At each prenatal visit, eating disorders screening may be conducted (see Table 9.4) along with measurement and documentation of parameters or outcomes related to nutrition interventions and diagnoses. Body weight and rate of weight gain should be tracked and evaluated. Adjustments in energy intake should be based on appropriateness of weight changes. Eating behaviors and dietary intake should be examined at each prenatal visit to assess the adequacy of dietary composition and patterns of intake. Changes in purging and nonpurging behaviors should be noted and addressed. Fingersticks to check hematocrit and glucose may be useful in the monitoring of iron status and hypoglycemia or hyperglycemia. In women with established eating disorders, urinalysis may detect starvation or dehydration as noted by urinary ketones, elevated specific gravity, and alkaline urine. Vital signs will show any change in general health status. Glucose tolerance testing should be conducted in the 24th to 28th week of pregnancy to screen for gestational diabetes mellitus (see Chap. 10, "Diabetes and Pregnancy"). Resolution of any nutrition diagnoses should be documented and any new issues addressed.
More aggressive and intensive inpatient care may be warranted if monitoring and evaluation shows a worsening of the eating disorder, IUGR, or other fetal growth and development problems. In AN or BN, a reduction in body weight to less than 75% of expected; hypokalemia, hyponatremia, or hypochloremic alkalosis; dehydration; hyperemesis gravidarum; cardiovascular changes; prolonged fasting; uncontrolled binge eating-purging cycles; severe depression; suicidal ideation; and any obstetrical complication are justification for hospitalization.
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