Obsession with restriction of nutrient intake because of the fear of gaining weight and distorted body image may sometimes carry forward during pregnancy. This eating disorder called anorexia, has a greater risk during pregnancy impacting the child and leading to various complications. Research recommends focusing on specialist mental health, obstetric, medical, and nutritional care for such pregnant ladies to ensure good health for mother and child.
According to a Monash University-led study, pregnant women with anorexia are more likely to have a stillbirth, an underweight baby, or a preterm birth, yet there are no established recommendations for how doctors should treat the illness.
Recommendations and guiding principles for the multidisciplinary therapy of anorexia nervosa in pregnancy have been created by researchers. These suggestions emphasise the need for specialised obstetric, medical, and nutritional care to guarantee the best results for women and their newborns.
Researchers in Melbourne, Australia, under the direction of Professor Megan Galbally, Director of the Centre for Women’s, and Children’s Mental Health at Monash University’s School of Clinical Sciences, have established guidelines and recommendations for multidisciplinary therapy of anorexia nervosa in pregnancy.
The focus of these suggestions, which were published in The Lancet Psychiatry, is on the specialized obstetric, nutritional, and mental health care necessary to guarantee the best results for women and their infants.
What is Anorexia nervosa?
The restriction of nutritional intake compared to needs, which results in noticeably low body weight, is what is known as anorexia nervosa. Patients with this eating disorder will have a distorted body image, a fear of gaining weight, and a lack of understanding of how serious their situation is.
What does anorexia mean in pregnancy?
It is a condition indicated by a significant reduction in food consumption, a skewed body image, and a difficulty to keep one’s weight within 85% of the optimal weight.
Anorexic pregnant women may be more likely to experience high blood pressure, miscarriage, challenging labour, early birth, and intrauterine growth restriction.
Up to one in 200 pregnant women have anorexia nervosa, making it more common in women of all reproductive ages. It is frequently linked to behaviour like limiting, bingeing, or both.
A multidisciplinary team must be included in the management of pregnancy complicated by anorexia nervosa, and in severe situations, hospitalisation is necessary.
According to Professor Galbally, there are few therapeutic guidelines and studies available for treating anorexic pregnant women.
Assessment tools for anorexia require modifications in the context of pregnancy
“Unlike mood disorders and anxiety and psychotic disorders, little guidance and research is available for anorexia nervosa in pregnancy. Perinatal mental health guidelines, including those in the UK and Australia, provide only limited or no mention of the assessment and management of eating disorders in pregnancy,” she said.
“Assessment measures used outside of pregnancy, such as the Eating Disorder Inventory, or the reliance on body mass index, have been shown to have limited validity in pregnancy.
“Clearly, the assessment and monitoring of measures and tools for anorexia nervosa require modification in the context of pregnancy.” Research into managing the health of pregnant women in general has highlighted the importance of maternal antenatal nutrition, pregnancy weight gain, and the infant’s birth weight as critical risk factors and vital intervention points for improving lifelong health including for areas such as heart disease, diabetes, and obesity.
Women with anorexia nervosa in pregnancy have 1.32 times the risk of pre-term birth
Anorexia nervosa may have an impact on obstetric and neonatal outcomes due to low-calorie intake, nutritional and vitamin deficiencies, stress, fasting, low body mass, and issues with placenta function, claim the study’s authors.
In addition, there are psychological and psychosocial hazards associated with untreated or inadequately managed anorexia nervosa during pregnancy, such as perinatal depression and anxiety.
Obstetric problems are more frequently documented in women with anorexia nervosa. According to a 2020 Canadian study, women with anorexia nervosa during pregnancy had a 1.32 times higher risk of preterm birth, a 1.69 times higher adjusted risk of a baby being born underweight, and a 1.99 times higher adjusted risk of stillbirth than those who did not.
Management of Anorexia nervosa
“The management of anorexia nervosa requires a multidisciplinary team approach with expertise across mental health, specialist medical care, and dietetics at a minimum; in pregnancy, key experts include obstetricians (particularly experts who manage high-risk pregnancies), physicians with pregnancy expertise, dieticians who also have expertise in pregnancy nutrition requirements, paediatricians, and mental health clinicians with perinatal expertise,” the authors recommend.
“Although many of the principles developed for the management of anorexia nervosa in adults are applicable in pregnancy, they require expert modification and adaptation to the substantial physiological, psychological, and social changes in pregnancy, and foetal growth and wellbeing should also be taken into consideration.”
Materials provided by Monash University; https://www.ncbi.nlm.nih.gov/
Note: Content may be edited for style and length.
Megan Galbally, Hubertus Himmerich, Shivanthi Senaratne, Phoebe Fitzgerald, Jeanette Frost, Nicole Woods, Jan E Dickinson. Management of anorexia nervosa in pregnancy: a systematic and state-of-the-art review. The Lancet Psychiatry, 2022; DOI: 10.1016/s2215-0366(22)00031-1
Monash University. “The hidden issue of anorexia in pregnancy.” ScienceDaily. ScienceDaily, 28 March 2022. <www.sciencedaily.com/releases/2022/03/220325093722.htm>.
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