From the Guidelines
Eating disorders, such as Anorexia Nervosa (AN) and Bulimia Nervosa (BN), can have a significant impact on pregnancy outcomes, posing risks to both mother and baby, and therefore, pregnant women with eating disorders should seek specialized prenatal care immediately, ideally before conception. Women with active eating disorders during pregnancy face higher chances of complications including miscarriage, preterm birth, low birth weight, and cesarean delivery 1. Anorexia nervosa may cause fertility problems and nutritional deficiencies that affect fetal development, while bulimia's cycle of binging and purging can create electrolyte imbalances dangerous during pregnancy.
Key Considerations
- Severe cases of anorexia nervosa and/or bulimia nervosa have the potential to lead to caloric and nutrient deficiencies in utero that impair fetal, infant and child development 1.
- The majority of women with current eating disorders are able to reduce their restrictive or compensatory eating behaviours during pregnancy 1.
- Treatment typically involves a multidisciplinary approach with obstetricians, psychiatrists, nutritionists, and therapists working together.
- While medications like selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac) or sertraline (Zoloft) may be prescribed in some cases, the risks and benefits must be carefully weighed.
- Nutritional counseling is essential to ensure adequate caloric intake and proper nutrient levels, with prenatal vitamins containing folic acid (400-800 mcg daily) being particularly important 1.
Monitoring and Support
- Regular monitoring of weight gain, vital signs, and fetal growth is necessary throughout pregnancy 1.
- The physiological and psychological changes of pregnancy can trigger or worsen eating disorder symptoms, as body changes may intensify body image concerns.
- Additionally, eating disorders can affect bonding and increase postpartum depression risk, making continued support crucial after delivery 1.
From the Research
Impact of Eating Disorders on Pregnancy Outcomes
- Eating disorders, such as Anorexia Nervosa (AN) and Bulimia Nervosa (BN), can have a significant impact on pregnancy outcomes, including an increased risk of miscarriage, preterm delivery, poor fetal growth, and malformations 2, 3, 4, 5, 6.
- Maternal malnutrition, altered hormonal pathways, low pre-pregnancy body mass index, and poor gestational weight gain, combined with maternal psychopathology and stress, may impair the evolution of pregnancy 2.
- Environmental factors, such as malnutrition or substance abuse, may also induce epigenetic changes in the fetal epigenome, which can mark lifelong health concerns in offspring 2.
Risk Factors and Complications
- Women with eating disorders are at a higher risk of developing pregnancy-related complications, including pregnancy-induced hypertension, gestational diabetes, and placental abruption 3, 5, 6.
- The incidence of eating disorders in women of childbearing age is increasing, and the effects of these disorders on pregnancy outcomes can be severe 4, 5.
- Early intervention strategies, including nutritional support, psychotherapeutic techniques, and the use of psychotropics if necessary, can help prevent lifelong morbidity for both mother and fetus 2, 4, 5, 6.
Management and Supervision
- A multidisciplinary approach to the management of pregnant women with eating disorders is recommended, including routine screening for eating disorders and attention to possible harmful comorbid behaviors 3, 4, 5, 6.
- The development of a multidisciplinary screening strategy and standards of management and supervision for this group of patients is necessary to mitigate the risks associated with eating disorders during pregnancy 5, 6.