that the link between maternal obesity and neural tube defects has been confirmed in numerous studies. Neural tube defects are among the most serious and common birth defects in the United States. Each year, an estimated 2,500 babies are born with these defects, and many other affected pregnancies end in miscarriage and stillbirth. The most common neural tube defect is spina bifida, which is a leading cause of childhood paralysis. The research suggests a doubling of risk for babies born to obese women, compared with those born to normal-weight women.

The risk is still very small -- two affected births for every 1,000 among women who are obese instead on one in 1,000. But Scialli says while this is not a huge number, it is not insignificant.

"There are 4 million pregnancies in the U.S. each year, so two in a thousand still ends up being a lot of kids," he says.

And while folic acid supplementation helps protect everyone from the birth defect, obese women who got enough folic acid were still twice as likely as normal-weight women who also got enough to deliver babies with neural tube defects.

Scialli says health care providers must make sure that their patients know about the risks.

"The point is not to bash obese women and make them feel bad," he says. "It is to make health care providers aware of this, because they are in a position to make a difference."

The American College of Obstetricians and Gynecologists (ACOG) put out a similar message last fall, calling on ob-gyns to evaluate all of their patients for obesity and to inform patients of potential pregnancy complications associated with carrying excess weight.

ACOG former President Vivian M. Dickerson, MD, says ob-gyns have an obligation to discuss the dangers of obesity with their patients.

"While the topic may make us uncomfortable, in that we feel we may offend our patients, we should take a more direct approach in helping to identify their health risks," she says.

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