Generic placeholder image

Current Women`s Health Reviews

Editor-in-Chief

ISSN (Print): 1573-4048
ISSN (Online): 1875-6581

Review Article

Diagnosis and Management of Eating Disorders in Pregnancy

Author(s): Gianna Wilkie*, Leena Mittal and Nicole Smith

Volume 15, Issue 4, 2019

Page: [251 - 256] Pages: 6

DOI: 10.2174/1573404815666190401182815

Price: $65

Open Access Journals Promotions 2
Abstract

Objective: To provide a review of the literature with regards to the diagnosis and management of eating disorders in pregnancy.

Methods: Available literature was reviewed and summarized to discuss the epidemiology, diagnosis, natural history of the illness, and treatment.

Results: Eating disorders are common mental health conditions in reproductive-aged women, including pregnant women. Anorexia nervosa, bulimia nervosa, and binge eating disorder are the most commonly diagnosed, with a mixed clinical picture existing due to the fluidity between these conditions. Pregnancy can often act as a trigger for eating disorders given the focus on weight gain and the stressors associated with the changing physical appearance of pregnancy. There are significant maternal and fetal risks associated with eating disorders in pregnancy including an elevated risk of cesarean delivery, postpartum depression, preterm delivery, and perinatal mortality. Treatment of eating disorders should involve a multidisciplinary team of providers with close monitoring in pregnancy and the postpartum period with honest discussions on handling weight gain and triggering restrictions associated with pregnancy.

Conclusion: Pregnancy is a high-risk time for women with eating disorders given the significant maternal and fetal risks of their illness.

Keywords: Eating disorders, anorexia, bulimia, binge eating, pregnancy, eating disorder treatment.

Graphical Abstract
[1]
Udo T, Grilo CM. Prevalence and correlates of DSM-5- defined eating disorders in a nationally representative sample of U.S. adults. Biol Psychiatry 2018; 84(5): 345-54.
[2]
Smink FR, van Hoeken D, Hoek HW. Epidemiology, course, and outcome of eating disorders. Curr Opin Psychiatry 2013; 26(6): 543-8.
[3]
Mathieu J. What is pregorexia? J Am Diet Assoc 2009; 109(6): 976-9.
[4]
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5thEdition (DSM-5), American Psychiatric Association, Arlington, VA. 2013.
[5]
Keel PK, McCormick L. Diagnosis, assessment, and treatment planning for anorexia nervosa In: The Treatment of Eating Disorders: A Clinical Handbook, Grilo CM, Mitchell JE, (Eds), The Guilford Press: New York 2010; pp.3.
[6]
Hudson JI, Hiripi E, Pope HG Jr, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry 2007; 61(3): 348-58.
[7]
Morgan JF, Lacey JH, Sedgwick PM. Impact of pregnancy on bulimia nervosa. Br J Psychiatry 1999; 174: 135-40.
[8]
Easter A, Bye A, Taborelli E, et al. Recognising the symptoms: how common are eating disorders in pregnancy? Eur Eat Disord Rev 2013; 21(4): 340-4.
[9]
Cooper Z, Fairburn C. The eating disorder examination: A semi-structured interview for the assessment of the specific psychopathology of eating disorders. Int J Eat Disord 1987; 6(1): 1-8.
[10]
Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ 1999; 319(7223): 1467-8.
[11]
Fairburn CG, Cooper Z. Eating Disorders, DSM-5, and clinical reality. Br J Psychiatry 2011; 198(1): 8-10.
[12]
Triunfo S, Lanzone A. Impact of maternal under nutrition on obstetrics outcomes. J Endocrinol Invest 2015; 38(1): 31-8.
[13]
American Dietetic Association. Position of the American Dietetic Association: Nutritional intervention in the treatment of anorexia nervosa, bulimia nervosa, and other eating disorders. J Am Diet Assoc 2006; 106(12): 2073-82.
[14]
Franko DL, Spirrell EB. Detection and management of eating disorders during pregnancy. Obstet Gynecol 2000; 95(6): 942-6.
[15]
Bulik CM, Von Holle A, Siega-Riz AM, et al. Birth outcomes in women with eating disorders in the Norwegian Mother and Child Cohort study. Int J Eat Disord 2009; 42(1): 9-18.
[16]
Mitchell-Gieleghem A, Mittelstaedt ME, Bulik CM. Eating disorders and children bearing: Concealment and consequences. Birth 2002; 29(3): 182-91.
[17]
Carmichael SL, Shaw GM, Schaffer DM, Laurent C, Selvin S. Dieting behaviors and risk of neural tube defects. Am J Epidemiol 2003; 158(12): 1127-31.
[18]
Micali N, Simonoff E, Treasure J. Risk of major adverse perinatal outcomes in women with eating disorders. Br J Psychiatry 2007; 190: 255-9.
[19]
Linna MS, Raevuori A, Haukka J, Suvisaari JM, Suokas JT, Gissler M. Pregnancy, obstetric, and perinatal health outcomes in eating disorders. Am J Obstet Gynecol 2014; 211: 392.e1-8.
[20]
Barona M, Nybo Andersen AM, Micali N. Childhood psychopathology in children of women with eating disorders. Acta Psychiatr Scand 2016; 134(4): 295-304.
[21]
Bulik CM, Von Holle A, Hamer R, et al. Patterns of Remission, continuation, and incidence of broadly defined eating disorders during early pregnancy in the Norwegian Mother and Child Cohort Study (MoBa). Psychol Med 2007; 37(8): 1109-18.
[22]
Coker EL, Mitchell-Wong LA, Abraham SF. Is pregnancy a trigger for recovery from an eating disorder? Acta Obstet Gynecol Scand 2013; 92(12): 1407-13.
[23]
Cardwell M. Eating disorders during pregnancy. Obstet Gynecol Surv 2013; 68(4): 312-23.
[24]
Mazer-Poline C, Fornari V. Anorexia nervosa and pregnancy: Having a baby when you are dying to be thin-case report and proposed treatment guidelines. Int J Eat Disord 2009; 42(4): 382-4.
[25]
Hilbert A, Hoek HW, Schmidt R. Evidence-based clinical guidelines for eating disorders: International comparison. Curr Opin Psychiatry 2017; 30(6): 423-37.
[26]
Andersen AE, Ryan GL. Eating disorders in the obstetric and gynecologic patient population. Obstet Gynecol 2009; 114(6): 1353-67.
[27]
Sachs K, Andersen D, Sommer J, Winkelman A, Mehler PS. Avoiding medical complications during refeeding of patients with anorexia nervosa. Eat Disord 2015; 23(5): 411-21.
[28]
Weisskopf E, Fischer CJ, Bickle Graz M, et al. Risk-benefit balance assessment of SSRI antidepressant use during pregnancy and lactation based on best available evidence. Expert Opin Drug Saf 2015; 14(3): 413-27.
[29]
Grigoriadis S, Vonderporten EH, Mamisashvili L, et al. Prenatal exposure to antidepressants and persistent pulmonary hypertension of the newborn: systematic review and meta-analysis. BMJ 2014; 14(348): f6932.
[30]
Franko D, Walton B. Pregnancy and eating disorders: A review and clinical implications. Int J Eat Disord 1993; 13(1): 41-7.
[31]
Harris A. Practical advice for caring for women with eating disorders during the perinatal period. J Midwifery Womens Health 2010; 55(6): 579-86.
[32]
Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines; Rasmussen KM, Yaktine AL, (eds.). Weight gain during pregnancy: Reexamining the guidelines. Washington (DC): National Academies Press (US);. 2009.
[33]
Kouba S, Hallstrom T, Lindholm C, Hirschberg AL. Pregnancy and neonatal outcomes in women with eating disorders. Obstet Gynecol 2005; 105: 255-60.
[34]
Crow SJ, Agras WS, Crosby R, Halmi K, Mitchell JE. Eating disorder symptoms in pregnancy: A prospective study. Int J Eat Disord 2008; 41: 277-9.
[35]
Kimmel MC, Ferguson EH, Zerwas S, Bulik CM, Meltzer-Brody S. Obstetric and gynecologic problems associated with eating disorders. Int J Eat Disord 2016; 49(3): 260-75.
[36]
Morgan JF, Lacey JH, Chung E. Risk of postnatal depression, miscarriage, and preterm birth in bulimia nervosa: retrospective controlled study. Psychosom Med 2006; 68: 487-92.
[37]
Gibson J, McKenzie MK, Shakespeare J, Price J, Gray R. A systematic review of studies validating the Edinburgh Postnatal Depression scale in antepartum and postpartum women. Acta Psychiatr Scand 2009; 119(5): 350-64.
[38]
Bulik C, Hoffman E, Van Holle A, Torgersen L, Stoltenber C, Reichborn-Kjennerud T. Unplanned pregnancy in women with anorexia nervosa. Obstet Gynecol 2010; 116: 1136-40.
[39]
Hicks C, Demarsh S, Singh H, Gillespie L, Worley S, Rome E. Knowledge about various contraceptive methods in young women with and without eating disorders. Int J Eat Disord 2013; 46(2): 171-6.

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy