ABSTRACT
Importance: While eating disorders (EDs) affect people of all ages, reproductive stages, and genders, they are most prevalent in women of reproductive age and can have a profound impact on fertility and obstetric outcomes. Due to the high prevalence and health consequences, EDs in this group of women require specific attention.
Objective: To discuss the implications of EDs in infertility, pregnancy, and the postpartum period and to introduce tools to aid in identifying disordered eating and appropriate treatment recommendations for women with suspected EDs.
Evidence Review: A comprehensive literature search was conducted of articles available on PubMed, last updated retrieval date March 27, 2023. Chain searching was used to identify other relevant articles. The following search terms were included: (pregnancy OR postpartum) AND (bulimia nervosa OR eating disorder OR anorexia nervosa OR binge eating disorder) AND (obstetric outcome OR infant outcome OR infant development OR depression OR anxiety); (fertility OR infertility) AND (bulimia nervosa OR eating disorder OR anorexia nervosa OR binge eating disorder OR weight suppression OR eating disorder not otherwise specified OR other specified feeding and eating disorder OR atypical anorexia nervosa OR binge eating OR low weight); and eating disorders AND PCOS. Articles pertinent to the impact of eating disorders on fertility and the impact of perinatal eating disorders on infant and mother were selected.
Findings: Perinatal EDs impact maternal mental health and obstetric and infant outcomes. They can have a long-lasting effect on the offspring via epigenetic changes. EDs are also a common and treatable cause of infertility.
Conclusions and Relevance: Recognition and treatment of EDs in women prior to conception can minimize obstetric risks to the woman and potential long-term adverse effects on the offspring. For women with infertility, recognition and treatment of EDs can increase the probability of conception.
Prim Care Companion CNS Disord 2023;25(4):22nr03475
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References (70)
- Udo T, Grilo CM. Prevalence and correlates of DSM-5–defined eating disorders in a nationally representative sample of US adults. Biol Psychiatry. 2018;84(5):345–354. PubMed CrossRef
- American Psychiatric Association. American Psychiatric Association: DSM-5. Washington, DC: American Psychiatric Association; 2013.
- Hudson JI, Hiripi E, Pope HG Jr, et al. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007;61(3):348–358. PubMed CrossRef
- Fursland A, Watson HJ. Eating disorders: a hidden phenomenon in outpatient mental health? Int J Eat Disord. 2014;47(4):422–425. PubMed CrossRef
- Goel NJ, Jennings Mathis K, Egbert AH, et al. Accountability in promoting representation of historically marginalized racial and ethnic populations in the eating disorders field: a call to action. Int J Eat Disord. 2022;55(4):463–469. PubMed CrossRef
- Harrop EN, Mensinger JL, Moore M, et al. Restrictive eating disorders in higher weight persons: A systematic review of atypical anorexia nervosa prevalence and consecutive admission literature. Int J Eat Disord. 2021;54(8):1328–1357. PubMed CrossRef
- Harshman SG, Jo J, Kuhnle M, et al. A moving target: how we define avoidant/restrictive food intake disorder can double its prevalence. J Clin Psychiatry. 2021;82(5):20m13831. PubMed CrossRef
- Freizinger M, Franko DL, Dacey M, et al. The prevalence of eating disorders in infertile women. Fertil Steril. 2010;93(1):72–78. PubMed CrossRef
- Le Floch M, Crohin A, Duverger P, et al. Prevalence and phenotype of eating disorders in assisted reproduction: a systematic review. Reprod Health. 2022;19(1):38. PubMed CrossRef
- Hecht LM, Hadwiger A, Patel S, et al. Disordered eating and eating disorders among women seeking fertility treatment: a systematic review. Arch Women Ment Health. 2022;25(1):21–32. PubMed CrossRef
- Barbosa-Magalhaes I, Corcos M, Galey J, et al. Prevalence of lifetime eating disorders in infertile women seeking pregnancy with pulsatile gonadotropin-releasing hormone therapy. Eat Weight Disord. 2021;26(2):709–715. PubMed CrossRef
- 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):340–344. PubMed CrossRef
- Pettersson CB, Zandian M, Clinton D. Eating disorder symptoms pre- and postpartum. Arch Women Ment Health. 2016;19(4):675–680. PubMed CrossRef
- Sollid C, Clausen L, Maimburg RD. The first 20 weeks of pregnancy is a high-risk period for eating disorder relapse. Int J Eat Disord. 2021;54(12):2132–2142. PubMed CrossRef
- Makino M, Yasushi M, Tsutsui S. The risk of eating disorder relapse during pregnancy and after delivery and postpartum depression among women recovered from eating disorders. BMC Pregnancy Childbirth. 2020;20(1):323. PubMed CrossRef
- Dörsam AF, Preißl H, Micali N, et al. The impact of maternal eating disorders on dietary intake and eating patterns during pregnancy: a systematic review. Nutrients. 2019;11(4):840. PubMed CrossRef
- Crow SJ, Agras WS, Crosby R, et al. Eating disorder symptoms in pregnancy: a prospective study. Int J Eat Disord. 2008;41(3):277–279. PubMed CrossRef
- Fogarty S, Elmir R, Hay P, et al. The experience of women with an eating disorder in the perinatal period: a meta-ethnographic study. BMC Pregnancy Childbirth. 2018;18(1):121. PubMed CrossRef
- Paslakis G, de Zwaan M. Clinical management of females seeking fertility treatment and of pregnant females with eating disorders. Eur Eat Disord Rev. 2019;27(3):215–223. PubMed CrossRef
- Jahraus J. Medical complications of eating disorders. Psychiatr Ann. 2018;48(10):463–467. CrossRef
- Peebles R, Sieke EH. Medical complications of eating disorders in youth. Child Adolesc Psychiatr Clin N Am. 2019;28(4):593–615. PubMed CrossRef
- Kerns J, Itriyeva K, Fisher M. Etiology and management of amenorrhea in adolescent and young adult women. Curr Probl Pediatr Adolesc Health Care. 2022;52(5):101184. PubMed CrossRef
- Best D, Bhattacharya S. Obesity and fertility. Horm Mol Biol Clin Investig. 2015;24(1):5–10. PubMed
- Grilo CM, Pagano ME, Stout RL, et al. Stressful life events predict eating disorder relapse following remission: six-year prospective outcomes. Int J Eat Disord. 2012;45(2):185–192. PubMed CrossRef
- Paganini C, Peterson G, Stavropoulos V, et al. The overlap between binge eating behaviors and polycystic ovarian syndrome: an etiological integrative model. Curr Pharm Des. 2018;24(9):999–1006. PubMed CrossRef
- Pirotta S, Barillaro M, Brennan L, et al. Disordered eating behaviours and eating disorders in women in australia with and without polycystic ovary syndrome: a cross-sectional study. J Clin Med. 2019;8(10):1682. PubMed CrossRef
- Zerwas SC, Von Holle A, Perrin EM, et al. Gestational and postpartum weight change patterns in mothers with eating disorders. Eur Eat Disord Rev. 2014;22(6):397–404. PubMed CrossRef
- Verma A, Shrimali L. Maternal body mass index and pregnancy outcome. J Clin Diagn Res. 2012;6(9):1531–1533. PubMed CrossRef
- Kosa JL, Guendelman S, Pearl M, et al. The association between pre-pregnancy BMI and preterm delivery in a diverse southern California population of working women. Matern Child Health J. 2011;15(6):772–781. PubMed CrossRef
- Chan CY, Lee AM, Koh YW, et al. Course, risk factors, and adverse outcomes of disordered eating in pregnancy. Int J Eat Disord. 2019;52(6):652–658. PubMed CrossRef
- Ante Z, Luu TM, Healy-Profitós J, et al. Pregnancy outcomes in women with anorexia nervosa. Int J Eat Disord. 2020;53(5):403–412. PubMed CrossRef
- Morgan JF, Lacey JH, Chung E. Risk of postnatal depression, miscarriage, and preterm birth in bulimia nervosa: retrospective controlled study. Psychosom Med. 2006;68(3):487–492. PubMed CrossRef
- Grigoriadis S, Wilton AS, Kurdyak PA, et al. Perinatal suicide in Ontario, Canada: a 15-year population-based study. CMAJ. 2017;189(34):E1085–E1092. PubMed CrossRef
- Mochache K, Mathai M, Gachuno O, et al. Depression during pregnancy and preterm delivery: a prospective cohort study among women attending antenatal clinic at Pumwani Maternity Hospital. Ann Gen Psychiatry. 2018;17(1):31. PubMed CrossRef
- Grote NK, Bridge JA, Gavin AR, et al. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010;67(10):1012–1024. PubMed CrossRef
- Doktorchik C, Premji S, Slater D, et al. Patterns of change in anxiety and depression during pregnancy predict preterm birth. J Affect Disord. 2018;227:71–78. PubMed CrossRef
- Weissman MM, Wickramaratne P, Nomura Y, et al. Offspring of depressed parents: 20 years later. Am J Psychiatry. 2006;163(6):1001–1008. PubMed CrossRef
- Borchers LR, Dennis EL, King LS, et al. Prenatal and postnatal depressive symptoms, infant white matter, and toddler behavioral problems. J Affect Disord. 2021;282:465–471. PubMed CrossRef
- Allen KL, Gibson LY, McLean NJ, et al. Maternal and family factors and child eating pathology: risk and protective relationships. J Eat Disord. 2014;2(1):11. PubMed CrossRef
- Torgersen L, Ystrom E, Siega-Riz AM, et al. Maternal eating disorder and infant diet. A latent class analysis based on the Norwegian Mother and Child Cohort Study (MoBa). Appetite. 2015;84:291–298. PubMed CrossRef
- Kaß A, Dörsam AF, Weiß M, et al. The impact of maternal eating disorders on breastfeeding practices: a systematic review. Arch Women Ment Health. 2021;24(5):693–708. PubMed CrossRef
- Bailey-Straebler SM, Susser LC, Cooper Z. Breastfeeding and pumping as maladaptive weight control behaviors [published online ahead of print June 1, 2023]. Int J Eat Disord. 2023:eat.24006. PubMed CrossRef
- Stapleton H, Fielder A, Kirkham M. Breast or bottle? eating disordered childbearing women and infant-feeding decisions. Matern Child Nutr. 2008;4(2):106–120. PubMed CrossRef
- 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 (MoBa). Int J Eat Disord. 2009;42(1):9–18. PubMed CrossRef
- Gicquel C, El-Osta A, Le Bouc Y. Epigenetic regulation and fetal programming. Best Pract Res Clin Endocrinol Metab. 2008;22(1):1–16. PubMed CrossRef
- Yan S, Hou W, Wu H, et al. Prenatal exposure to the Chinese famine and the risk of metabolic syndrome in adulthood across consecutive generations. Eur J Clin Nutr. 2020;74(8):1229–1236. PubMed CrossRef
- Dunford AR, Sangster JM. Maternal and paternal periconceptional nutrition as an indicator of offspring metabolic syndrome risk in later life through epigenetic imprinting: a systematic review. Diabetes Metab Syndr. 2017;11(suppl 2):S655–S662. PubMed CrossRef
- Levine SZ, Kodesh A, Viktorin A, et al. Association of maternal use of folic acid and multivitamin supplements in the periods before and during pregnancy with the risk of autism spectrum disorder in offspring. JAMA Psychiatry. 2018;75(2):176–184. PubMed CrossRef
- Wald NJ, Law MR, Morris JK, et al. Quantifying the effect of folic acid. Lancet. 2001;358(9298):2069–2073. PubMed CrossRef
- Cimino S, Cerniglia L, Porreca A, et al. Mothers and fathers with binge eating disorder and their 18–36 months old children: a longitudinal study on parent-infant interactions and offspring’s emotional-behavioral profiles. Front Psychol. 2016;7:580. PubMed CrossRef
- Martini MG, Taborelli E, Schmidt U, et al. Infant feeding behaviours and attitudes to feeding amongst mothers with eating disorders: a longitudinal study. Eur Eat Disord Rev. 2019;27(2):137–146. PubMed CrossRef
- Micali N, Simonoff E, Treasure J. Infant feeding and weight in the first year of life in babies of women with eating disorders. J Pediatr. 2009;154(1):55–60.e1. PubMed CrossRef
- Micali N, Simonoff E, Stahl D, et al. Maternal eating disorders and infant feeding difficulties: maternal and child mediators in a longitudinal general population study. J Child Psychol Psychiatry. 2011;52(7):800–807. PubMed CrossRef
- Perrin EM, Von Holle A, Zerwas S, et al. Weight-for-length trajectories in the first year of life in children of mothers with eating disorders in a large Norwegian cohort. Int J Eat Disord. 2015;48(4):406–414. PubMed CrossRef
- Stein A, Woolley H, Cooper S, et al. Eating habits and attitudes among 10-year-old children of mothers with eating disorders: longitudinal study. Br J Psychiatry. 2006;189(4):324–329. PubMed CrossRef
- Nicholls DE, Viner RM. Childhood risk factors for lifetime anorexia nervosa by age 30 years in a national birth cohort. J Am Acad Child Adolesc Psychiatry. 2009;48(8):791–799. PubMed CrossRef
- Hill LS, Reid F, Morgan JF, et al. SCOFF, the development of an eating disorder screening questionnaire. Int J Eat Disord. 2010;43(4):344–351. PubMed
- Kutz AM, Marsh AG, Gunderson CG, et al. Eating disorder screening: a systematic review and meta-analysis of diagnostic test characteristics of the SCOFF. J Gen Intern Med. 2020;35(3):885–893. PubMed CrossRef
- Maguen S, Hebenstreit C, Li Y, et al. Screen for disordered eating: improving the accuracy of eating disorder screening in primary care. Gen Hosp Psychiatry. 2018;50:20–25. PubMed CrossRef
- Claydon EA, Lilly CL, Ceglar JX, et al. Development and validation across trimester of the Prenatal Eating Behaviors Screening tool. Arch Women Ment Health. 2022;25(4):705–716. PubMed CrossRef
- Rodino IS, Byrne SM, Sanders KA. Eating disorders in the context of preconception care: fertility specialists’ knowledge, attitudes, and clinical practices. Fertil Steril. 2017;107(2):494–501. PubMed CrossRef
- Deyhoul N, Mohamaddoost T, Hosseini M. Infertility-related risk factors: a systematic review. IJWHR. 2017;5(1):24–29. CrossRef
- Eating disorders: recognition and treatment: Guidance. NICE website. Accessed November 2, 2022. https://www.nice.org.uk/guidance/ng69
- Raykos B, Watson H. Treating Eating Disorders in Pregnancy and the Postpartum Period. In: Tortolani CC, ed. Adapting Evidence-Based Eating Disorder Treatments for Novel Populations and Settings. 1st ed. Routledge; 2020:238-267.
- Walsh BT, Agras WS, Devlin MJ, et al. Fluoxetine for bulimia nervosa following poor response to psychotherapy. Am J Psychiatry. 2000;157(8):1332–1334. PubMed CrossRef
- Brownley KA, Berkman ND, Peat CM, et al. Binge-eating disorder in adults: a systematic review and meta-analysis. Ann Intern Med. 2016;165(6):409–420. PubMed CrossRef
- Gibson MES, Fleming N, Zuijdwijk C, et al. Where have the periods gone? The evaluation and management of functional hypothalamic amenorrhea. J Clin Res Pediatr Endocrinol. 2020;12(suppl 1):18–27. PubMed CrossRef
- Academy of Eating Disorders. Eating Disorders: A Guide to Medical Care. 4th ed. 2021. AED website. Accessed November 20, 2022. https://higherlogicdownload.s3.amazonaws.com/AEDWEB/27a3b69a-8aae-45b2-a04c-2a078d02145d/UploadedImages/Publications_Slider/2120_AED_Medical_Care_4th_Ed_FINAL.pdf
- McIver B, Romanski SA, Nippoldt TB. Evaluation and management of amenorrhea. Mayo Clin Proc. 1997;72(12):1161–1169. PubMed CrossRef
- Gibson D, Workman C, Mehler PS. Medical complications of anorexia nervosa and bulimia nervosa. Psychiatr Clin North Am. 2019;42(2):263–274. PubMed CrossRef
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