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Recognising the Symptoms: How Common Are Eating Disorders in Pregnancy?
Abstract
Objectives:
This study aimed to investigate eating disorder diagnostic status and related symptoms in early pregnancy.
Methods:
Pregnant women (n=739), attending their first routine antenatal scan, were assessed using an adapted version of the Eating Disorder Diagnostic Scale (EDDS). Prevalence estimates and eating disorder symptoms were assessed during the first 3 months of pregnancy and, retrospectively, in the 6 to 12 months prior to pregnancy.
Results:
During pregnancy 7.5% of women met diagnostic criteria for an eating disorder, compared to prepregnancy prevalence of 9.2%. Approximately one quarter (23.4%) of women reported high weight and shape concern during pregnancy; binge eating was endorsed by 8.8%, and 2.3% of women engaged in regular compensatory behaviours.
Conclusions:
Eating disorders are more common than previously thought in pregnancy. There is a clinical need for increased understanding of eating disorder symptomatology during pregnancy and for appropriate screening tools to be incorporated into antenatal care.
... Few studies have investigated the prevalence of EDs in antenatal samples. Of those available, prevalence rates for active EDs during pregnancy range between 1.5% and 7.6% (12)(13)(14)(15). These wide discrepancies are largely due to variations in diagnostic tools and the definitions employed, in the absence of validated screening tools and consensus around operationalised definitions for antenatal populations (16,17). ...
... These wide discrepancies are largely due to variations in diagnostic tools and the definitions employed, in the absence of validated screening tools and consensus around operationalised definitions for antenatal populations (16,17). There is some evidence to suggest pregnancy may also represent a risk for the development of a new ED (12,13). Although less common than the exacerbation of pre-existing EDs, the significant physical, hormonal and psychological changes associated with pregnancy may also contribute to the onset of new cases, most commonly BED (12). ...
... There is some evidence to suggest pregnancy may also represent a risk for the development of a new ED (12,13). Although less common than the exacerbation of pre-existing EDs, the significant physical, hormonal and psychological changes associated with pregnancy may also contribute to the onset of new cases, most commonly BED (12). The estimated lifetime prevalence -which is the proportion of the population who have experienced an ED at any point in their life -in pregnant women is considerably higher than the rate of active EDs, at around 15.4%, the majority of whom will have lifetime AN or OSFED (15). ...
Eating disorders (EDs) are severe psychiatric disorders that affect women in reproductive age. Although ED features tend to reduce during pregnancy, remission may only be temporary, with features typically resurfacing during the postpartum period. There is evidence that women with EDs may have increased risk of adverse pregnancy and birth outcomes and be more vulnerable to psychiatric comorbidities such as depression and anxiety. Maternal EDs may also have implications for child psychological, cognitive and eating behaviours. Pregnancy and motherhood , particularly in the early stages, is an opportune time in a woman's life for health professionals to engage with affected women and initiate appropriate treatment and support to promote the best possible maternal and infant outcomes.
... Binge eating is a common form of eating disorder during pregnancy and can cause significant weight gain. Studies showed that 25-44% of women experience regular binge eating during their first pregnancy [3,[6][7][8]. Women who have a history of restrictive eating patterns or overeating in response to negative emotions are more likely to experience binge eating during pregnancy. Moreover, some women may struggle to determine what constitutes appropriate weight gain during pregnancy and may have distorted perceptions of their body image [9]. ...
... In this study, we report a prevalence of 1.6% of a potential diagnosis of an eating disorder, with the most common inappropriate behavior being binge eating at a prevalence of 18.8%, followed by self-induced vomiting at a prevalence of 14.4%. There is a range of prevalence rates for eating disorders in pregnant women across different studies [2,3,7,[13][14][15]. Using DSM-IV criteria, a recent study in southeast London in 2020 calculated the weighted prevalence of lifetime ED in a pregnant woman as 15.35% and the current ED as 1.47% [14]. ...
... In another study in Brazil in 2009, 0.6% of pregnant women indicated a probable diagnosis of eating disorder using the Eating Disorder Examination Questionnaire [3]. Using the Eating Disorder Diagnostic Scale, a 2009 study in the United Kingdom discovered that 7.5% of pregnant women met the diagnostic criteria for an ED [7]. Various factors can account for the differences in prevalence rates among studies investigating eating disorders in pregnant women. ...
Background: Eating disorders are complex illnesses with serious long-term consequences. They are linked to negative outcomes such as miscarriage, low birth weight, and other obstetric and postpartum difficulties. Our study in Muscat, Oman, examines the eating habits of pregnant women who consult primary care physicians. In this study, our aim is to identify key sociodemographic factors linked with eating disorders in Oman. Method: We used the Eating Disorder Examination Questionnaire to assess the potential for the presence of eating disorders. Chi-Square and Fisher’s Exact tests were used to analyze relationships between improper eating behavior and independent variables. Results: The study showed that 1.6% of participants had a potential diagnosis of an eating disorder, with the most common inappropriate behavior being binge eating at a prevalence of 18.8%. A pre-gestational low Body Mass Index (BMI) was associated with a higher prevalence of binge eating during pregnancy. Additionally, we found that pregnant women who were working were more prone to self-induced vomiting. High BMI before pregnancy was significantly associated with various inappropriate eating behaviors, such as restraint behavior (p = 0.000), shape concern (p = 0.000), weight concern (p = 0.040), eating (p = 0.045), laxative use (p = 0.020), and excessive exercise (p = 0.043). Conclusion: The study reveals a high prevalence of eating disorders in pregnancy. Less educated women exhibit higher laxative use, while working women show more instances of binge eating and self-induced vomiting. These findings emphasize the critical need to prioritize targeted interventions and support for vulnerable pregnant women.
... (www.preprints.org) | NOT PEER-REVIEWED | Posted: 20 June 2024 doi:10.20944/preprints202406.1442.v1 2 binge eating during their first pregnancy [3,[5][6][7]. Women who have a history of restrictive eating patterns or overeating in response to negative emotions are more likely to experience binge eating during pregnancy. Moreover, some women may struggle to determine what constitutes appropriate weight gain during pregnancy and may have distorted perceptions of their body image [8]. ...
... The prevalence, according to the literature, varies considerably across studies, ranging from 0.6% to 27.8% [3,5,6]. We calculated a sample size of 700 participants based on an 18% prevalence with a precision of 3%. ...
... In this study, we report a prevalence of 1.6% of a potential diagnosis of an eating disorder, with the most common inappropriate behavior being binge-eating at a prevalence of 18.8%, followed by self-induced vomiting at a prevalence of 14.4%. There is a range of prevalence rates for eating disorders in pregnant women across different studies [2,3,6,[11][12][13]. Using DSM-IV criteria, a recent study in South-East London in 2020 calculated the weighted prevalence of lifetime ED in a pregnant woman as 15.35% and the current ED as 1.47% [12]. ...
Background Eating disorders are complex illnesses with serious long-term consequences. They are linked to negative outcomes such as miscarriage, low birth weight, and other obstetric and postpartum difficulties. Our study in Muscat, Oman, examines the eating habits of pregnant women who consult primary care physicians. We aim to understand how eating disorders affect pregnant women and inform more effective interventions. Method We used the Eating Disorder Examination Questionnaire to assess the potential for the presence of eating disorders. Chi-Square and Fisher's Exact tests were used to analyze relationships between improper eating behavior and independent variables. Results The study showed that 1.6% of participants had a potential diagnosis of an eating disorder, with the most common inappropriate behavior being binge-eating at a prevalence of 18.8%. A pre- gestational low Body Mass Index (BMI) was associated with a higher prevalence of binge eating during pregnancy. Additionally, we found that pregnant women who were working were more prone to self-induced vomiting. High BMI before pregnancy was significantly associated with various inappropriate eating behaviors such as restraint behavior (p = 0.000), shape concern (p = 0.000), weight concern (p = 0.040), eating (p = 0.045), laxative use (p = 0.020), and excessive exercise (p = 0.043). Conclusion The study reveals a high prevalence of eating disorders in pregnancy. Less educated women exhibit higher laxative use, while working women show more instances of binge eating and self-induced vomiting. These findings emphasize the critical need to prioritize targeted interventions and support for vulnerable pregnant women.
... Motivated by their new role as a mother, some pregnant women are willing to adopt healthier habits such as healthier dietary intake and being active (Maher & Lowe, 2015). On the other hand, some pregnant women reported heightened body dissatisfaction (Meireles et al., 2015), increased preoccupations with eating habits (Bianchi et al., 2016) and disordered eating (Easter et al., 2013). In a recent French-Canadian study (n = 103) most pregnant women expressed concerns about their eating habits, weight, and body shape (Achim et al., 2022). ...
... Prevalence of disordered eating during pregnancy varies across studies due to sample characteristics, screening tools, and the retained clinical cutoff. A longitudinal study (N = 739) revealed that 7.5% of pregnant women from the general population met DSM-IV criteria for ED, while nearly 9% of them engaged in binge eating behaviors and 2.3% of them adopted compensatory behaviors (Easter et al., 2013). Among all EDs, binge eating disorder (BED) has the highest new onset rate during pregnancy (1.2 new cases of BED per 1000 person per week; Bulik et al., 2007). ...
... Although one ED screening tool was adapted (SCOFF; Hubin-Gayte & Squires, 2012) and another partially validated for pregnant women (first section of the EDE-Q5; Pettersson et al., 2016), they primarily focus on eating restriction. Notably, no validated measure includes items related to binge eating, despite its increased prevalence during pregnancy (Easter et al., 2013). In addition, in spite of Content courtesy of Springer Nature, terms of use apply. ...
Pregnant women undergo many physiological and psychological changes which can lead to body image disturbances and disordered eating. This study aimed to develop and validate a new scale measuring body image disturbances and disordered eating. The Maternal Body Image and Eating Behaviors Scale (MBIEB-S) was developed based on a multidimensional body image framework, qualitative insights into maternal body image and disordered eating, and limitations of existing instruments. In an online survey, 350 primiparous pregnant women completed the 72-item MBIEB-S. An exploratory factorial analysis yielded a six-factor model (50 items): Body Dissatisfaction, Overeating, Healthy Eating, Eating Restriction, Physical Exercise, and Avoidance. The scale has good convergent validity with related constructs (concerns about weight, shape and eating, eating restriction, and antenatal depression) and shows good criterion validity with relevant constructs (history of eating disorders and antenatal depression). The MBIEB-S measures key dimensions related to body image and eating behaviors during pregnancy, some of which may adversely affect both maternal and fetal health.
... The results of the pooled EDs prevalence in pregnant women are given in Table 1. The prevalence of EDs was analyzed by 10 studies [19][20][21][22][23][24][25][26][27][28] (Fig. 2). The prevalence of EDs in pregnant women was 4.3% (95% CI, 2%-9%; p < 0.001). ...
... Three studies [22,23,27] revealed a relationship between the prevalence of ED types in pre-pregnancy, and eight studies [19-23, 25, 27, 29] revealed a relationship between the prevalence of ED types during pregnancy. Pre-pregnancy AN prevalence was 0.2%, and AN prevalence during pregnancy was 0.4%. ...
... ED-related behaviors were examined in two studies [22,23]. Excessive exercise is observed in 0.7% of pregnant women, fasting in 0.3%, laxative or diuretic use in 0.1%, and self-induced vomiting behavior in 0.6% (p < 0.05). ...
Purpose
To reveal the prevalence of eating disorders (EDs) and related factors in pregnancy.
Methods
The search was performed in PubMed, EBSCOhost, Web of Science, Scopus, Google Scholar, and Ovid databases search up to April 3, 2022, using the keywords combination of "(eating disorders OR anorexia nervosa OR bulimia nervosa OR binge eating disorder) AND (pregnancy OR pregnant)". Two researchers independently extracted data from the articles using a standard form. We evaluated the quality of the studies according to the Joanna Briggs Institute assessment tools.
Results
The prevalence of EDs in pregnant women in the 11 studies involving 2,369,520 pregnant women was ranging between 0.5 and 10.6%. The prevalence of EDs in pregnant women was 4.3% (95% confidence interval 2%–9%; I² = 99.5%). The prevalence of anorexia nervosa and binge eating disorder during pregnancy shows a statistically significant increase compared to pre-pregnancy, and the prevalence of bulimia nervosa during pregnancy decreases. The prevalence of EDs is higher in pregnant women under 30 years of age, secondary school graduates, married, and with normal BMI. Half of the pregnant women with EDs had anxiety and about one-third of pregnant women had depression. Excessive exercise is observed in 0.7% of pregnant women, fasting in 0.3%, laxative or diuretic use in 0.1%, and self-induced vomiting in 0.6%.
Conclusions
This study is important as it is the first systematic review and meta-analysis to reveal the global prevalence of EDs in pregnant women and related factors. Continuing routine screening tests to detect EDs during pregnancy may contribute to taking special preventive measures for risk groups and protecting mother–child health.
Trial registration
PROSPERO registration number (CRD42022324721), date of registration: 10/05/2022.
... However, pregnancy is possible even during the active and partial recovery phases [5]. Approximately 5%-8% of pregnant women meet ED diagnostic criteria [6][7][8]. This is particularly concerning given the mental and physical health consequences associated with EDs [9][10][11], including increased risk of adverse obstetric and neonatal outcomes like Caesarean section (C-section) [12][13][14] and having low birthweight [14][15][16][17][18][19]. ...
... Second, EDs diagnosed in outpatient settings have only been registered since 1995, so any maternal EDs in this study that were diagnosed between 1991 and 1994 likely reflect more severe EDs as they were diagnosed in inpatient settings. The occurrence of EDs in our population are lower than reported in other pregnant populations [6][7][8], which is likely attributable the difference in assessing EDs in the registers versus self-reported information. Third, part of the explanation of preterm birth in mothers with AN may include higher rates of medication use during pregnancy [38,39]. ...
Objective
We examined the risk of adverse neonatal outcomes among children born to mothers with anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS).
Design
Cohort study.
Setting
Population‐based using Danish national registers.
Population
We included 1 517 839 singletons born between 1991 and 2015 in Denmark.
Methods
For each ED subtype, we compared children born to mothers with a recent (≤ 2 years before conception and during pregnancy) or past (> 2 years before conception) diagnosis, with children born to mothers who had not been diagnosed with the ED of interest before the index delivery.
Main Outcome Measures
Using multinomial logistic regression, we estimated relative risk ratios (RRRs) and 95% confidence intervals (CIs) for gestational age, birthweight, weight‐for‐gestational age, low Apgar score, Caesarean section, congenital malformations and postpartum haemorrhage.
Results
Both recent and past AN were associated with increased risk of low birthweight (recent: RRR = 2.36 [95% CI = 1.76–3.18]; past: 1.22 [1.04–1.43]), small‐for‐gestational age (recent: 1.52 [1.01–2.26]; past: 1.37 [1.16–1.62]), and preterm birth (recent: 1.83 [1.37–2.45]; past: 1.17 [1.00–1.36]), with more pronounced risks in recent AN. Recent (but not past) BN was associated with increased risk of low Apgar score (1.44 [1.03–2.00]). Recent (but not past) EDNOS was associated with increased risk of SGA (1.53 [1.04–2.27]).
Conclusions
Children born to mothers with EDs have an increased risk of some adverse neonatal outcomes, with more pronounced risks in recent than past EDs. These results underscore the need for improved prevention of maternal EDs and enhanced monitoring throughout pregnancy to mitigate adverse outcomes.
... Pregnancy and early motherhood are known to be vulnerable times for women with EDs (3)(4)(5)(6)(7). Reported prevalence during pregnancy is 5-8% (8,9), increasing to 12.8% after birth (9), compared with 0.8% for AN and 2.8% for BN for comparable age groups in the general population (10). One assumption is that these differences are linked to profound and rapid changes in body appearance, body image, body functions, body sensations, and sense of self-identity during these phases in life (5,(11)(12)(13). ...
... The distorted cognitions and behaviors associated with EDs have been observed to persist through pregnancy and postpartum (14,15). Women who experience persistent ED pathologies through pregnancy and early motherhood also tend to report higher levels of anxiety and depression (8,16,17). Furthermore, postpartum depression seems to occur more frequently in women who have or have had an ED (16,18). Taborelli et al. (19) examined retrospectively the transition from pregnancy to motherhood among women with a current ED. ...
Background
During pregnancy and early motherhood, risks of relapse and worsening are high for women with a history of eating disorders (EDs), as are adverse sequelae for their babies. However, systematic descriptions of the processes that these women undergo through pregnancy, birth, and early motherhood are lacking, as are good descriptions of the various trajectories these women follow through pregnancy and early motherhood. This study addresses both these knowledge gaps.
Methods
We used a longitudinal research interview design, recruiting a non-clinical sample of 24 women with a history of severe EDs from routine pregnancy controls in five public, local, family health care centers in Norway. The participants were interviewed twice, first during pregnancy and then 4–6 months after delivery. Data were analyzed according to grounded theory. The focus was on modeling the trajectories of EDs through pregnancy, birth, and early motherhood. All the participants were diagnosed (DSM-5) using the Eating Disorder Examination and then completed the Eating Disorder Examination Questionnaire.
Results
Five perceived trajectories through pregnancy and early motherhood were identified: “The mastering mother,” in which an ED pathology seems to be absent through pregnancy and early motherhood; “The inadequate mother,” in which the ED pathology worsens before pregnancy, through pregnancy, and early motherhood; “The overwhelmed mother,” in which the ED worsens during pregnancy and early motherhood; “The depressed mother,” in which the ED is put on hold during pregnancy, but worsens in early motherhood; and “The succeeding mother,” in which the ED worsens during pregnancy, but reduces in early motherhood.
Discussion
ED trajectories through pregnancy and early motherhood vary greatly among women with a history of EDs. This may indicate different psychological dynamics through these phases. A model with five trajectories captures a large degree of the variation. The model may help clinicians’ preparedness when dealing with these patients.
... EDs are more common than previously understood during pregnancy, with best prevalence estimates at 5% [12,13] and ranges from 0.6% to 27% [14][15][16][17][18][19], demonstrating there is a greater need to understand ED symptomatology during pregnancy [16]. Maternal EDs are associated with adverse pregnancy outcomes, including increased risk of hyperemesis and anemia during pregnancy and preterm birth, as well as neonatal outcomes such as giving birth to an offspring with microcephaly [20]. ...
... EDs are more common than previously understood during pregnancy, with best prevalence estimates at 5% [12,13] and ranges from 0.6% to 27% [14][15][16][17][18][19], demonstrating there is a greater need to understand ED symptomatology during pregnancy [16]. Maternal EDs are associated with adverse pregnancy outcomes, including increased risk of hyperemesis and anemia during pregnancy and preterm birth, as well as neonatal outcomes such as giving birth to an offspring with microcephaly [20]. ...
It is more isolating to patients if you aren’t familiar with the resources: A pilot test of a clinician sensitivity training on eating disorders in pregnancy.
(IRB Number: 1909705198).
Background Pregnant women with a history of eating disorders (EDs) or active EDs have greater maternal and child health complications. They are also unlikely to disclose their history with an ED to their clinician, few of which are confident in their knowledge to provide appropriate care for patients who present with EDs. This study’s goal was to evaluate changes to knowledge, behavior, and attitudes for health professionals who were part of a sensitivity training (to provide information of and awareness, address potential clinician biases, and offer strategies for more patient-centered care with de-stigmatizing language) about eating disorders and pregnancy compared with those who received a reference document.
Methods Our pilot study compared responses of health professionals before and after this sensitivity training (N = 54) with a group who were provided a clinician reference document about the same topic (N = 61).
Results Mann–Whitney Wilcoxon tests showed significant differences between the sensitivity training and reference document groups, with the sensitivity training resulting in increases to participants’ perception of ED’s relevance to overall treatment (p = 0.018), comfort in providing resources (p < 0.0001), frequency of ability to introduce strategies (p = 0.001), and interest in additional strategies/recommendations in treating patients with eating disorders (p = 0.009). Thematic analysis of the open-ended responses indicated four major themes: Resources and support, Treatment, Additional training, and Clinician Strategies.
Discussion Results indicated that the sensitivity training improved training outcomes compared to the reference document group. Qualitative responses from both groups indicated four themes that can help inform ED-centered care. This study provides context for future directions for continuing education courses as well as clinical training recommendations for treating pregnant patients with EDs.
... Recent investigations suggest that approximately one-third of pregnant women have body image dissatisfaction, and nearly one-quarter of them experience problems with body shape or eating disorders (EDs) [15,16]. Body dissatisfaction during pregnancy has been linked to an increased risk of developing ED [17,18]. ...
... Body dissatisfaction was observed to reach clinical signi cance in approximately ten percent of the sample, with a notably higher prevalence in concerns related to body shape, affecting more than one-sixth of participants. These data indicate a slightly lower prevalence of body discomfort within our population compared to previous studies in the literature, which have reported body dissatisfaction in up to one-quarter to one-third of pregnant individuals [15,16]. Conversely, concerns regarding restrictive behaviors and food-related issues were less prevalent, affecting fewer than 10% of the individuals. ...
Introduction. During pregnancy, the body undergoes extreme changes that can lead to dissatisfaction and a loss of self-esteem. This vulnerability arises from objective physical changes and societal pressures to conform to beauty norms. This study aimed to investigate the presence of body dissatisfaction and its association with depression and anxiety in a sample of pregnant women.
Methods. A cross-sectional digital survey was administered between May and June 2022. The survey included sociodemographic, pregnancy, weight-nutritional, and mental health domains. The latter included an exploration of psychiatric self-reported history alongside standardized instruments for evaluating body dissatisfaction (Eating Disorder Examination Questionnaire, EDE-Q), depressive symptoms (Patient Health Questionnaire-9, PHQ-9), and anxiety symptoms (General Anxiety Disorder-7, GAD-7). Subsequently, the dataset underwent descriptive analyses, followed by applying Kendall’s Tau correlations and linear regression models to explore the association between depression, anxiety, and body dissatisfaction.
Results. Within our sample (N = 711), one in ten subjects reported body dissatisfaction during pregnancy, with nearly half experiencing symptoms indicative of anxiety and depression. Body dissatisfaction was found to be associated with anxious-depressive symptoms and with a history of depression.
Conclusions. The conspicuous prevalence of body dissatisfaction, associated with depression and anxiety, suggests considering the issue of body experience as an indicative marker of perinatal emotional distress. This justifies the need for in-depth exploration within clinical settings, where opportunities for therapeutic interventions can be explored.
... Although preclinical models of placental insufficiency have provided insights into the impact of hypoglycaemia and hypoxaemia on fetal cardiac development, the independent role of hypoglycaemia in the absence of hypoxaemia remains unclear. FGR can also result from maternal nutrient restriction (MNR) despite a normoxaemic in utero environment, and understanding how hypoglycaemia without hypoxaemia contributes to the fetal origins of cardiovascular disease (CVD) is important, given the global prevalence of MNR due to food poverty or eating disorders during pregnancy (das Neves et al., 2022;Easter et al., 2013;Santos et al., 2017). ...
There is an association between fetal growth restriction (FGR) and a poor lifetime cardiac health trajectory. Defining the underlying mechanisms will aid in developing interventions to decrease the contribution of FGR‐born offspring to the global burden of cardiovascular disease. One cause of FGR is maternal undernutrition. In late‐gestation undernutrition (LGUN) fetal glucose supply, a main energy source for the fetal heart, is reduced. This may be a key contributor to altered fetal cardiac development; thus restoration of fetal glucose availability in the LGUN setting may be a viable target for intervention. To investigate the role of glucose availability in fetal heart development, we utilized an established pregnant sheep model of LGUN (50% global nutrient restriction) with or without a continuous intrafetal glucose infusion. LGUN reduced fetal plasma glucose concentrations, resulting in brain sparing that was normalized by intrafetal glucose infusion. LGUN decreased the protein abundance of oxidative phosphorylation complexes 1 and 3; however glucose infusion returned complex 3 abundance to that of controls. LGUN increased the phosphorylation of contractility and hypertrophy marker CAMKII, which was associated with increased left ventricular cardiac output; however intrafetal glucose infusion normalized CAMKII. Our findings demonstrate that glucose plays a specific role in regulating cardiac development in utero, highlighting the importance of adequate maternal nutrition in late gestation. image
Key points
Maternal late‐gestation undernutrition (LGUN) reduces fetal plasma glucose concentrations. To investigate the role of glucose availability in fetal left ventricle (LV) development, we assessed whether LGUN‐induced alterations in the contractility, metabolic and hormonal profiles can be ameliorated in LGUN fetuses receiving glucose infusion (LGUN+G).
Relative brain weight was increased in LGUN compared to controls and restored in LGUN+G despite fetal glucose infusion only partially normalizing fetal plasma glucose concentrations to that of controls.
LGUN decreased cardiac oxidative phosphorylation (OXPHOS)complex 1 and 3 abundance, and LGUN+G restored complex 3 to that of controls.
LGUN increased the activation of the contractility marker, Ca²⁺/calmodulin‐dependent protein kinase II (p‐CAMKII), but restored in LGUN+G. The magnetic resonance imaging measure of the LV cardiac output was positively correlated with p‐CAMKII expression in LGUN.
This study highlights the role of in utero glucose availability in regulating the abundance of fetal LV OXPHOS complex 3 and CAMKII activation in utero.
... [9]. Research suggests that ED symptoms continue during and after pregnancy, with approximately 4-7.5% of pregnant and 13% of postpartum women reporting impairing ED symptoms, where some women fulfil criteria for a specified ED [6,24]. ...
Background
During the peripartum period, four to 13 percent of women may be affected by eating disorders (ED). Previous reviews of qualitative studies in pregnant women with ED have mainly focused on the women’s experiences during pregnancy and not on their expressed needs. This systematic review aimed to identify which types of support were requested by pregnant women with ED.
Methods
The review was conducted in accordance with the “Enhancing transparency in reporting the synthesis of qualitative research” (ENTREQ) guidelines. Search for studies published between 1/1 2011- 14/3 2023 and 14/3 2023–9/1 2025, were performed in the following databases: PubMed, CINAHL, PsycInfo and Scopus. Studies were included if (1) the study population was pregnant women with ED symptoms /ED/ problems with food and eating, and (2) the study was an original qualitative study, and (3) the article was written in English. Rayyan, the AI-powered tool for systematic reviews, was used. Inclusion criteria were based on the SPICE-format. The CASP tool was used to assess quality in the included studies. Selected studies were read and critically appraised by two independent reviewers and a descriptive synthesis was conducted of expressed wishes for support based on quotes from the included studies. This review was preregistered in Prospero, 1/9 2023, (CRD42023456326).
Results
Of 992 studies, only five fulfilled the inclusion criteria. From these studies three themes emerged: wish for support from health care, wish to get support from a partner and wish to use self-help strategies.
Conclusion
This review found a knowledge gap regarding the type of support requested by pregnant women with ED symptoms.
Plain English summary
In this study, we aimed to explore the existing literature on the needs of support expressed by pregnant women with eating disorders. We reviewed studies published between 2011 and 2025, and found only five that partially addressed these needs. Three main themes emerged: wish for support, self-help strategies, and support from a partner. Our findings showed that the women expressed a desire for their midwives to have enough knowledge about eating disorders to bring up the topic and talk about it with them. We also identified a gap in the literature, highlight the need for more qualitative research to better understand the specific support these women want and need during pregnancy. The role of the partner in providing support should also be addressed in future research.
... Our research [16], and that of others [17,18], documents that as many as 41% of individuals with BMis ≥25 report lOc during the perinatal period. in addition, although other eating disorder symptoms often decrease during pregnancy [17,19], lOc persists and may even develop during pregnancy. For example, among individuals with BMi ≥25, rates of lOc are higher during pregnancy than in the period prior to pregnancy or in the postpartum period [16]. ...
Purpose
Loss of control while eating (LOC) or feeling unable to control the amount or type of food consumed during an eating episode, is the core psychopathology in binge eating disorders. Yet, the impact of LOC on other psychiatric symptoms during pregnancy is not known. This study evaluated the contribution of prenatal LOC to psychological distress and disordered eating attitudes.
Methods
Pregnant individuals with BMI ≥ 25 (N = 312) recruited for a perinatal health promotion trial self-reported past-month LOC; eating, shape, and weight concerns; prenatal depressive symptoms, anxiety, and stress. Propensity scores were used to reduce bias associated with cross-sectional data.
Results
Overall, 34.3% (n = 107) reported LOC. Individuals with prenatal LOC, relative to those without, endorsed more eating disorder symptoms (ps<.001) as well as more symptoms of depression (7.1±0.3 vs. 5.4±4.9) and anxiety (38.1 ± 11.7 vs. 33.4 ± 11.7) and greater perceived stress (25.0 ± 7.9 vs. 22.0±9.9, ps<.001). LOC frequency was associated with significantly more prenatal psychological distress, beyond the effect of other factors that increase the likelihood of LOC. (ps<.005).
Conclusions
Among individuals with elevated BMI, prenatal LOC is common and relates to eating disorder and other psychiatric symptoms. Prenatal LOC may represent a behavioral mechanism for improved psychological health.
... As the last trimester mean score of the participants of this study was under 21 points, they carried a low risk in terms of their eating attitudes. Eating behavior disorders are associated with maternal and newborn outcomes such as abortus, a significant increase in morbidity and mortality, preeclampsia, and low birth weight 4,11,33 . In a study that was conducted to determine the disrupted eating attitudes of the mothers of newborns requiring care at the newborn care unit in comparison to those who gave birth to healthy infants and investigate the prevalence of these, 127 mothers of healthy (>2500 g) newborns and 199 mothers of newborns hospitalized at the newborn intensive care unit were assessed with the Eating Attitude Test-26 and a questionnaire related to other perinatal health problems. ...
Background
Pregnancy is a process that involves social, psychological, and physical changes which may be a turning point for improvement or onset/relapse of eating disorders. Studies conducted have emphasized that, in addition to classical eating disorders (anorexia nervosa and bulimia nervosa), new types (e.g., orthorexia nervosa) and subclinical disorders are also seen in pregnant women. Based on this information, this is a descriptive study that was carried out to determine the relationship between the risk of orthorexia in pregnant women and body image.
Material-Method
The study included pregnant women receiving prenatal care at the obstetrics polyclinics of a state hospital in a province (n=175). After applying the first test on the pregnant women (in their first trimester), the posttests were carried out after the 30th week covering the third trimester of pregnancy. ORTO-11 scale, the Eating Attitude Test (EAT-40), and the Pregnancy Self-Perception Scale were used in data collection.
Results
The mean age of the pregnant women who participated in the study was 27.02±5.02. The mean first-test ORTO-11 score of the participants was 29.29±3.77, and their mean post-test ORTO-11 score was 26.58±4.08, while the difference was statistically significant, and the concerns of the pregnant women in their final trimester regarding eating healthy were higher than those when they first learned about their pregnancy. Among the pregnant women in their final trimester, the mean EAT-40 score was 19.64±8.66, the mean pregnancy motherhood perception dimension score was 25.30±2.97, and the mean pregnancy body perception dimension score was 15.39±4.00.
Conclusion
Based on the data of the study, it may be stated that the pregnant women in their final trimester had obsessions about healthy eating, and they had a negative perception of the changes in their bodies. Disorders in eating attitudes in pregnancy may significantly affect the outcomes of pregnancy and newborn health.
... Over women's lifespan, puberty, pregnancy, and postpartum have been identified as windows of vulnerability for the development or exacerbation of body image disturbances [34][35][36][37][38][39]. Indeed, these reproductive milestones involve a complex storm of physical, psychological, and social changes that can deeply affect women's sense of identity and satisfaction with their body, as they try to navigate the often narrow and unrealistic expectations of beauty imposed during these critical life stages [2]. ...
Body image is an important aspect of psychological well-being that is influenced by several biological and psychosocial risk factors. Cultural determinants of body image include the patterns of shared beliefs, values, practices, and social norms within a group that can act as a lens through which a person perceives, compares, and evaluates their body. Women tend to experience higher rates of body dissatisfaction than men, with reproductive milestones such as puberty, pregnancy, and postpartum being windows of vulnerability for body image concerns. The menopausal transition is another reproductive stage of women's lives that involves major physical changes, psychological challenges, and social pressures that can impact body image negatively. However, the literature on the influence of cultural determinants on the body image of menopausal women is limited. Therefore, this perspective review paper aims to discuss the potential role of cultural determinants in influencing body image satisfaction in women undergoing the menopausal transition. To this end, the relationships between different cultural perspectives and body image around the world are first discussed. Sociocultural influences on body image throughout women's lifespan and reproductive stages are then presented. Finally, cultural perspectives on menopause and aging and their potential influence on the body image of menopausal women are explored. This paper underscores the importance of considering culture and sociocultural factors when studying body image and highlights the need for further research on the cultural determinants of body image during the menopausal transition.
... 18 In another study, 7.5% of pregnant women were found to meet the diagnostic criteria for EDs. 19 The finding that EDs are common complications during pregnancy aligns with data from our study where many obstetricians encountered pregnant women with complicated EDs. A review of complications during pregnancy and postpartum in patients with EDs suggested that complications during pregnancy and delivery included postpartum hemorrhage in AN, gestational diabetes, preeclampsia, more frequent abortions in BN, and in addition, hypertensive disorders of pregnancy, gestational diabetes, preeclampsia, and increased rate of miscarriage in Binge eating disorder (BED). ...
Aim
To investigate the attitudes and experiences of obstetricians and gynecologists in treating women with eating disorders (EDs) in Japan.
Methods
Members of the Japan Society of Obstetrics and Gynecology were invited to participate in a web‐based survey from March 1 to 31, 2022. We asked about the attitudes of obstetricians and gynecologists toward women with weight loss‐related amenorrhea and their experiences in treating EDs. We also assessed the characteristics of physicians who see many ED patients.
Results
A total of 662 ob/gyns. responded to the survey. While treating weight loss‐related amenorrhea, 25.8% reported screening patients for EDs. 88.5% of respondents reported having treated ED patients. The main medical concerns described when treating pregnant women with ED were fetal growth restriction and preterm delivery. The most common type of ED encountered by participants in both perinatal and infertility care settings was anorexia nervosa. Characteristics of physicians who treated 10 or more EDs per year were being board certified in women's health care and not providing delivery services (OR = 4.809, 1.896). The most common comment regarding optimizing the management of patients with EDs in obstetrics and gynecology practice was the need to implement guidelines for ED management.
Conclusions
Many obstetricians and gynecologists in Japan treat patients with ED. Standardized guidelines for the management of EDs for obstetricians and gynecologists are needed.
... 7 A systematic review suggests that between 5.2% and 7.5% of pregnant women have an ED and the prevalence in the post-partum period could be even higher. 8 A further study found that 28% of women displayed disordered eating and psychological traits associated with EDs during their pregnancy, and that this was not identified by their health practitioners 93.3% of the time. 9 In Australia, there are more than 305,000 births each year. ...
Background
Eating disorders (EDs) are estimated to affect 5.2%–7.5% of pregnant women, equating to 15,800–23,000 births in Australia annually. In pregnancy, an ED increases the risk of complications for both mother and child. Heightened motivation and increased utilisation of healthcare services during pregnancy present an opportunity to identify and commence ED treatment. Dietetic management of EDs differs from nutrition guidelines for pregnancy. This study aimed to assess current practice, confidence and training needs of dietitians to manage EDs in pregnancy.
Methods
A cross‐sectional survey of Australian dietitians with past year exposure to ED and/or antenatal fields was completed using Microsoft Forms between November 2022 and January 2023.
Results
One hundred and seventeen responses were analysed. Confidence was less for assessment of a woman with an active ED in pregnancy than a pregnant woman with a history of an ED, pregnancy or an ED alone (p < 0.001). Greater than 5 years of experience as a dietitian, but without recent exposure to the patient population, was associated with increased confidence (p < 0.01). Almost half provided descriptions of treatments and interventions used to treat a pregnant woman with an ED, some of which conflict with ED or antenatal guidelines. Dietitians were more likely to weigh a person with an ED in pregnancy. Most respondents indicated further training (93%) and guidelines (98%) would be helpful.
Conclusion
This is the first investigation into the dietetic management of EDs in pregnancy, and it highlights a need for guidelines and training for dietitians.
... A study by Easter et al. found that 7.5% of women in the United Kingdom had a diagnosed ED during pregnancy [12]. Another study by Bulik et al. found that the prevalence of EDs during pregnancy was 0.2% for BN and 4.8% for BED [13]. ...
Previous systematic reviews have reported on the relationship between eating disorders (EDs) and birth outcomes, but there are no existing meta-analyses on this topic. This systematic review and meta-analysis examines the association between lifetime maternal EDs, including anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) with low birth weight (LBW), preterm birth (PTB), small for gestational age (SGA), large for gestational age (LGA), and miscarriage. Four databases were systematically searched for quantitative literature on maternal EDs that preceded birth outcomes. Eighteen studies met the inclusion criteria and were included in the review. The meta-analyses included 6 studies on miscarriage, 11 on PTB, 4 on LBW, 9 on SGA, and 4 on LGA. The Mantel–Haenszel random effects model was used to test the associations between EDs and birth outcomes. The results showed significant positive associations between AN and LBW (OR 1.74, 95% confidence interval (CI) 1.49, 2.03), AN and SGA (OR 1.39, 95% CI 1.17, 1.65), BN and PTB (OR 1.19, 95% CI 1.04, 1.36), and BED and LGA (OR 1.43 95% CI 1.18, 1.72). EDs were not significantly correlated with miscarriage. These findings reveal the importance of screening for and treating EDs in pregnant women.
... Furthermore, in Western countries, 5.5%-17.9% of young women have undergone an ED by early adulthood (Silén & Keski-Rahkonen, 2022). During pregnancy, prevalences of EDs ranging from 5.1% to 15.3% have been observed (Dörsam et al., 2019;Easter et al., 2013;Martínez-Olcina et al., 2020). Maternal ED is a significant and challenging condition, since it may negatively impact adaptation to motherhood (Koubaa et al., 2008) and maternal infant bonding (Astrachan-Fletcher et al., 2008;Patel et al., 2002). ...
Objective
Hyperemesis gravidarum (HG) is a severe form of excessive vomiting during pregnancy. The connection between psychiatric morbidity and HG has been debated, but only a few studies have focused on eating disorders (EDs). The objective of this study was to evaluate the association between HG and both pre‐pregnancy and new post‐pregnancy EDs.
Methods
A register‐based controlled study. HG diagnoses were retrieved from healthcare registers between 2005 and 2017. Women with HG in their first pregnancy resulting in delivery were chosen as cases (n = 4265; the HG group) and women with no HG as controls (n = 302,663; the non‐HG group). The associations between EDs and HG were analyzed by binary logistic regression, adjusted with age, body mass index, smoking, socioeconomic status, and pre‐pregnancy psychiatric diagnoses.
Results
In the HG group, 1.6% and in the non‐HG group, 0.2% had a pre‐pregnancy ED. Women with ED were more likely to have HG in their first pregnancy compared with women with no history of EDs (adjusted odds ratio [AOR] 9.4, 95% CI 6.52–13.66, p < .0001). Moreover, 0.4% of the women in the HG group and 0.1% of the women in the non‐HG group had a new ED diagnosis after pregnancy, and thus the women in the HG group were more likely to have an ED diagnosis after pregnancy (AOR I 3.5, 95% CI 1.71–7.15, p < .001, AOR II 2.7, 95% CI 1.30–5.69, p = .008).
Discussion
We found a bidirectional association between ED and HG, suggesting a shared etiology or risk factors between these disorders. This finding emphasizes the importance of collaboration across various specialties when treating these patients.
Public Significance
Our findings suggest a bidirectional association between HG and EDs before and after pregnancy. This finding provides essential information for healthcare professionals working with pregnant women. As both of these disorders are known to have far‐reaching effects on the lives of both the mother and her offspring, our results help clinicians to target special attention and interventions to the patients suffering from these disorders.
... The exploration of eating disorders during pregnancy, such as anorexia nervosa, bulimia nervosa, binge eating disorders, and Other Specified Feeding and Eating Disorders (OSFED), has always been a subject of great interest in both research and clinical fields [1][2][3][4]. However, a peculiar designation of disordered eating attitudes during pregnancy has only begun to rise in attention few years ago-which is "Pregorexia". ...
Introduction: Despite the risks of gestational disordered eating for both the mother and fetus, research into this subject is scarce within developing countries, particularly in Lebanon. Our
study’s objective was to delve into the predictors of disordered eating attitudes during pregnancy
among a sample of Lebanese pregnant women while assessing the potential mediating effect of
body dissatisfaction between psychosocial factors and disordered eating attitudes in pregnancy.
Methods: We framed a cross-sectional study, built on self-report measures. Pregnant women of
18 years old and above were recruited from all the Lebanese governorates through an online
survey (N=433).
Results: The results showed that higher pregnancy-specific hassles (Beta=0.19), media and
pregnant celebrities’ influence (Beta=0.22), and body dissatisfaction (Beta=0.17) were
significantly associated with increased disordered eating attitudes in pregnancy; whereas higher
perceived social support (Beta=-0.03), lower socio-economic status (Beta=-0.84), and
multigravidity (Beta=-0.96) were significantly associated with less disordered eating attitudes
during pregnancy. Body dissatisfaction mediated the association between pregnancy-specific
hassles and disordered eating attitudes, and between social appearance concerns and disordered
eating attitudes.
Conclusion: Our study highlighted that antenatal care, particularly in Lebanon, should no longer
be limited to biological monitoring but rather seek to identify possible eating disorders and
mental health threats. Further investigations following longitudinal designs should pursue
identifying additional correlates of gestational disordered eating in the clinical context, in
furtherance of consolidating screening programs and building targeted treatment strategies.
... There is no consensus on the prevalence of pregorexia, ranging from 0.6% to 27.8% according to different studies [4]. Incorrect and delayed diagnosis of pregorexia can have adverse effects on a pregnancy, leading to impaired fetal growth and physical health deterioration in pregnant women. ...
Pregorexia refers to an eating disorder observed in pregnant women characterized by the adoption of extreme dieting and workout regime during pregnancy meant to ward off weight gain and keep body shape under control. Psychological factors such as a distortion of how one perceives their own body, concerns about visible signs of pregnancy, and fear of gaining weight have been identified as some of the underlying causes of pregorexia. This condition may have detrimental effects, such as stunted fetal growth, spontaneous miscarriage, and development of anemia by the pregnant woman.
... Although other serious disordered eating behaviors often improve during pregnancy [5,7,10], LOC does not improve during pregnancy [7]. To date, rates of LOC during pregnancy range from 8.4 to 36%, depending on the method of assessment and population studied [12,20,24,30]. For example, we previously reported that 24% of pregnant people with overweight or obesity endorsed LOC during pregnancy [24]. ...
Background
Excessive gestational weight gain (GWG) predicts negative health outcomes among individuals with overweight or obesity. Loss of control eating (LOC), the ingestion of food associated with being unable to control eating, is the core psychopathology of binge eating disorders. We evaluated the contribution of LOC to GWG among pregnant individuals with prepregnancy overweight/obesity.
Methods
In a prospective longitudinal study, individuals with prepregnancy BMI ≥ 25 (N = 257) were interviewed monthly to assess LOC and reported demographic, parity, and smoking information. GWG was abstracted from medical records.
Results
Among individuals with prepregnancy overweight/obesity, 39% endorsed LOC prior to or during pregnancy. After adjusting for factors that have previously been linked to GWG, LOC during pregnancy, uniquely predicted higher GWG and greater likelihood of exceeding GWG recommendations. Participants with prenatal LOC gained 3.14 kg (p = 0.03) more than did those without LOC during pregnancy and 78.7% (n = 48/61) exceeded IOM guidelines for GWG. The frequency of LOC episodes was also associated with greater weight gain.
Conclusions
Prenatal LOC is common among pregnant individuals with overweight/obesity and predicts greater GWG and increased likelihood of exceeding IOM GWG guidelines. LOC may represent a modifiable behavioral mechanism to prevent excessive GWG among individuals at risk for adverse pregnancy outcomes.
... In one retrospective study of 54 people during postpartum, 1.85% had a documented history of an eating disorder, but 27.8% had scores on the Eating Disorder Inventory-3 indicating they had psychological and behavioral symptoms congruent with diagnostic criteria (Broussard, 2012). Other correlational studies report a high prevalence of disordered eating symptomatology, including binge eating, food restriction, purging, and excessive exercise, among people in the antenatal period using the Eating Disorder Diagnostic Scale (Easter et al., 2013) and the Eating Disorder Examination Questionnaire (Soares et al., 2009). One Norwegian cohort study (N = 35, 929) assessed bulimia nervosa and BED symptoms in pregnant individuals, using a self-report questionnaire measuring eating disorders and behaviors, and found those with bulimia nervosa (BN) had higher GWG, and those with BED were more likely to have higher birth weight babies, babies large for gestational age, and cesarian births (Bulik et al., 2009). ...
Objective
Gestational weight gain (GWG) above or below recommendations is common and has implications for parent and infant health. Bulimia nervosa and binge‐eating disorder during pregnancy have been associated with higher GWG. Yet, little research has examined the associations between binge‐spectrum symptoms and GWG. Likewise, few interventions exist to adequately prevent GWG. The current study investigated a broad range of predictors of GWG, with the goal of identifying potentially modifiable risk factors.
Method
We conducted secondary data analyses of a subsample of individuals from the Alberta Pregnancy Outcome and Nutrition (APrON) longitudinal cohort study. Multinomial logistic regression estimated the odds of gestational weight gain (GWG) outside of Institute of Medicine (IOM) recommendations and linear regression was used to examine total GWG continuously.
Results
Of the 1644 participants included, 848 (51.6%) exceeded the IOM's guidelines for GWG, and 272 (16.5%) gained below these recommendations. Binge‐spectrum symptom symptomatology during pregnancy was not associated with exceeding GWG recommendations after accounting for post‐secondary education, identifying as European Canadian, and higher pre‐pregnancy body mass index (BMI). However, greater self‐reported binge‐spectrum symptomatology during pregnancy was associated with higher total GWG after accounting for age, parity, and pre‐pregnancy BMI.
Conclusions
In addition to replicating identified predictors of higher GWG, we found that greater binge‐spectrum symptomatology was associated with higher total GWG. These findings suggest that routine screening for eating pathology during pregnancy may identify those at risk for excess GWG.
Public Significance
Gestational weight gain (GWG) outside of recommended ranges is associated with adverse outcomes. Little work has examined the associations between eating disorder symptoms and GWG. This study found that bulimia and binge‐eating symptoms were uniquely associated with higher GWG beyond known risk factors. These findings support routine screening of eating disorder symptoms and interventions to help individuals gain within GWG recommendations during pregnancy.
... For detailed recruitment methods and study design, see (Easter et al., 2013(Easter et al., , 2015. ...
Aims:
This study aims to investigate the effect of maternal eating disorders (ED) on mother-infant quality of interaction at 8 weeks and bonding and child temperament at 1 and 2 years postnatally. We also aimed to explore the relationship between maternal ED psychopathology, comorbid psychiatric difficulties, and both mother-infant quality of interaction and bonding in women with ED. Women were recruited to a prospective longitudinal study. By the time of giving birth, the sample consisted of 101 women of the initial 137 (73.7%). Overall, 62 women (ED = 36; HC = 26) participated in the 8-week assessment, 42 (ED = 20; HC = 22) at 1 year, and 78 (ED = 34; HC = 44) at 2 years. Mann-Whitney U Test was used to explore association between maternal ED and mother-infant quality of interaction and between maternal ED and bonding. Spearman correlations were used to explore associations between maternal ED psychopathology, comorbid psychiatric difficulties, and both mother-infant quality of interaction and bonding.
Results:
We found no differences between early mother-infant interaction and bonding in mothers with ED in comparison to HC. High levels of maternal ED psychopathology were correlated with high anxiety levels, higher negative affectivity, and lower extraversion in children of ED mothers both at 1 and 2 years. Furthermore, high levels of ED psychopathology were also associated with lower effortful control at 1 year.
Conclusions:
Findings imply that maternal ED have an impact on child temperament. Future research should focus on resilience and on which protective factors might lead to positive outcomes. These factors can be then used as therapeutic and preventative targets.
... Surprisingly, the prevalence of eating disorders (i.e., anorexia nervosa, bulimia nervosa, binge eating disorders, Other Specified Feeding or Eating Disorder, etc.) during pregnancy varies greatly between studies, ranging from 0.6 to 27.8% [7][8][9][10][11][12][13][14][15][16][17][18]. These disparities could be explained by the diversity of assessment tools, varying from self-report questionnaires to structured interviews [8]. ...
Background: Pregorexia refers to the excessive fear of pregnancy-induced weight gain and the drive to control it through various measures (e.g., extreme restriction of calorie intake, excessive exercising, or diuretics and/or laxatives consumption). The Disordered Eating Attitudes in Pregnancy Scale (DEAPS, Bannatyne et al., in: Disordered eating in pregnancy: the development and validation of a pregnancy-specific screening instrument. Bond University, 2018) is a brief pregnancy-specific instrument developed to screen for antenatal eating disorders. Our study's objective was to examine the reliability and psychometric properties of the Arabic version of this pregnancy-specific scale among Lebanese pregnant women.
Methods: We conceived and implemented a cross-sectional survey between June and July 2021 (N=433). The sample was randomly divided in two as per the SPSS data selection option; the first subsample was used to conduct the DEAPS items’ exploratory factor analysis (EFA), whereas the second was used for the confirmatory factor analysis (CFA). Within this study, we described multiple indices of goodness-of-fit: the Relative Chi-square (χ2/df), Root Mean Square Error of Approximation (RMSEA), Tucker Lewis Index (TLI), and Comparative Fit Index (CFI).
Results: An EFA was conducted on subsample 1 (N=207), chosen randomly from the original sample. With the exception of item 8, all other 13 items converged over a two-factor solution [Factor 1 (3 items): Body Image Concerns during Pregnancy, and Factor 2 (10 items): Disordered Eating Attitudes during Pregnancy]. In subsample 2 (N=226), the CFA results showed that the one-factor model (Factor 2: 10 items), which derived from the EFA conducted on subsample 1, fitted well accordingly to CFI, TLI, and χ2/df values, and fitted modestly according to RMSEA. The CFA estimates obtained for model 1 (original scale of 14 items) and model 2 (according to the two-factor solution obtained from the EFA in subsample 1) fitted less than the third model (Factor 2). The analysis thus suggested retaining only Factor 2 with 10 items in the Arabic version of the scale.
Conclusion: Our study was able to provide preliminary evidence that the Arabic 10-item version of the DEAPS seems to be a good and reliable tool for the assessment of disordered eating attitudes among Lebanese pregnant women.
... In reality, as pregnancy progresses, women experience a high, even worsening, stress of dealing with body shape changes, body weight gain, and body dissatisfaction, compared to baseline levels before pregnancy (Knoph Berg et al., 2008). Consistently, eating disorders have also been numerously reported during pregnancy (Bye et al., 2020;Easter et al., 2013), in such a way that the literature has recently denoted a prominent interest in a disordered pregnancy-specific eating behavior, which has been peculiarly termed "pregorexia". Although "pregorexia" is not yet recognized diagnostically, it defines a state of unreasonable worry about pregnancy-related weight gain, added to a strenuous strive to restrict/control it through diverse manners (e.g., calorie restriction, intense exercise, etc.), in response to the desire to remain thin during pregnancy (Mathieu, 2009). ...
This cross-sectional study looked into sexual dysfunctions in a sample of Lebanese pregnant women (N=433) while assessing their psychopathological correlates. It was a first attempt in research to examine the role of disordered eating attitudes in pregnancy, using the Arabic version of the Disordered Eating Attitudes in Pregnancy Scale. The pre/post comparison in terms of sexual functioning was based on the women’s recall, using the Pregnancy Sexual Response Inventory. According to the pregnant persons perceptions of their sexual functioning before and during pregnancy, 66.1% of the participants reported a lower frequency of sexual activity during pregnancy, 52.7% lower sexual desire, and 47.3% dyspareunia; 33% were sexually satisfied contrasted to 70% before pregnancy. Pregnancy was significantly associated with lower sexual outcomes compared to before. Higher anxiety and more disordered eating attitudes during pregnancy were significantly associated with lower sexuality composite scores. Our study accentuates the need for rigorous medical guidance on sexual activity during pregnancy and highlights dysfunctional eating behaviors and anxiety disorders as pejorative predictors of the sexual response among pregnant women. It thus sustains the hypothesis that mental health disorders pertain to the pathogenesis of sexual problems and should therefore be targeted in sexual health promotion during prenatal care.
... A collection of mental health conditions known as eating disorders are characterized by eating behavior disruptions that can sometimes gravely harm one's physical and psychological well-being [2]. The most common eating disorders in pregnancy are anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) [3]. The eating disorder most commonly affects women of the reproductive age group and also may affect 5.1%-7.5% of women during pregnancy. ...
Numerous studies revealed that women in the first trimester of pregnancy (prenatal) and 6-12 months after delivery of a newborn (postnatal) suffer from eating disorders like anorexia nervosa, bulimia nervosa, and binge eating disorder. Pregnancy may increase or decrease the symptoms of eating disorders. It varies from person to person. The mother faces many complications during this period which may also affect the newborn child. Weight loss is an essential symptom of eating disorders, which may cause extreme anxiety and depression during and after pregnancy. Stress is another symptom that is associated with binge eating disorders. The main aim of this narrative review article is to critically analyze and discuss the association of prenatal and postnatal factors that lead to different eating disorders in the mother and child. A total of 38 published and standard articles were selected for this review. The studies under consideration showed numerous methodological shortcomings, necessitating additional investigation to explain these discrepancies. The evidence points to a connection between prenatal and perinatal variables, and the children of these women also develop eating disorders. Earlier research focused on linking pregnancy and eating disorders, mainly emphasizing anorexia nervosa and bulimia nervosa. However, any significant correlation between binge eating disorder and pregnancy is yet to be found. In the first half of pregnancy, about 33%-35% of women who had binge eating disorder before becoming pregnant no longer met the diagnostic criteria, their illness improved, and they seemed to recover. These patients with eating disorders are more likely to have pregnancy-related complications and births. Therefore, creating a multidisciplinary screening strategy and guidelines for managing and supervising this particular patient population makes sense.
Eating disorders (EDs) are relatively common, affecting approximately 3–5% of young men and 13–15% of young women by age 18. EDs occur across genders, races, ethnicities, and socioeconomic levels and often persist into senior adulthood. EDs are significant public-health concerns that are associated with elevated psychiatric and medical morbidity and mortality, making them important mental health conditions to routinely assess in both general and specialty mental health settings. In this chapter, we describe the diagnostic criteria for EDs, review key considerations for assessment, and provide a wealth of tips and user-friendly tools that clinicians and researchers can implement to assess for these serious disorders. Throughout the chapter, we focus on tailoring assessment based on client needs and demographic features to improve assessment in under-served and diverse populations.
Objective
To examine the effect of underweight maternal body mass index (BMI) on pregnancy complications and neonatal outcomes.
Design
Cohort study.
Setting
Tertiary academic center.
Patients
A total of 16,361 mothers who delivered a singleton between 2015-2021 with either a BMI <18.5kg/m2 (n=732) or normal BMI (18.5> BMI <23 or 25 kg/m2, n=15,629) at the initial prenatal visit or within six months of the initial visit.
Main Outcome Measures
Birthweight, gestational age, neonatal intensive care unit admission, preterm birth, and fetal death; obstetrical complications including pre-eclampsia/eclampsia, premature rupture of membranes, preterm premature rupture of membranes, and post-partum hemorrhage.
Results
Underweight women were younger and less likely to have private insurance (p<0.01 for both) than normal-weight women. Approximately 23% of infants born to underweight mothers were small for gestational age (SGA) and 15% were low birthweight versus 13.5% and 9% of infants of normal-weight mothers, respectively (p<0.01 for both). These differences remained significant after adjusting for potential confounders. In adjusted logistic regression models, underweight women had a decreased risk of premature rupture of membranes and post-partum hemorrhage compared to normal-weight women.
Conclusions
Underweight BMI during pregnancy is associated with an increased risk of small for gestational age and low birth weight infants and a decreased risk of premature rupture of membranes and post-partum hemorrhage. These findings suggest underweight BMI during pregnancy increases the risk of adverse neonatal outcomes, while maternal-related pregnancy outcomes are less affected.
O objetivo do estudo é verificar como ocorre um transtorno alimentar (TA) durante o período gestacional. Para tal, uma revisão narrativa foi conduzida através da consulta dos bancos de dados eletrônicos PubMED, Scielo e Science Direct, baseada no termo em inglês “eating disorders in pregnancy”, foram identificados trabalhos nos últimos 20 anos que se adequassem à temática e aos tópicos previamente definidos. Foram incluídos neste estudo trabalhos em espanhol, inglês e português, realizados no período de 2000 a 2022. Ao longo do texto, foi discutido como os transtornos alimentares durante o período gestacional influenciam na fertilidade, o impacto da imagem corporal em sua sintomatologia, as dificuldades em sua detecção, as possíveis complicações e, por fim, a condução terapêutica. Concluiu-se que a busca pelo corpo ideal e o ganho de peso gestacional podem atuar como gatilhos para o desenvolvimento de TAs em mulheres, que devem ser identificados e acompanhados. Portanto, o acolhimento é diretriz máxima de acompanhamento da equipe multiprofissional dessa gestante e, futura, puérpera, feito com boa comunicação entre os profissionais e a paciente, atuando na prevenção ou minimização dos agravos à saúde física e mental decorrente desses transtornos.
Pregnancy represents a crucial timepoint to screen for disordered eating due to the significant adverse impact on the woman and her infant. There has been an increased interest in disordered eating in pregnancy since the COVID-19 pandemic, which has disproportionately affected the mental health of pregnant women compared to the general population. This systematic review is an update to a previous review aiming to explore current psychometric evidence for any new pregnancy-specific instruments and other measures of disordered eating developed for non-pregnant populations. Systematic searches were conducted in PubMed, ProQuest, PsycInfo, CINAHL, Scopus, MEDLINE, and Embase from April 2019 to February 2024. A total of 20 citations met criteria for inclusion, with most studies of reasonable quality. Fourteen psychometric instruments were identified, including two new pregnancy-specific screening instruments. Overall, preliminary psychometric evidence for the PEBS, DEAPS, and EDE-PV was promising. There is an ongoing need for validation in different samples, study designs, settings, and administration methods are required. Similar to the original review on this topic, we did not find evidence to support a gold standard recommendation.
Los estudios sobre recomendaciones nutricionales para la embarazada que realiza ejercicio físico son escasos. El objetivo de este artículo no es centrarnos en la dieta de la embarazada de forma global, sino revisar aquellos aspectos de la misma que pueden tener relación con el ejercicio físico. Para ello, se recogen las recomendaciones nutricionales y sobre hidratación contenidas en las principales guías de práctica clínica sobre ejercicio físico durante el embarazo, incluyendo las primeras guías españolas.
Así mismo, se abordan los requerimientos energéticos que precisan las gestantes que realizan ejercicio físico durante el embarazo para una ganancia de peso gestacional adecuada, aspectos relacionados con los macronutrientes en el citado grupo de población, y dos temas específicos, como son las necesidades nutricionales en la adolescente que practica ejercicio físico durante su embarazo y los trastornos de la conducta alimentaria en deportistas embarazadas.
Se concluye afirmando que las embarazadas que realizan ejercicio físico de forma regular deben llevar una dieta variada y equilibrada, como es la dieta mediterránea, eludir períodos largos de ayuno para evitar la aparición de hipoglucemias y mantener una adecuada ingesta de líquidos antes, durante y después del ejercicio físico. Las adolescentes embarazadas que realizan ejercicio físico requieren una supervisión nutricional para que alcancen una ganancia de peso gestacional adecuada. La deportista embarazada con un trastorno de la conducta alimentaria tiene un mayor riesgo de complicaciones durante el embarazo y parto, ginecológicas, fetales y neonatales, y, por tanto, requiere un estrecho seguimiento por especialistas en medicina maternofetal. //
Studies on nutritional recommendations for pregnant women who exercise are scarce. The objective of this article is not to focus on the diet of women as a whole, but to review those aspects of it that may be related to physical exercise. To this end, the nutritional and hydration recommendations contained in the main clinical practice guides on physical exercise during pregnancy are collected, including the first Spanish guides.
Likewise, the energy requirements required by pregnant women who perform physical exercise during pregnancy for adequate gestational weight gain are addressed, aspects related to macronutrients in the aforementioned population group, and two specific topics, such as nutritional needs in the adolescent who practices physical exercise during pregnancy and eating disorders in pregnant athletes
It is concluded by stating that pregnant women who exercise regularly should eat a varied and balanced diet, such as the Mediterranean diet, avoid long periods of fasting to avoid the appearance of hypoglycemia and maintain adequate fluid intake before, during and after physical exercise. Pregnant adolescents who engage in physical exercise require nutritional supervision to achieve adequate gestational weight gain. The pregnant athlete with an eating disorder has a higher risk of complications during pregnancy and childbirth, gynecological, fetal and neonatal, and, therefore, requires close monitoring by specialists in maternal-fetal medicine.
Objective
Disordered eating is common in pregnancy and associated with adverse health outcomes. Weight suppression (WS), the discrepancy between highest lifetime and current weight, is a robust predictor of loss of control (LOC) and binge eating and weight gain trajectories in clinical populations. This study explored the role of preconception WS as a predictor of disordered eating and weight gain in pregnancy.
Method
Pregnant individuals ( n = 137) reported their highest, preconception, and current weights to calculate preconception WS, actual gestational weight gain (GWG), and deviations from recommended weight gain trajectories in pregnancy. Participants also completed the Prenatal Eating Behaviours Screening (PEBS) tool, a validated measure of disordered eating specifically in pregnancy.
Results
Preconception WS was a significant predictor of PEBS total scores [ F (5, 122) = 2.70, p = 0.02, R ² = 0.10] and significantly and positively correlated with individual item scores quantifying restrictive eating behaviours. Preconception WS was not predictive of deviations from recommended GWG trajectories or LOC or binge eating frequency and did not interact with pre‐pregnancy body mass index or GWG to predict eating disorder symptom severity.
Conclusions
Preconception WS was predictive of disordered eating, and specifically restrictive eating behaviours in pregnancy, and should be assessed as part of screening for eating disorder risk in pregnant individuals.
Eating disorders are serious psychiatric disorders that commonly occur in women of childbearing age. Pregnancy is a vulnerable time where eating disorders can be influential for the health of both mother and child. The purpose of this literature review was to assess the relationship between eating disorders during pregnancy with complications during pregnancy and birth outcomes. A search was conducted using Pub Med, Cinahl and Scopus and references of selected articles reviewed. Sixteen comparative studies were found and used. The main findings are that the results of the impact of eating disorders on pregnancy and birth are inconclusive. Ten out of twelve studies showed that eating disorders seem to affect the neonatal birth weight. The effects on other outcomes of pregnancy and birth are inconclusive. Seven out of thirteen studies showed that women with eating disorders are more likely to give premature birth and four out of seven studies that miscarraige is more prevalent among women with some type of eating disorder. Women with eating disorders are not easily detected and they tend to hide their disorder. Midwives are in a key postition when it comes to diagnosing eating disorders during pregnancy. The usefulness of screening for eating disorders during pregnancy needs to be discussed and if useful, how it should be performed. The design of the studies included in the literature review was different, regarding scope and sample sizes. In many of the studies, the strength was not sufficient to make any reasonable conclusions.
The importance of detecting eating disorders (EDs) during pregnancy cannot be overemphasized, because of the major negative effects this pathology has on both maternal and fetal health. Based on a rapid review including primary and secondary reports, PN may still be considered an elusive diagnosis entity, that partially overlaps with other EDs, either well-defined, like anorexia nervosa, or still in search of their own diagnosis criteria, like orthorexia nervosa. Neurochemical and hormonal factors, psychological and social mechanisms, along with lifestyle changes create a very complex framework for clinicians interested in defining the typical features of pregorexia nervosa (PN). The personal history of EDs is considered one of the most important risk factors for PN. The core diagnostic criteria for this entity are, so far, lack of gaining weight during pregnancy, an excessive focus on counting calories and/or intense physical exercising with a secondary decrease of interest in the fetus’s health, lack of acceptance of the change in body shape during pregnancy, and pathological attention for own body image. Regarding the treatment of PN, nutritional and psychosocial interventions are recommended but no specific therapeutic strategies for this disorder have been detected in the literature. Psychotherapy is considered the main intervention for pregnant women with associated EDs and mood disorders, as the pharmacological agents could have teratogenic effects or insufficient data to support their safety in this population. In conclusion, taking into consideration the methodological limitations of a rapid review, data supporting the existence of PN were found, mainly regarding tentative diagnostic criteria, risk factors, and pathophysiological aspects. These data, corroborated with the importance of preserving optimal mental health in a vulnerable population, e.g., pregnant women, justify the need for further research focused on finding specific diagnostic criteria and targeted therapeutic approaches.
Objective
Loss of control over eating (LOC) during pregnancy impacts prenatal health and often co‐occurs with depressive symptoms. However, the role of depression history as a risk factor for LOC prior to pregnancy is unclear; information that is essential for effective prenatal health promotion. We examined the association between trajectories of depressive symptoms from childhood to first pregnancy and preconception LOC.
Method
Participants (N = 1031) were predominantly Black, first‐time mothers enrolled in the population‐based Pittsburgh Girls Study. LOC and depressive symptoms were measured annually. Pre‐pregnancy height and weight, and gestational weight gain data were abstracted from medical records.
Results
There was a significant difference in age of first conception for Black and White individuals (t = 8.73, df = 976, p < .001). Latent class analysis revealed four and three classes of depressive symptom trajectories for Black and White individuals, respectively. In the entire sample, the high‐changing and moderate‐decreasing classes of depressive symptoms were each associated with lifetime, in preconception year and not in preconception year, LOC (X² = 56.7, p < .001).
Discussion
High levels of lifetime depressive symptoms may increase vulnerability to future LOC prior to first pregnancy, suggesting potential targets for interventions to improve maternal health.
Public Significance
Both depression history and disordered eating behaviors are known to influence prenatal health. The present study revealed associations between high levels of depressive symptoms from childhood through first pregnancy and loss of control over eating that included the year prior to conception. Results highlight potential targets for preconception interventions with relevance for future prenatal health.
Eating disorders (EDs) represent a contradictory chapter of clinical psychiatry, i.e., although they are associated with significant prevalence and risks in the long term (including vital risk, especially for anorexia nervosa), the therapeutic resources are minimal and based on low-quality data. Another contradiction arose in the last few decades, i.e., a variety of new EDs have been described, either by clinicians or signaled by mass media, but their systematic exploration is progressing very slowly. Entities like “food addiction,” “orthorexia nervosa,” or “emotional eating disorder” still require intensive exploration in order to find the most accurate diagnostic instruments, diagnosis criteria, prevalence data, vulnerability factors, and therapeutic approaches. This article is focused on integrating into a comprehensive model a variety of EDs not specified or loosely defined by the current international classifications of psychiatric disorders. This framework is intended as an instrument for stimulating clinical and epidemiological research, with potential favorable consequences for therapeutic research. The dimensional model suggested here includes four main categories that accommodate the already recognized EDs (i.e., anorexia nervosa, bulimia nervosa, and binge eating disorder) as well as ten EDs that still need intensive research to find their clinical and pathophysiological characteristics. More good-quality studies are urgently required regarding this topic, based on the mental and physical negative impact these EDs may have in the short and long term, especially in vulnerable populations (e.g., pregnant women, athletes, adolescents, etc.).
Breast cancer is the most prevalent cancer in women worldwide and is the most common cancer diagnosis made during pregnancy or in the postpartum period. When breast cancer is diagnosed either during pregnancy or in the first-year postpartum, it is referred to as pregnancy-associated breast cancer. The aim of this review is to assess existing literature regarding the recommendations and outcomes of participating in exercise for people with pregnancy-associated breast cancer. The occurrence of pregnancy-associated breast cancer is increasing as a growing number of women delay first pregnancies. Women undergoing treatment for pregnancy-associated breast cancer are dealing with both cancer and its treatment as well as a pregnancy or postpartum period, and often encounter symptoms associated with cancer diagnosis and treatment, such as nausea, pain and fatigue while simultaneously navigating a pregnancy or early motherhood. These experiences can be barriers to participating in exercise, despite exercise being associated with numerous benefits for both pregnancy health and breast cancer outcomes. Numerous studies report the benefits of exercising during breast cancer treatment in ameliorating associated symptoms, and some studies report that engaging in exercise can lead to healthier and lower risk pregnancies. However, there is a lack of consensus around appropriate exercise programmes for this specific population. Given the associated benefits of participating in exercise for both breast cancer patients and pregnant/postpartum women as separate groups, research into exercise medicine designed specifically for the pregnancy-associated breast cancer population is needed.
During pregnancy, women tend to improve their lifestyle habits and refine their dietary intake. Quite often, however, these dietary improvements take an unhealthy turn, with orthorexia nervosa (ON) practices being apparent. The aim of the present pilot cross-sectional study was to assess the prevalence of ON tendencies and the incidence of pica and record diet practices in a sample of pregnant women. A total of 157 pregnant women were recruited through private practice gynecologists during the first months of 2021. Nutrition-related practices were recorded, orthorexic tendencies were assessed using the translated and culturally adapted Greek version of the ORTO-15 questionnaire, pica practices were evaluated with a binary question and nausea and emesis during pregnancy (NVP) was evaluated using the translated modified Pregnancy—Unique Quantification of Emesis and Nausea (mPUQE). Only two women reported pica tendencies, with ice and snow being the consumed items. The majority (61.1%) of women reported improving their diet since conception was achieved. Folic acid and iron oral nutrient supplements (ONS) were reportedly consumed by the majority of participants (87.9% and 72.6%, respectively) and 9.6% reported using herbal medicine products. The ORTO-15 score was reduced with tertiary education attainment, ART conception, being in the third trimester of pregnancy, consumption of folic acid and MV supplements and was only increased among women who were at their first pregnancy. The majority of participants experienced severe NVP and the remaining experienced moderate NVP. NVP was associated with lower hemoglobin levels, lack of supplementary iron intake, avoidance of gluten-containing foods, as well as with increased gestational weight gain. The results highlight the need to screen pregnant women for disturbed eating behaviors and nutrition-related problems, in order to ensure a healthy pregnancy outcome.
This article describes the development and validation of a brief self-report scale for diagnosing anorexia nervosa, bulimia nervosa, and binge-eating disorder. Study 1 used a panel of eating-disorder experts and provided evidence for the content validity of this scale. Study 2 used data from female participants with and without eating disorders (N = 367) and suggested that the diagnoses from this scale possessed temporal reliability (mean κ = .80) and criterion validity (with interview diagnoses; mean κ = .83). In support of convergent validity, individuals with eating disorders identified by this scale showed elevations on validated measures of eating disturbances. The overall symptom composite also showed test–retest reliability (r = .87), internal consistency (mean α = .89), and convergent validity with extant eating-pathology scales. Results implied that this scale was reliable and valid in this investigation and that it may be useful for clinical and research applications.
To explore the experience of pregnancy for women who have a history of anorexia nervosa (AN), in relation to the impact of AN on pregnancy, and pregnancy on AN.
Semi-structured interviews were conducted with six women with a history of AN. Data were analysed using Interpretive Phenomenological Analysis.
Four super-ordinate themes emerged: 'Effortful resistance of AN'; 'The unvalued self, valued other dialectic'; 'In new territory'; and 'Feeling distanced'.
Various factors motivated the women to try and change their AN behaviours. This was achieved with varying degrees of success. Attempts to manage AN cognitions and emotions were less successful, and this aspect of their illness persisted. Whilst the baby was viewed as worthy of nurturance, the self was not. Pregnancy represented an unfamiliar experience, and was a time of relative isolation and lack of psychological support. Findings are discussed in the context of theory, research and practice.
To determine the prevalence of eating disorders in a sample of infertile women.
A descriptive comparative two-group design in which collected data were compared with a published community sample.
Private infertility center.
Eighty-two participants beginning their first gonadotropin/intrauterine insemination (IUI) treatment cycle completed self-report measures that assessed eating disorder pathology and exercise habits. Each subject was telephone-administered the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) Module H (Eating Disorders) and a demographic questionnaire.
None.
Past or current diagnosis of an eating disorder.
Seventeen participants (20.7%) met criteria for a past or current eating disorder, which is five times higher than the U.S. lifetime prevalence rate. None of the participants who met the criteria for an eating disorder had disclosed their past or current diagnosis to their reproductive endocrinologist.
Infertility clinics are likely to be treating women with a past or current eating disorder history. Therefore, an eating disorder screening tool should be included in the initial intake, because these patients may be at a higher risk for negative maternal and fetal outcomes than non-eating disorder patients. Additionally, patients with a past or current eating disorder may not disclose this information to reproductive health care providers, which may limit providers' ability to provide appropriate medical and psychologic referrals.
We explored the impact of eating disorders on birth outcomes in the Norwegian Mother and Child Cohort Study.
Of 35,929 pregnant women, 35 reported broad anorexia nervosa (AN), 304 bulimia nervosa (BN), 1,812 binge eating disorder (BED), and 36 EDNOS-purging type (EDNOS-P) in the six months before or during pregnancy. The referent comprised 33,742 women with no eating disorder.
Pre-pregnancy body mass index (BMI) was lower in AN and higher in BED than the referent. AN, BN, and BED mothers reported greater gestational weight gain, and smoking was elevated in all eating disorder groups. BED mothers had higher birth weight babies, lower risk of small for gestational age, and higher risk of large for gestational age and cesarean section than the referent. Pre-pregnancy BMI and gestational weight gain attenuated the effects.
BED influences birth outcomes either directly or via higher maternal weight and gestational weight gain. The absence of differences in AN and EDNOS-P may reflect small numbers and lesser severity in population samples. Adequate gestational weight gain in AN may mitigate against adverse birth outcomes. Detecting eating disorders in pregnancy could identify modifiable factors (e.g., high gestational weight gain, binge eating, and smoking) that influence birth outcomes.
This study examines the impact of pregnancy on the reported eating behaviour of 20 untreated normal body weight bulimia nervosa women; it also reports foetal and obstetric abnormalities and indicates the initial eating habits of the infants. The prevalence of binge-eating and self-induced vomiting reduced sequentially during each trimester of pregnancy. By the third trimester 15 women (75%) had stopped all bulimic behaviour and in the remainder the disturbed eating was less severe. Symptoms tended to return in the puerperium and in nearly half the sample abnormal eating was more disturbed after delivery than before conception. However, the improvement associated with the pregnancy described by seven patients was maintained and for five it appears to have been curative. The common fear among pregnant bulimics that their abnormal eating behaviour may damage their unborn child cannot be dispelled by this study; the incidence of foetal abnormality (including cleft palate and cleft lip), multiple pregnancies and obstetric complications (including breech presentation and surgical intervention) was high. The nutrition and development of the infants was good although three mothers (15%) reported slimming their babies down within the first year.
Bulimia nervosa affects women at a peak age of reproductive functioning, but few studies have examined the impact of pregnancy on bulimia.
To examine the impact of pregnancy on symptoms of bulimia nervosa and associated psychopathology.
Women actively suffering from bulimia nervosa during pregnancy (n = 94) were interviewed using the eating disorder examination (12th edn) and structured clinical interview for DSM-III-R, with additional structured questions. Behaviours were recorded at conception, each trimester and postnatally. Relative risks were calculated for prognostic factors.
Bulimic symptoms improved throughout pregnancy. After delivery, 57% had worse symptoms than pre-pregnancy, but 34% were no longer bulimic. Relapse was predicted by behavioural severity and persistence, previous anorexia nervosa ('Type II' bulimia), gestational diabetes and 'unplanned' pregnancy. Unplanned pregnancies were the norm, usually resulting from mistaken beliefs about fertility. 'Postnatal depression' was suggested in one-third of the sample, and in two-thirds of those with'Type II' bulimia, and was predicted by alcohol misuse, symptom severity and persistence.
Postnatal treatment intervention should focus on women 'at risk' of relapse, but all women with bulimia should be assessed for postnatal depression.
This article describes the development and validation of a brief self-report scale for diagnosing anorexia nervosa, bulimia nervosa, and binge-eating disorder. Study 1 used a panel of eating-disorder experts and provided evidence for the content validity of this scale. Study 2 used data from female participants with and without eating disorders (N = 367) and suggested that the diagnoses from this scale possessed temporal reliability (mean kappa = .80) and criterion validity (with interview diagnoses; mean kappa = .83). In support of convergent validity, individuals with eating disorders identified by this scale showed elevations on validated measures of eating disturbances. The overall symptom composite also showed test-retest reliability (r = .87), internal consistency (mean alpha = .89), and convergent validity with extant eating-pathology scales. Results implied that this scale was reliable and valid in this investigation and that it may be useful for clinical and research applications.
Low birth weight, prematurity and higher miscarriage rates have previously been reported in women with eating disorders.
To determine whether women with a history of eating disorders are at higher risk of major adverse perinatal outcomes.
Adjusted birth weight, preterm delivery and miscarriage history were compared in those with a history of eating disorders (anorexia nervosa (n=171), bulimia nervosa (n=199) and both (n=82)) and those with other (n=1166) and no psychiatric disorders (n=10 636) in a longitudinal cohort study.
The group with bulimia nervosa had significantly higher rates of past miscarriages (relative risk ratio 2.0, P=0.01) and the group with anorexia nervosa delivered babies of significantly lower birth weight than the general population (P=0.01), which was mainly explained by lower pre-pregnancy body mass index. Preterm delivery rates were comparable across groups.
Women with a history of eating disorders are at higher risk of major adverse obstetric outcomes. Antenatal services should be aware of this higher risk.
We explored the course of broadly defined eating disorders during pregnancy in the Norwegian Mother and Child Cohort Study (MoBa) at the Norwegian Institute of Public Health.
A total of 41,157 pregnant women, enrolled at approximately 18 weeks' gestation, had valid data from the Norwegian Medical Birth Registry. We collected questionnaire-based diagnostic information on broadly defined anorexia nervosa (AN), and bulimia nervosa (BN), and eating disorders not otherwise specified (EDNOS). EDNOS subtypes included binge eating disorder (BED) and recurrent self-induced purging in the absence of binge eating (EDNOS-P). We explored rates of remission, continuation and incidence of BN, BED and EDNOS-P during pregnancy.
Prepregnancy prevalence estimates were 0.1% for AN, 0.7% for BN, 3.5% for BED and 0.1% for EDNOS-P. During early pregnancy, estimates were 0.2% (BN), 4.8% (BED) and 0.1% (EDNOS-P). Proportions of individuals remitting during pregnancy were 78% (EDNOS-P), 40% (BN purging), 39% (BED), 34% (BN any type) and 29% (BN non-purging type). Additional individuals with BN achieved partial remission. Incident BN and EDNOS-P during pregnancy were rare. For BED, the incidence rate was 1.1 per 1000 person-weeks, equating to 711 new cases of BED during pregnancy. Incident BED was associated with indices of lower socio-economic status.
Pregnancy appears to be a catalyst for remission of some eating disorders but also a vulnerability window for the new onset of broadly defined BED, especially in economically disadvantaged individuals. Vigilance by health-care professionals for continuation and emergence of eating disorders in pregnancy is warranted.
The authors conducted 4 studies investigating the reliability and validity of the Eating Disorder Diagnostic Scale (HDDS; E. Stice, C. F. Telch, & S. L. Rizvi, 2000), a brief self-report measure for diagnosing anorexia nervosa, bulimia nervosa, and binge eating disorder. Study 1 found that the HDDS showed criterion validity with interview-based diagnoses, convergent validity with risk factors for eating pathology, and internal consistency. Studies 2 and 3 found that the EDDS was sufficiently sensitive to detect the effects of eating disorder prevention programs. Regarding predictive validity, Studies 3 and 4 found that the EDDS predicted response to a prevention program and future onset of eating pathology and depression. Results provide additional evidence of the reliability and validity of this scale and suggest it may be useful in clinical and research applications.
Anorexia nervosa (AN) typically affects women during their childbearing years. Despite known problems with fertility, women with AN can and do become pregnant. Symptoms of AN tend to improve during pregnancy; however, they do not re-emit completely and commonly resurge during the postpartum period. AN can affect obstetrics at various stages including: reproduction, the pre-natal period, birth and the post-partum period. The risk of obstetric complications (such as miscarriages, prematurity and low birth weight) is high in women with AN. The postpartum period also represents a time of significant risk, not only for the resumption of eating disorder (ED) behaviours but also for post-natal depression and potential feeding and attachment difficulties with their offspring. The aim of this manuscript is to review the current literature on women with AN during the whole obstetric process; from conception to the postpartum period. Based on the current evidence three potential broad categories of risk mechanisms for obstetric complications in women with AN are considered. This paper concludes by highlighting clinical recommendations for managing women with ED during pregnancy and the post-partum period.
BACKGROUND Bulimia nervosa affects women at a peak age of reproductive functioning, but few studies have examined the impact of pregnancy on bulimia.
AIM To examine the impact of pregnancy on symptoms of bulimia nervosa and associated psychopathology.
METHOD Women actively suffering from bulimia nervosa during pregnancy (n = 94) were interviewed using the eating disorder examination (12th edn) and structured clinical interview for DSM-III-R, with additional structured questions. Behaviours were recorded at conception, each trimester and postnatally. Relative risks were calculated for prognostic factors.
RESULTS Bulimic symptoms improved throughout pregnancy. After delivery, 57% had worse symptoms than pre-pregnancy, but 34% were no longer bulimic. Relapse was predicted by behavioural severity and persistence, previous anorexia nervosa ('Type II' bulimia), gestational diabetes and 'unplanned' pregnancy. Unplanned pregnancies were the norm, usually resulting from mistaken beliefs about fertility. 'Postnatal depression' was suggested in one-third of the sample, and in two-thirds of those with'Type II' bulimia, and was predicted by alcohol misuse, symptom severity and persistence.
CONCLUSIONS Postnatal treatment intervention should focus on women 'at risk' of relapse, but all women with bulimia should be assessed for postnatal depression.
We report a case series of 23 patients, in whom the development of an eating disorder appears to have been precipitated by pregnancy, the disorder developing either during pregnancy or in the early post-natal period. The clinical features of these patients are described and management implications discussed. © 1998 John Wiley & Sons, Ltd and Eating Disorders Association.
Objective
This study investigates both the impact of eating disorders (ED) on pregnancy outcome and the impact of pregnancy on cognitive and behavioral symptoms of EDs.Method
Data on pregnancy outcome (live birth [LB], therapeutic abortion [TAB], and spontaneous abortion [SAB]) and ED symptomatology were collected as part of a large, prospective longitudinal study of anorexia nervosa (AN) and bulimia nervosa (BN). Data were gathered using a semistructured interview administered every 6 months to 246 subjects.ResultsWe identified 54 women who reported 82 pregnancies (46 LB, 25 TAB, and 11 SAB). Pregnancy outcome was not significantly related to any of the clinical variables studied. Women with BN showed a significant decrease in the severity of their ED symptoms during pregnancy, and this decrease was sustained through 9 months postpartum. Women with AN also demonstrated a significant reduction in ED symptoms, however, these symptoms returned to prepregnancy levels by 6 months postpartum.Conclusions
Our prospective findings reveal an elevated TAB rate for ED women along with a general reduction in the severity of ED symptoms during pregnancy. © 2000 by John Wiley & Sons, Inc. Int J Eat Disord 27: 140–149, 2000.
The aims of this pilot study were to determine the feasibility of conducting a large-scale study exploring the extent to which self-report psychological and behavioral traits associated with eating disorders occur during pregnancy, to test the design, and to gather preliminary data on the magnitude of the problem. Although eating disorders are estimated to affect 5.9% of women of childbearing age, little is known about pregnancy in women who have an undocumented history of disordered eating behavior in the United States. Understanding and identifying eating disorders is important because optimal maternal nutrition contributes to favorable pregnancy and neonatal outcomes.
In our study using a retrospective descriptive design, a convenience sample of 54 postpartum women aged 19 to 43 years voluntarily completed a demographic questionnaire and the Eating Disorder Inventory-3 (EDI-3) before discharge from the hospital. Medical records were reviewed for documented eating disorders.
Fifteen women (27.8%) had scores on the EDI-3 indicating that they had psychological and behavioral traits associated with eating disorders. One (1.85%) of the 54 participants' medical records listed a history of an eating disorder.
Exploration of self-report symptoms associated with eating disorders during pregnancy warrants further investigation. Health professionals providing care to pregnant women should assess all clients for eating disorders throughout pregnancy and the postpartum period, regardless of history.
To study the effects of eating disorders (EDs) on fertility and attitudes to pregnancy.
A longitudinal prospective birth cohort.
Avon area, UK.
A cohort of 14,663 women who enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC). Singleton and live births were included across four groups of women: lifetime anorexia nervosa (AN; n = 171); lifetime bulimia nervosa (BN; n = 199), lifetime anorexia nervosa and bulimia nervosa (AN + BN; n = 82); and the general population (n = 10,636).
Fertility problems, conception time and attitudes to pregnancy were investigated in women with AN, BN and AN + BN, compared with the remaining sample (general population).
Having seen a doctor for fertility problems, time taken to conceive (>12 months, and >6 months), unplanned pregnancies, and attitudes to pregnancy at 12 and 18 weeks of gestation.
Women with AN (OR 1.6, 95% CI 1.1-2.5; P < 0.021) and women with AN + BN (OR 1.9, 95% CI 1.1-3.4; P < 0.020) were more likely to have seen a doctor for lifetime fertility problems, and women with AN + BN were also more likely to take longer than 6 months to conceive (OR 1.9, 95% CI 1.0-3.5; P < 0.04), and to have conceived the current pregnancy with fertility treatment. Unplanned pregnancies were more common in the AN group compared with the general population. All ED groups more frequently experienced negative feelings upon discovering their pregnancy, which remained higher in the AN + BN group at 18 weeks of gestation.
Lifetime EDs are associated with fertility problems, unplanned pregnancies and negative attitudes to pregnancy. Health professionals should be aware of EDs when assessing fertility and providing treatment for this.
To compare the frequency with which unplanned pregnancies occur in individuals with anorexia nervosa relative to women without eating disorders in the Norwegian Mother and Child Cohort Study.
In a sample of 62,060 women, 62 reported anorexia nervosa. Using data from a questionnaire completed by all participating mothers, we compared mother's age at birth and the frequency with which mothers reported their index pregnancy as being unplanned.
Women with anorexia nervosa were younger (26.2 years, standard deviation 4.76) than women with no eating disorder (29.9 years, standard deviation 4.60) at the time of birth. Significantly more women with anorexia nervosa (50.0%) reported unplanned pregnancy than women in the referent group (18.9%). After adjustment for maternal age and infertility treatment, the relative risk of unplanned pregnancy in individuals with anorexia nervosa was 2.11 (95% confidence interval 1.64-2.72). Induced abortion was also significantly more common in women with anorexia nervosa than referent women (24.2% compared with 14.6%).
The higher rate of unplanned pregnancy and abortion in women with anorexia nervosa is of clinical concern because absent or irregular menstruation may be misinterpreted as decreasing risk of pregnancy.
II.
Pregnancy in patients with anorexia nervosa is rarely suspected. Amenorrhea is invariably present, often accompanied by sensations such as a bloated abdomen, nausea, vomiting, and fatigue. The detection of conception in anorectic patients is often delayed. Two extreme cases of belated recognition of pregnancy (at Weeks 25 and 26) in anorectic patients are described: Both had been amenorrheic prior to conception, had no notion of pregnancy, and in both, discovery was incidental. Termination of pregnancy, requested by one of the patients, was unfeasible at this gestational age. Pregnancy in patients with eating disorders is elusive, prone to complications, and should be considered when symptoms are suggestive.
To obtain a picture of eating disorder symptoms in a population of pregnant women.
Five hundred thirty women attending antenatal follow-up clinics at a large London district general hospital during a 4-week period were surveyed. The Eating Attitudes Test (EAT), the Edinburgh Postnatal Depression Scale (EPDS), and a demographic questionnaire were administered. Unadjusted relative risks and their 95% confidence intervals were calculated for a series of prognostic factors.
4.9% of women scored above the recommended threshold on the EAT in pregnancy. Eating disorder symptomatology was found to be associated with younger age, previous symptomatology, lower educational attainment, poorer housing, employment status, and previous miscarriage.
The meaning and potential implications of high levels of eating disorder symptomatology in a pregnant population are discussed in the light of the physiological and psychological effects of eating disorders on both pregnancy outcome and infant development.
There is good evidence that children of parents with psychological disorders are themselves at increased risk of disturbances in their development. Although there has been considerable research on a variety of disorders such as depression and alcohol, research on the children of parents with eating disorders has been relatively recent. This paper aims to review the evidence and covers a number of areas, including genetic factors, pregnancy, the perinatal and postpartum period, infancy, and the early years of life, focusing on feeding and mealtimes, general parenting functions, and growth. This is followed by a consideration of psychopathology in the children, parental attitudes to children's weight and shape, and adolescence. What is clear is that although there are numerous case reports and case series, the number of systematic controlled studies is relatively small, and almost nothing has been written about the children of fathers with eating disorders. What is evident from the available evidence is that children of mothers with eating disorders are at increased risk of disturbance, but that the risk depends on a variety of factors, and that difficulties in the children are far from invariable. The paper concludes by summarizing five broad categories of putative mechanisms, based on the evidence to date, by which eating disturbance in parents can influence child development.
There is good evidence that children of parents with psychiatric disorders are at increased risk of disturbances in their development. There is considerable research on disorders such as depression and alcohol abuse, but research on the children of parents with eating disorders has only recently emerged. This paper reviews evidence in a number of domains, including genetic factors; pregnancy; the perinatal and postpartum period; followed by infancy, and the early years, focusing on feeding and mealtimes, general parenting functions and growth. Psychopathology in the children, parental attitudes to children's weight and shape, and adolescence are then considered.
While numerous case reports and series have been published, there are very few systematic controlled studies, and virtually no reports of the influence of fathers with eating disorders or the male partners of mothers with eating disorders. The available evidence suggests that children of mothers with eating disorders are themselves at increased risk of disturbance in a variety of domains. This risk depends on a range of factors, and it should be noted that difficulties in the offspring of mothers with an eating disorder are far from invariable. Finally, based on current evidence, five types of mechanisms by which eating disturbance in parents can influence child development are summarised.
Bulimia nervosa is common and treatable. An association between bulimia and obstetric complications has been suggested, but sample size and absence of control have limited previous studies. Our aim was to determine if active bulimia nervosa affects obstetric outcome.
This was a retrospective case-control comparison of obstetric complications in primigravidae previously treated for bulimia in a specialist eating disorder service. A cohort of 122 women with active bulimia during pregnancy was contrasted against 82 with quiescent bulimia, using structured interviews comprising the Eating Disorders Examination, Structured Clinical Interview for DSM-III-R, and systematic questions addressing obstetric complications.
Odds ratios (ORs) for postnatal depression, miscarriage, and preterm delivery were 2.8 (95% confidence interval [CI], 1.2-6.2), 2.6 (95% CI, 1.2-5.6) and 3.3 (95% CI, 1.3-8.8) respectively. Risk of unplanned pregnancy was markedly elevated (OR, 30.0; 95% CI, 12.8-68.7). Risk estimates were not explained by differences in adiposity, demographics, alcohol/substance/laxative misuse, smoking, or year of birth, but relative contributions of bulimic behaviors were not discerned.
Active bulimia during pregnancy is associated with postnatal depression, miscarriage, and preterm delivery. Bulimia may be a treatable cause of adverse obstetric outcome.
To determine the impact of pregnancy on eating disorders (ED) symptoms using data from a large prospective, community-based cohort study.
Women (12,254) were classified according to whether they had a recent or past history of ED, were obese before pregnancy, or constituted part of the general population control group. We evaluated self-induced vomiting (SIV), laxative use, exercise behavior, and appraisals about weight gain during pregnancy, as well as dieting, and shape and weight concern before and during pregnancy.
Women with a recent episode of ED dieted, used laxatives, reported SIV, and exercised more than other groups during pregnancy. They were also more likely to report ED cognitions in pregnancy and their weight and shape concern scores remained high during pregnancy. Women with past ED were also more likely than controls to have some ED behaviors and/or concerns about weight gain during pregnancy.
Women with a recent ED continued to have some ED symptoms in pregnancy, albeit fewer compared to before pregnancy. Although at a lower level, women with a past history of ED also had ED symptoms in pregnancy. Screening for ED symptoms during pregnancy may provide a useful opportunity for engagement in treatment and to reduce behaviors that might be detrimental to the foetus.
Previous work suggests that eating disorder symptoms diminish with pregnancy. However, little prospective study has been conducted, and little is known about pregnancy symptoms in eating disorder not otherwise specified. This research prospectively studies both eating behaviors and disordered eating cognitions in pregnant women with various eating disorder diagnoses.
Forty-two participants became pregnant during 4-year follow-up of 385 women with full or subthreshold anorexia nervosa, bulimia nervosa, or binge eating disorder. Participants completed the Eating Disorders Examination (EDE) at 6-month intervals. Mixed modeling procedures were used to examine change in eating disorder cognitions, binge eating, and purging.
EDE restraint, EDE shape concerns, EDE weight concerns, binge eating, and purging diminished from prepartum to intrapartum, but returned to approximately baseline levels postpartum.
In this longitudinal sample of women with diverse eating disorder diagnoses, eating disorder symptoms improved during pregnancy, but worsened postpartum. These results highlight pregnancy as a potential time for eating disorder interventions.
Psychological and behavioral traits associated with eating disorders and pregnancy: A pilot study Unplanned pregnancy in women with anorexia nervosa Patterns of remission
- B Broussard
- C M Bulik
- E Hoffman
- Von Holle
- A Torgersen
- L Stoltenberg
- C Kjennerud
Broussard, B. (2012). Psychological and behavioral traits associated with eating disorders and pregnancy: A pilot study. Journal of Midwifery & Women's Health 54(1), 61–66 Bulik, C. M., Hoffman, E., Von Holle, A., Torgersen, L., Stoltenberg, C., & Reichborn-Kjennerud, T. (2010). Unplanned pregnancy in women with anorexia nervosa. Obstetrics and Gynecology, 116(5), 1136. Bulik, C. M., Von Holle, A., Hamer, R., Knoph Berg, C., Torgersen, L., Magnus, P., & Reichborn-Kjennerud, T. (2007). Patterns of remission, continuation and incidence of broadly defined