ESHRE 2022 Feferkorn

Anorexia nervosa and risk of complications during pregnancy

Findings from a retrospective population study show an association between the serious eating disorder anorexia and a significantly increased risk of adverse pregnancy outcomes.

According to a comprehensive new study, women diagnosed with anorexia nervosa are, on average, five times (500%) more likely to have babies with a short gestational age (SGA). Results presented at the 2022 ESHRE Annual Meeting also show a significantly increased risk (298%) of preterm birth and more than threefold the chance (341%) of placental abruption, compared to mothers without anorexia.

The analysis was based on data from more than 9 million women in North America, both with and without anorexia, a major psychiatric disorder characterized by self-starvation and malnutrition. Presenting the data, Dr. Michael Dahan of McGill University, Montreal, that the incidence of SGA neonates in the anorexic group was “unexpected and striking” compared to the outcomes for healthy-weight women.

Dahan said the results of the study conveyed a serious health message about treating such patients during and after pregnancy. Women with anorexia who are planning to become pregnant, he added, should be encouraged to seek and arrange for help before becoming pregnant, and those using fertility services should be screened for anorexia prior to treatment.

Eating disorders can affect the regularity of the cycle, but women with anorexia get pregnant naturally or using fertility drugs to stimulate ovulation. In his presentation, Dahn referred to a 2021 systematic review which found that the prevalence of current eating disorders ranges from 0.5%-16.7%, with anorexia being reported in up to 2% of patients and a history of anorexia in up to 18. .5%.

Still other evidence, he said, based on a survey of fertility doctors showed that only a small proportion (35%) who responded said they routinely screened for eating disorders. Those who do face the dilemma of treating women who are malnourished or, by refusing to do so, potentially banning these patients from parenthood.

Dahn and his group, including lead author Ido Feferkorn, used data from a large publicly available database of U.S. hospital admissions. All deliveries between 2004 and 2014 were included that involved women diagnosed with anorexia during pregnancy (n=214) and those who did not (n=9,096,574). The age range was from younger than 25 years to 35 years or older. The criteria for an anorexia diagnosis were based on the Diagnostic and Statistical Manual (DSM) definition, which includes a refusal to maintain body weight at/or above a minimum normal weight for age and height.

Overall, the results showed significant adverse pregnancy outcomes for women with anorexia. In addition, they showed that in addition to anorexia, these subjects were more likely to have another psychiatric problem, such as anxiety disorder (15% vs 0.9%), bipolar disorder (6.1% vs 0.5%) and depression (8.4 % vs 0.4). † They were also likely smokers, had thyroid disease, were white, or had higher incomes. No difference was found in rates for other conditions that can affect women during pregnancy, such as hypertensive conditions or gestational diabetes. The percentage requiring cesarean section was similar (30.8% versus 32.3%) in both groups.

While the study authors were unable to assess the severity of anorexia and adherence to treatment, Dahan said the findings likely represented an “underdiagnosis of risk” for women with the eating disorder.

His closing message to the public was that women with anorexia can become pregnant, and based on this, health care providers and in particular fertility specialists should be aware of “the magnitude of the adverse effects” associated with pregnancy in women with anorexia.

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