Nutritional recommendations during pregnancy are often predicated upon maternal preconceptional nutritional status; thus, attention to preconceptional risk factors may reduce the burden of ‘‘catching up’’ during pregnancy. However, improving nutritional status before pregnancy is problematic because a large proportion of pregnancies in the United States are not planned, and, even among women planning pregnancy, few seek medical or nutritional advice before attempting pregnancy. Further, most women do not have their first prenatal care visit until well into the first trimester 1