Anorexia nervosa and the risk of complications in pregnancy

Findings from a retrospective population-based study demonstrated an association between severe eating disorder anorexia and a substantially increased risk of adverse pregnancy outcome.

Women diagnosed with anorexia nervosa are five times (500%) more likely, on average, to have a small baby for gestational age (SGA), according to a new, comprehensive study. The results presented at the 2022 ESHRE annual meeting also showed a substantially increased risk (298%) of preterm delivery and a more than threefold (341%) chance of placental abruption, when compared with mothers without anorexia.

The analysis is based on data from more than 9 million women living in North America both with and without anorexia, a severe psychiatric disorder characterized by self-starvation and malnutrition. In presenting the data, Dr Michael Dahan of McGill University, Montreal, said that the incidence of newborn SGA in the anorexic group was ‘unexpected and striking’ when compared with the results for women of healthy weight.

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

Eating disorders can impact cycle regularity, but women with anorexia can get pregnant naturally or with the help of fertility drugs to stimulate ovulation. In his presentation, Dahn referred to a systematic review from 2021 which found that the current prevalence of eating disorders ranges from 0.5%-16.7%, with anorexia reported in up to 2% of patients, and a history of anorexia in up to 18.5%.

But other evidence, he said, based on a survey of fertility doctors showed that only a small proportion (35%) who answered said they routinely screened for eating disorders. Those who face the dilemma of caring for malnourished women or, by refusing to do so, may prevent these patients from becoming parents.

Dahn and his group, including lead author Ido Feferkorn, used data from a large publicly available database of US hospital inpatient care records. All deliveries between 2004 and 2014 included those related to women diagnosed with anorexia during pregnancy (n=214) and those not (n=9,096,574). Age range is from under 25 years old to 35 years old or more. The criteria for the diagnosis of anorexia are based on the Diagnostic and Statistical Manual (DSM) definition, which includes a refusal to maintain body weight at/or above the minimum normal weight for age and height.

Overall, the results demonstrated a significant adverse pregnancy outcome for women with anorexia. In addition, they showed that these individuals were more likely to have other psychiatric problems besides anorexia, such as anxiety disorders (15% vs 0.9%), bipolar disorder (6.1% vs 0.5%) and depression (8, 4% vs. 0.4). %). They were also more likely to be smokers, have thyroid disease, be white, or earn more. No differences were found in rates for other conditions that may affect women in pregnancy, such as hypertensive disorders or gestational diabetes. The proportion requiring caesarean section was similar (30.8% vs 32.3%) in the two groups.

Although the study authors were unable to assess the severity of anorexia, or adherence to medication, Dahan said the findings may represent an ‘undiagnosed risk’ for women with eating disorders.

His closing message to the audience is that women with anorexia do become pregnant, and on this basis healthcare providers and especially fertility specialists should be aware of the ‘magnitude of adverse outcomes’ associated with pregnancy in women with anorexia.

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