Anorexia nervosa, bulimia, and bulimia nervosa36,37 are serious eating disorders that affect a small proportion of U.S. women in their childbearing years. Severely restricting food intake may result in general malnutrition (which sometimes is so serious that it prevents ovulation), whereas purging may result in life-threatening fluid and electrolyte imbalances. 38 Women with eating disorders may begin pregnancy in a poor nutritional state; they are at risk of developing imbalances, deficiencies, or weight gain abnormalities during pregnancy if aberrant eating behaviors are not controlled.39
Because treatment for these conditions requires long-term psychotherapy and behavior modification, referral for care should be accomplished before conception if possible. Published information on this problem during pregnancy is largely anecdotal but suggests that increased efforts are needed to identify women with bulimia nervosa.40
Prior to pregnancy, dietary counseling may substantially improve the nutritional status of women with serious chronic gastrointestinal disorders such as Crohn's disease, celiac disease, or liver disorders. Preconceptional nutritional interventions such as weight loss programs for the treatment of hypertension and modified diets to control blood lipids may be useful alternatives to medications that are not considered desirable for the fetus.
Nutrition exerts an important influence on pregnancy outcome.10,41 The U.S. surgeon general,41 the publication Healthy People 2000,42 and many expert groups (e.g., the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists,2 the American Nurses Association,43 the Public Health Service Expert Panel on the Content of Prenatal Care,1 the Institute of Medicine,44 and the U.S. Preventive Services Task Force45) have all pointed out the value of interventions to help pregnant women achieve adequate diets. Congress has tangibly recognized the importance of prenatal nutrition by appropriating funds for the Special Supplemental Food Program for Women, Infants, and Children (WIC) continuously since 1974 (see Chapter 1). Moreover, at