To the Editor:

Re “Pregnant, Obese ... and in Danger,” by Claire A. Putnam (Sunday Review, March 29):

Dr. Putnam could not have been more on the mark about the dangers of obesity in pregnancy and childbirth. While those of us in the field know very well how challenging pregnancy and childbirth are in the obese population, it is considered inappropriate to hammer away at it. In view of the fact that most of these women have tried for years to lose weight and have not succeeded, that seems reasonable.

However, the modifiable factor that is in the obstetrician’s reach is how much the patient will gain during pregnancy. If an obese woman gains very little weight — and this is where encouragement from her obstetrician will help — she and her baby will do better.

I am known for nudging my patients about diet and weight gain, and I am often battling deeply entrenched notions about starving their fetuses, standing in sharp contrast to some colleagues of mine who reassure their patients that they can eat what they want.

I am sometimes less popular for this, and have lost patients for my “old-fashioned” strictness, but I am doing what I can to avoid all the known dangers of obesity in pregnancy, including, by the way, stillbirth.