Obesity, diabetes, and links to congenital defects: a review of the evidence and recommendations for intervention.

OBJECTIVE:
To review evidence on the link between obesity and diabetes in pregnant women and the incidence of birth defects. In addition, the article offers recommendations for facilitating the broader scale implementation of evidence-based approaches to preventing obesity, particularly among pregnant women.

METHODS:
A review of the evidence, primarily from epidemiologic studies, linking obesity and obesity-related metabolic disturbances in pregnant women to a range of birth defects. It also reviews potential mechanisms by which obesity and diabetes during pregnancy lead to damage in the developing embryo and highlights some evidence-based approaches to prevention. Finally it reviews policy options for positively impacting obesity and diabetes in this population.

RESULTS:
Obesity and diabetes are a growing problem in the US population. This problem is particularly acute among women of childbearing age because the combination of obesity and diabetes is toxic to the developing fetus, which each contributing independently to embryopathy.

CONCLUSIONS:
There is an urgent need for a national strategy for combating the growing and related problems of obesity and diabetes in the population. This strategy needs to encompass a spectrum of tax breaks, economic incentives, legislation, and educational approaches in order to be effective.