A 21-year-old gravida 1, para 0 at 11 weeks and 4/7 days by last normal menstrual period presented to our clinic for prenatal care. She has never had a serious illness, surgery, or hospitalization. Her family history was positive for chronic depression and substance abuse. Her psychological history was positive for bulimia nervosa, which she reported first developing at 18 years of age. Although she had been working with a therapist for the past couple of years, she reported binge eating 1 to 2 times a week and compensatory behaviors, including excessive exercise, laxative use, fasting, and self-induced vomiting. She denied suicidal and homicidal ideation. She reported that her boyfriend and family provided a good social support system. Over the past few weeks, she had experienced symptoms of fatigue, nausea, and vomiting, but she denied dizziness and hyperemesis. The physical examination revealed that her vital signs were stable, and all systems were found to be normal, with uterine size equal to dates. She measured 5 feet 6 inches tall, with a prepregnancy weight of 127 pounds and a body mass index (BMI) of 20.5. She estimated gaining about 5 pounds since becoming pregnant. Moderate ketones were noted on urine dipstick. Laboratory values ordered at the first prenatal visit and at 28 weeks' gestation were all within normal limits, with the exception of a hemoglobin value of 11.6 and a hematocrit of 33.8 at 28 weeks' gestation, indicating mild anemia. The woman attended clinic regularly and had an uncomplicated prenatal course, gaining a total of 34 pounds. She was offered anticipatory guidance at each antepartum visit and was counseled by her midwife on nutrition and weight gain. She kept bimonthly appointments with her regular therapist throughout the duration of her pregnancy. While she attempted to refrain from binging and compensatory behaviors, she did not completely abstain, reporting an average of 1 to 3 binge eating episodes (followed by self-induced vomiting or laxative use) per month. She gave birth vaginally to a healthy 8 lb, 5 oz baby boy at 40 weeks and 3/7 days without complications.
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