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Weight Gain During Pregnancy: Reexaming the Guidelines
disease activity at conception. Fonager et al. (1998) reported a decrease in birth weight and increased preterm delivery in women with active Crohn’s disease at conception. Similarly in women with lupus complicating pregnancy, pregnancy outcomes are improved if lupus has been quiescent for at least 6 months before conception (Cunningham et al., 2005).
Although as many as 70-85 percent of pregnant women will have nausea and occasional vomiting in pregnancy (Jewell and Young, 2003), this often resolves by the second trimester. There are usually no long-term sequelae, and treatment is mostly symptomatic including avoidance of certain foods and eating small frequent meals. However, approximately 0.5-2.0 percent of pregnant women will develop hyperemesis gravidarum (ACOG, 2004). The most commonly cited criteria for hyperemesis gravidarum include: persistent vomiting unrelated to other medical conditions, ketonuria, and weight loss of 5 percent or greater of prepregnancy weight at < 16 weeks’ gestation (Goodwin et al., 1992). Other associated findings include dehydration, ketonuria, and electrolyte imbalance. The underlying etiology of this disorder is not known with certainty, but rapid increases in circulating human chorionic gonadotropin (HCG) and estrogen in early pregnancy have been associated with the condition (Furneaux et al., 2001; Goodwin, 2002).
In mild cases of nausea and vomiting there appears to be no adverse effect on maternal weight gain or pregnancy outcome. However, among women with hyperemesis gravidarum there is evidence of decreased GWG and a higher risk of low birth weight. Gross et al. (1989) reported on 64 women with a diagnosis of hyperemesis gravidarum. When compared to women with a similar diagnosis but who lost < 5 percent of their prepregnancy weight, women who lost > 5 percent of their prepregnancy body weight had lower total GWG (9.6 ± 2.4 versus 13.7 ± 3.2 kg, p < 0.05), compromised, fetal growth (i.e., smaller percent weight for gestational age; 38 percentile versus 72 percentile, p < 0.025), and increased growth restriction (30 percent versus 6 percent, p < 0.01). In a more recent study, Vilming and Nesheim (2000) and Bailit (2005) likewise reported that women with hyperemesis gravidarum had overall lower GWG and birth weight in comparison with a control group. Evidence for long-term outcomes on infant growth was not found.
Anorexia Nervosa and Bulimia Nervosa
Anorexia nervosa and bulimia nervosa are frequently encountered in young women of reproductive age. Both disorders are characterized by a