Eating disorders in pregnancy
Eating disorders (EDs) commonly occur in young women of childbearing age. The prevalence of anorexia nervosa is estimated at between 0.5% and 3% of the general population, among women aged 15 to 30. Bulimia is two to three times more prevalent than anorexia nervosa. Approximately 10% to 19% of women experience bulimic episodes at some point in their lives.
Regarding general data on pregnancy rates, the average number of pregnancies per woman, or the age at first pregnancy, no differences were observed between women with an eating disorder and those without. However, unplanned pregnancies may occur due to menstrual irregularities or the belief of infertility resulting from the anorexia they suffered.
How to prevent relapses in eating disorders?
Eating disorders are related to a need for control, and pregnancy can be seen as a situation of loss of that control.
The bodily changes that occur during pregnancy can cause conflicting, ambivalent feelings, as well as guilt. These emotions increase the likelihood that women with eating disorders will experience specific problems during pregnancy and postpartum.
Despite this, the impact of eating disorder symptoms during pregnancy remains relatively unknown. Two hypotheses have been proposed. The first is that eating disorders (and associated symptoms) improve during early pregnancy due to concerns about the well-being of the fetus. The second is that weight gain during pregnancy may exacerbate latent concerns about weight and body image, which can lead to a worsening of symptoms in the postpartum period.
Complications during pregnancy and childbirth are more frequent in women with active eating disorder symptoms during pregnancy, including malnutrition, miscarriage, preterm delivery, high incidence of cesarean sections, and low birth weight.
Complications for a pregnant woman with active symptoms of anorexia nervosa
Specifically, in the case of anorexia nervosa, the complications for the mother can be:
- Inadequate weight gain.
- Abortion.
- Vaginal bleeding.
- Decreased uterine size.
- Hyperemesis, that is, intense and persistent nausea and vomiting during pregnancy.
The risks to the baby are:
- Low birth weight.
- Developmental delay.
- Premature birth.
- Prenatal death.
Complications for a pregnant woman with active symptoms of bulimia nervosa
In the case of bulimia nervosa, the complications for the mother can be:
- Increased binge eating and vomiting.
- Excessive physical exercise.
- Little or excessive weight gain.
- Abortion.
- High blood pressure.
The risks to the baby are:
- Fetal death.
- Low birth weight.
- Low Apgar score.
- Breech birth.
- Cleft palate.
Although the literature has focused mainly on the medical and physical consequences of eating disorders in pregnancy, the psychological consequences that occur in these women have also been highlighted: intense fear of pregnancy and childbirth, postpartum depression and anxiety.
What are the main warning signs of eating disorders?
For all the reasons described, pregnant women with eating disorders need the support of a multidisciplinary team that can guide and prepare them not only during pregnancy, but also during the postpartum period and in the mother-child relationship. Furthermore, increased obstetric and psychological monitoring , appropriate nutritional follow-up, and specialized care from midwives and nurses involved in the woman's pregnancy, childbirth, and postpartum period will be essential. These care plans should be standardized and adapted to each clinical case to ensure high-quality, effective, and efficient care. Women receiving treatment should be advised to address their eating disorder before pregnancy and to work throughout pregnancy and the postpartum period to prevent relapse.
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