dysfunctional perception of body weight and shape (Wisner et al., 2007), and both may affect GWG. Anorexia, which is defined as body weight less than 85 percent of expected weight for age and height, occurs in between 0.5-1.0 percent of women of reproductive age. Bulimia is defined as weight at the minimally normal range but where the individual employs binge eating and subsequent compensatory methods such as self-induced vomiting, laxative, or diuretic medications to avoid appropriate weight gain. Bulimia occurs in 1-3 percent of young women.

In a Danish register-based follow-up study, Sollid et al. (2004) compared 302 women with eating disorders before pregnancy and who were delivered of 504 children with 900 control subjects who were delivered of 1,552 children. They reported an almost two-fold increased risk of preterm delivery (less than 37 weeks) and SGA (birth weight < 10th percentile) in women with eating disorders. Unfortunately the investigators were not able to obtain any information on prepregnancy BMI or GWG. In a smaller study from Sweden, Kouba et al. (2005) reported that among 49 women with previously diagnosed eating disorders 22 percent had a relapse of their eating disorder in pregnancy. Compared to a control group, the women with either a past or current eating disorder were at significantly increased risk of hyperemesis, and delivered children with significantly lower birth weight and head circumference as compared with a control group. Although there were no significant differences in GWG between the groups, the anorectic women (n = 24) gained less weight than women with previous history of eating disorders (10.4 ± 3.9 versus 12.1 ± 2.6 kg, p < 0.05). The authors speculated that one of the potential causes for the decreased fetal growth in the women with a history of eating disorders include their inability to achieve the recommended weight gain of 11.5-16.0 kg during pregnancy. There was no significant difference in intake of folate, protein, or total caloric intake between the two groups. Finally, in a cohort of 35,929 pregnant Norwegian women, 35 women reported broad anorexia nervosa, 304 bulimia nervosa, 1,812 binge eating disorder, and 36 eating disorder not otherwise specified (EDNOS)-purging type in the 6 months before or during pregnancy (Bulik et al., 2008). Prepregnancy BMI was lower in anorexia, and higher in binge eating disorder than the referent group, and anorexia, bulimia, and binge eating disordered mothers reported greater GWG.

Bariatric Surgery

As discussed in Chapter 2, the prevalence of obesity in the U.S. population has been steadily increasing since 1990. This has been paralleled by a recent increase in the number of bariatric surgeries performed as treatment for obesity. The reported total number of bariatric surgical procedures performed in the United States increased from approximately 13,365 in



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