Clinical Review

Eating for 2: Managing eating disorders in pregnancy

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Clinician knowledge of complications and risks specific to disordered eating and pregnancy can affect outcomes for both mother and baby



Eating disorders affect nearly 1% of US adults,1 and disordered eating, or unspecified eating disorder, affects at least 1% of all pregnancies.2 Among 739 pregnant women assessed with the Eating Disorder Diagnostic scale, 7.5% of patients met criteria for an eating disorder, with 8.8% of women reporting binge eating and 2.3% of pregnant women engaging in regular compensatory behaviors. In fact, 23.4% of the study population expressed concerns about pregnancy-related weight gain and body shape.3 Eating disorders during pregnancy are more common than previously thought, and they create unique clinical challenges for obstetric providers.

Types of eating disorders

There are 3 major types of eating disorders: anorexia nervosa, bulimia nervosa, and binge eating disorder, with significant fluidity existing between all 3 conditions.

Anorexia nervosa is a condition in which an individual believes he or she is significantly overweight despite being underweight. Patients with anorexia nervosa often restrict food intake and have compulsive rituals around eating and exercise, leading to weight loss and starvation.4

Bulimia nervosa is marked by intensive dieting, uncontrolled episodes of overeating, and compensatory behaviors.4 Compensatory behaviors include self-induced vomiting; excessive exercise; and misuse of laxatives, diuretics, or other medications.

Binge eating disorder is classified as recurrent episodes of uncontrolled overeating without compensatory purging behaviors, leading to excessive weight gain.4

Eating disorders and pregnancy

Pregnancy can impact the course of pre­existing eating disorders, and women also can develop symptoms of eating disorders for the first time during pregnancy. This is clinically significant as there are both maternal and fetal consequences to a mother’s disordered eating.

The risks of anorexia nervosa include vitamin deficiencies (vitamin B12/folate), dehydration leading to renal injury and electrolyte imbalances, hypoglycemia, abnormal lipid profiles, cardiac arrhythmia, and even death. The mortality rate of patients with anorexia nervosa may approach 10%; however, death during pregnancy is quite rare.2 Bulimia nervosa also carries the risks of protein and vitamin deficiencies, hypoglycemia and hyperglycemia, and death, with mortality estimated at 7% for those with a 5-year history of the illness. However, death in pregnancy due to the condition is again quite rare.5

Eating disorders can cause significant maternal and fetal complications during pregnancy and postpartum.

Maternal complications. When women with eating disorders become pregnant, they have increased risks of some pregnancy complications. Approximately 10% to 25% of pregnant women with eating disorders develop hyperemesis gravidarum.6 The nausea can serve as a trigger for a woman with an eating disorder, particularly among women with a history of purging behaviors.

Cesarean delivery is more common among women with eating disorders, which may be due to preexisting fetal compromise, leading to poor tolerance of labor, or to clinicians perceiving these pregnancies as higher risk.7

It is well known that eating disorders are highly comorbid with depression and other psychiatric conditions. In fact, 30% to 40% of women with an eating disorder develop symptoms of postpartum depression.8

Continue to: Fetal risks and complications...

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