Eating Disorders during Pregnancy

1. Eating Disorders during Pregnancy By: Elisabeth, Wendy, and Christina

2. Introduction Eating disorders during pregnancy are associated with a variety of adverse outcomes, and can pose potential dangers to both the mother and child (Madsen, 2009). In today’s presentation we will focus on the potential risks and complications, behaviors and attitudes of pregnant women with E.D., and the possible prevention techniques.

3. Risks and Complications of Eating Disorders • Miscarriage • Low birth weight • Obstetric complications • Postpartum depression • Increased anxiety/anxiety disorders • Preterm delivery • Low Apgar score: health of newborns immediately after birth • Hypertension: high blood pressure • Stillbirth: intrauterine death • Breech delivery: baby exits pelvis with feet or buttocks first rather then head first • Cleft Palates • Pre-eclampsia: protein in urine; can lead to eclampsia: seizures • Delivery by C-section • Microcephaly: neurodevelopmental disorder • Being small for gestational age • Metabolic abnormalities • Jaundice • Respiratory distress

4. Continuing… • Most women with severe ED can experience decreased cardiovascular output during pregnancy, which may result in fetal compromise due to circulatory impairment. • Increased percentage of stillbirths from inadequate weight gain and nutrients from the mother to the fetus. • Increased abnormal physical developments due to premature delivery such as malformations. • The child can develop eating or weight problems in adolescent years • Elevated ketone levels/development of chronic ketosis: results in development delays in children, lower intelligence quotients, and an increase in learning disabilities. • Laxative or diuretic abuse interferes with nutrition for the fetus.

5. Behaviors and Attitudes • Fear of becoming fat/obsession with being thin • Self-punishment through harsh dietary restrictions • Exacerbation of ED • Higher laxative use/misuse of them • Self-induced vomiting • High exercise levels • Conflicted between heeding to the demands of an ED and doing what they feel is best for the child • Avoid socializing with other mothers • Concerned about being judged negatively by others • Fasting • Binge eating and loss of control • Replace caloric restriction or purging with shoplifting or self-mutilation as “safer” coping mechanisms

6. ED during pregnancy may go unrecognized due to… • Inadequate or no screening • Failure of client to inform the health care professional • The client’s denial that a ED exists

7. Example of ED during Pregnancy • (C): I’d go two or three days without binging and purging, I think I made it for a couple of weeks. . . . I was small and the baby was small.... I also had low blood pressure...I exercised two, no may be three days a week on the treadmill . . . it’s like a constant battle . . . like in my brain . . . the wicked eating disorder talking to me and then the one who wants to get out of it, talking back and forth, back and forth. . . . I always made sure I ate something after I purged while I was pregnant. • Journal of Midwifery & Women’s Health • Vol. 45, No. 4, July/August 2000

8. Prevention Prior to and during pregnancy: • Achieve and maintain a healthy weight • Avoid purging • Meet with a nutritionist and start a healthy pregnancy diet, including prenatal vitamins • Seek counseling for ED and any underlying concerns • Be honest with your prenatal health care provider • Attend support group with people with EDs • Attend prenatal exercise class to learn healthy exercising if doctor approves • Allow prenatal health doctor to weigh you After Pregnancy: • Continue counseling to improve physical and mental health • Inform your safe network (family, friends, health provider) • Continue meeting with a nutritionist to stay healthy, manage your weight, and invest in your baby

9. 5 Cases Reported • Case 1: BN. Age 22, BMI 20 • Eating Disorder since age 13 which involved induced vomiting one to three times daily and extensive laxative abuse of as much as 200 tablets of 500mg magnesium oxide. • Case 2: E.D.N.O.S. Age 32 (one induced abortion), BMI 17-18 • The eating disorder appeared after her first pregnancy at age 21 and involved restrictive diet containing no fat, only diet products, vegetables and lean meats. • Case 3: AN. Age 24, BMI 17 • Eating disorder since age 14 involving a restrictive diet, count calories, abuse laxatives and self-induced vomiting several times daily. • Case 4: EDNOS and comorbid personality disorder. Age 20, BMI 16. • The patient had been underweight her entire adult life. She had been thoroughly examined and there was found no somatic explanation for the lack of weight gain. • Case 5: EDNOS and marijuana abuse. Age 27, BMI 15. • The patient was referred to a specialist eating disorder unit by her general practitioner prior to the pregnancy after an unintended weigh loss of 10kg and bad eating habit Besides their eating disorders prior to pregnancy, all women entered remission and followed dieting guidelines. Psychologically they felt a responsibility and a change of perception of their child. The problem was postpartum (after 6 months). Of all cases, there was only one relapse. Which do you think and what may be the possible causes?

10. Summary • There are many risks and complications that can occur among pregnant women with ED. These complications can range from developmental issues, malformations, and ultimately death. • Eating disorders may go unrecognized due to the behaviors/attitudes of pregnant women. • There are preventative methods to assure the safety of the mother and baby from complications that can occur from having an ED during pregnancy.

11. Questions • Q #1: What are some suggested guidelines for women with eating disorders who are trying to conceive or have discovered they are pregnant? • Q #2: What complications can occur if the mother has an eating disorder during pregnancy? Why can these complications occur? How can this affect the mother and/or baby? • Q #3: What are some common behaviors and attitudes for women with ED during pregnancy? How may their disorder be concealed?

12. References • Easter, A., Bye, A., Taborelli, E., Corfield, F., Schmidt, U., Treasure, J., & Micali, N. (2013). Recognising the symptoms: How common are eating disorders in pregnancy?. Wiley Online Library, 21, 340-344. DOI: 10.1002/erv.2229 • Greer, L. (2013). Pregnant with Anorexia Nervosa. International Journal Of Childbirth Education, 28(4), 68-71. • Harris, A. (2010). Practical Advice for Caring for Women With Eating Disorders During the Perinatal Period. Journal Of Midwifery & Women's Health, 55(6), 579-586. doi:10.1016/j.jmwh.2010.07.008 • James, D. (2001). Eating disorders, fertility, and pregnancy: relationships and complications. Journal Of Perinatal & Neonatal Nursing, 15(2), • Little, L., & Lowkes, L. (2000). Critical issues in the care of pregnant women with eating disorders and the impact on their children. Journal of Midwifery & Women’s Health, 45(4), 299-305. • Madsen, I.R., Horder, K., & Stoving, R.K. (June 2009). Remission of eating disorder during pregnancy: five cases and brief clinical review. Journal of Psychosomatic Obstetrics & Gynecology; 30(2): 122-126. DOI: 10.1080/01674820902789217 • Martos-Ordonez, C. (2005). Pregnancy in women with eating disorders: a review. British Journal Of Midwifery, 13(7), 446-448. • N/A. (2014).  Pregnancy and Eating Disorders. American Pregnancy Association. http://americanpregnancy.org/pregnancyhealth/eatingdisorders.html> • N/A. (2014). Pregnancy and Eating Disorders. National Eating Disorders Association. http://www.nationaleatingdisorders.org/pregnancy-and-eating-disorders