Abstract
Introduction: most evidence shows negative pre and post natal consequences for the mother and the product in pregnant and puerperal women with eating disorders. Objective: to describe the evidence about physical and psychological complications in pregnant and puerperal women suffering from eating disorders. Method: medline/Pubmed data bases were used to look for evidence on eating disorders in pregnant and puerperal women. Results: the percentage of symptomatology of eating disorders in a non clinical sample of pregnant women reaches 23.4% and a previous or present history (12%) of eating disorders in them emerges as a significant risk factor (Odds ratio=14.7586) for the maintenance of the eating disorders. There are several physical and psychopathological complications, both, maternal and fetal in women suffering from eating disorders. Anorectic patients show maternity fears and concerning about body weight and shape and they are very exposed to postpartum relapses. Bulimic patients frequently improve their symptoms during pregnancy. Previously symptomatic women worsen their symptoms during pregnancy. Conclusion: the percentage of pregnant women who displayed abnormal eating behaviors exceeds the rate described in literature for anorexia nervosa and bulimia nervosa. Besides, it reflects a tendency to be a chronic disease even in pregnancy. Additional studies are required to help health personnel to prevent, early detect and treat women with eating disorders in pregnancy and postpartum. (MÉD.UIS. 2013;26(1)21:8).
References
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2. Chizawsky L, Newton M. Eatingdisorders. Identification and treatment in obstetricalpatients. AWHONN Lifelines 2006;10(6):482-88.
3. Newton M, Chizawsky L. Treating vulnerable populations: The case of eating disorders during pregnancy. J Psychosom Obstet Ginecol 2006;27(1):5-7.
4. Mitchell A, Bulik C. Eatingdisorders and women’shealth: anupdate. J MidwiferyWomen’sHealth 2006;51(3):193-201.
5. Pui-YeeLai B, So-KumTang C, Kwok-LaiTse W. Prevalence and psychosocialcorrelates of disordered eating among Chinese pregnant women in Hong Kong. EatDisord 2005;13:171-86.
6. Garner D, Olmstead M, Bohr I, Garfinkel P. Theeatingattitudes test: psychometricfeatures and clinicalcorrelates. PsycholMed 1982;12:871-8.
7. Garner D, Olmstead M, Polivy J. Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int J EatDisord 1983;2:15-34.
8. Turton P, Hughes P, Bolton H, Sedgwick P. Incidence and demographic correlates of eating disorder symptoms in a pregnant population. Int J Eat Disord 1999;26:448-52.
9. Behar R. Trastornos de la conducta alimentaria: Clínica y epidemiología. En: Behar R, Figueroa G, editores. Trastornos de la conducta alimentaria. Segunda Edición. Santiago de Chile: Mediterráneo, 2010.p. 121-147.
10. Gueron-Sela N, Atzaba-Poria N, Meiri G, Yerushalmi B. Maternal worries about child underweight mediate and moderate the relation ship between childfeeding disorders and mother-childfeed inginteractions. Int J NursStud 2011t;48(10):1223-33.
11. Fairburn C, Stein A, Jones R. Eatinghabits and eating disorders during pregnancy. PsychosomMed 1992;54(6):665-72.
12. Levey L, Ragan K, Hower-Hartley A, Newport D, Stowe Z. Psychiatricdisorders in pregnancy. NeurolClin 2004;22:863-93.
13. Crow S, Keel P, Thuras P, Mitchell J. Bulimia symptoms and other risk behaviors during pregnancy in women with bulimia nervosa. Int J EatDisord 2004;36:220-3.
14. Morgan J, Lacey J, Sedgwick P. Impact of pregnancyon bulimia nervosa. Br J Psychiatry 1999;174:135-40.
15. Rocco P, Orbitello B, Perini L, Pera V, Ciano R, Balestrieri M. Effects of pregnancy on eating attitudes and disorders. A prospectivestudy. J Psychosom Res 2005;59:175-9.
16. Lacey H, Smith G. Bulimia nervosa: Theimpact of pregnancy on mother and baby. Br J Psychiat 1987;150:777-81.
17. Blais M, Becker A, Burwell R, Flores A, Nussbaum K, Greenwood D, et al. Pregnancy: Outcome and impactonsymptomatology in a cohort of eating-disorderedwomen. Int J EatDisord 2000;27:140-9.
18. Larsson G, Andersson-Ellström A. Experiences of pregnancy-related body shape changes and of breast-feeding in womenwith a history of eating disorders. EurEatDisordersRev 2003;11(2):116-24.
19. Stewart D, Raskin J, Garfinkel P, MacDonald O, Robinson E. Anorexia nervosa, bulimia, and pregnancy. Am J ObstetGynecol 1987;157:1194-8.
20. Conrad R, Schablewski J, Schilling G, Liedtke R. Worsening of symptoms of bulimia nervosa duringpregnancy. Psychosomatics 2003;44(1):76-8.
21. Mazzeo S, Slof-Op’t Landt M, Jones I, Mitchell K, Kendler K, Neale M, et al. Associationsamongpostpartumdepression, eatingdisorders, and perfectionism in a population-basedsample of adultwomen. Int J EatDisord 2006;39(3):202-11.
22. Franko D, Blais M, Becker A, Selwin S, Greenwood D, Flores A, et al. Pregnancycomplications and neonatal outcomes in women with eating disorders. Am J Psychiatry 2001;158(9):1461-6.
23. Abraham S, Taylor A, Conti J. Postnatal depression, eating, exercise, and vomitingbefore and duringpregnancy. Int J EatDisord 2001; 29(4):482-7.
24. Kouba S, Hällström T, Hirschberg A. Early maternal adjustment in womenwitheatingdisorders. Int J EatDisord 2008; 41(5):405-10.
25. Bulik C, Von Holle A, Siega-Riz A, Torgersen L, Lie K, Hamer R, Berg C, et al. Birthoutcomes in women with eating disorders in theNorwegianmother and childcohortstudy (MoBa). Int J EatDisord 2009; 42(1):9-18.
26. Ekéus C, Lindberg L, Lindblad F, Hjern A. Birthoutcomes and pregnancycomplications in womenwith a history of anorexia nervosa. BJOG 2006;113:925-9.
27. Willis D, Rand C. Pregnancy in bulimicwomen. ObstetGynecol 1988;71(5):708-10.
28. American Psychiatric Association. Practice guide line forthe treatment of patients with eating disorders. ThirdEdition. American PsychiatricAssociationWorkGrouponEatingDisorders. Am J Psychiatry 2006;163:7(Suppl):1-54.
29. Sollid C, Wisborg K, Hjort J, Jørgen N. Eating disorders that was diagnosed before pregnancy and pregnancy outcome. Am J Obstet Ginecol 2004;190: 206-10.
30. Micali N, Simonoff E, Treasure J. Risk of major adverse perinatal outcomes in women with eating disorders. Br J Psychiat 2007;190:255-9.
31. Kouba S, Hällström T, Lindholm C, Lindén A. Pregnancy and neonatal outcomes in women with eating disorders. Obstet Gynecol 2005;105(2):255-60.
32. Carmichael S, Shaw G, Schaffer D, Laurent C, Selvin S. Dietingbehaviors and risk of neural tubedefects. Am J Epidemiol 2003;158(12):1127-31.
33. Brinch M, Isager T, Tolstrup K. Anorexia nervosa and motherhood: Reproductional pattern and mothering behaviour of 50 women. Acta PsychiatScand 1988;77:98-104.
34. Treasure J, Russell G. Intrauterinegrowth and neonatal weightgain in babies of women with anorexia nervosa. BMJ 1988; 296(6628):1038.
35. Evans J, le Grange D. Bodysize and parenting in eating disorders: A comparative study of theattitudes of mothers to wards their children. Int J EatDisord 1995;18(1):39-48.
36. Goldman RD, Koren G. Anorexia nervosa during pregnancy. Can FamPhysician 2003; 49:425-6.
37. Vignalou J, Guedeney N. About off springs of mothers with anorexia nervosa: what about clinical practice in pediatric settings?.ArchPediatr 2006;13(5):484-7.
38. Waugh E, Bulik C. Offspring of women with eating disorders. Int J Eat Disord 1999;25:123-33.
39. Astrachan-Fletcher E, Veldhuis C, Lively N, Fowler C, Marcks B. The reciprocal effects of eating disorders and the postpartum period: a review of theliterature and recommendations for
clinical care. J Womens Health (Larchmt). 2008;17(2):227-39.
40. Garner D. Manual del EDI 2: inventario de trastornos de la conducta alimentaria. Madrid: TEA Ediciones, SA; 1998.
41. Lai BP, Tang CS, Tse WK. A longitudinal study investigating disordered eating during the transition to motherhood among Chinese women in Hong Kong. Int J EatDisord 2006; 39(4):303-11.
42. Stein A, Fairburn C. Eatinghabits and attitudes in the post partumperiod. PsychosomMed 1996;58(4):321-5.
43. Stein A, Woolley H, Cooper SD, Fairburn CG. An observational study of motherswitheatingdisorders and theirinfants. J ChildPsycholPsychiatry. 1994;35(4):733-48.
44. Abraham S, Llewellyn-Jones D. Eatingdisorders: thefacts (5th Edition). Oxford, NY: Oxford UniversityPress, Inc.; 2001.
45. Norré J, Vandereycken W, Gordts S, Lemburg R, Phillips J. Theimpact of pregnancyon anorexia nervosa and bulimia nervosa. Int J EatDisord 1989; 8: 285-295.
46. Wolfe B. Reproductive health in women with eating disorders. J ObstetGynecol& Neonatal Nurs 2005; 34: 225-263.
47. Resch M, Szendei G. Gynecologist and obstetric complications in eating disorders. Orvosi Hetilap 2002; 143(25): 1529-32.
48. Edelstein C, King B. Pregnancy and eating disorders. In: J. Yager J, Gwirtsman E, Edelstein C, editors. Special problems in managing eating disorders. Washington DC: American PsychiatricPress, Inc; 1992. p.163-184.
49. Russell G, Treasure J, Eisler I. Motherswith anorexia who under feed their children: the irrecognition and management. PsycholMed 1998; 28(1):93-108.
50. Lemburg R, Phillips J. Theimpact of pregnancyon anorexia nervosa and bulimia nervosa. Int J EatDisord 1989; 8: 285-295.
51. Levine M, Smolak L. Theprevention of eatingproblems and eatingdisorder: Theory, research, and practice. Mahwah NJ: ErlbaumAssociates; 2006.
52. Franzen U, Gerlinghoff M. Parenting by patients with eating disorders: Experienceswith a mother-childgroup. EatDisord 1997;5:5-14.
53. Woodside D, Shekter-Wolfson L. Parentingbypatientswith anorexia nervosa and bulimia nervosa. Int J Eat Disord 1990; 9: 303-309.
54. vanWezel-Meijler G, Wit J. The off spring of mothers with anorexia nervosa: a high-risk group forunder nutrition and stunting? Eur JPediatr 1989; 149:130-135.
55. Agras S, Hammer L, McNicholas F. A prospectivestudy of theinfluence of eating-disordered mothers on their children. Int J Eat Disord 1999; 25(3):253-262.
56. Herrera A, Martínez J, Fernández M. Anorexia nerviosa en el embarazo: Cuidados en la enfermería obstétrico-ginecológica. Enfermería Global 2011; 23: 147-57.
57. Brisch K. Treatingattachmentdisorders. New York: TheGuilfordPress, 2002.
58. Bulik C, Hoffman E, Von Holle A, Torgersen L, Stoltenberg, Reichborn-Kjennerud T. Unplannedpregnancy in womenwith anorexia nervosa. ObstetGynecol 2010;116:1136-40.
59. Franko D, Spurrell E. Detection and management of eating disorders during pregnancy. ObstetGynecol 2000;6:942-6.
60. Rapaport E, Florenzano R. Enfermedades psiquiátricas y aspectos psicológicos del estado grávido-puerperal. En: Pérez A, Donoso E, editores. Obstetricia. 3 ed. Santiago de Chile: Editorial Mediterráneo; 1999. p.820-30.
2. Chizawsky L, Newton M. Eatingdisorders. Identification and treatment in obstetricalpatients. AWHONN Lifelines 2006;10(6):482-88.
3. Newton M, Chizawsky L. Treating vulnerable populations: The case of eating disorders during pregnancy. J Psychosom Obstet Ginecol 2006;27(1):5-7.
4. Mitchell A, Bulik C. Eatingdisorders and women’shealth: anupdate. J MidwiferyWomen’sHealth 2006;51(3):193-201.
5. Pui-YeeLai B, So-KumTang C, Kwok-LaiTse W. Prevalence and psychosocialcorrelates of disordered eating among Chinese pregnant women in Hong Kong. EatDisord 2005;13:171-86.
6. Garner D, Olmstead M, Bohr I, Garfinkel P. Theeatingattitudes test: psychometricfeatures and clinicalcorrelates. PsycholMed 1982;12:871-8.
7. Garner D, Olmstead M, Polivy J. Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. Int J EatDisord 1983;2:15-34.
8. Turton P, Hughes P, Bolton H, Sedgwick P. Incidence and demographic correlates of eating disorder symptoms in a pregnant population. Int J Eat Disord 1999;26:448-52.
9. Behar R. Trastornos de la conducta alimentaria: Clínica y epidemiología. En: Behar R, Figueroa G, editores. Trastornos de la conducta alimentaria. Segunda Edición. Santiago de Chile: Mediterráneo, 2010.p. 121-147.
10. Gueron-Sela N, Atzaba-Poria N, Meiri G, Yerushalmi B. Maternal worries about child underweight mediate and moderate the relation ship between childfeeding disorders and mother-childfeed inginteractions. Int J NursStud 2011t;48(10):1223-33.
11. Fairburn C, Stein A, Jones R. Eatinghabits and eating disorders during pregnancy. PsychosomMed 1992;54(6):665-72.
12. Levey L, Ragan K, Hower-Hartley A, Newport D, Stowe Z. Psychiatricdisorders in pregnancy. NeurolClin 2004;22:863-93.
13. Crow S, Keel P, Thuras P, Mitchell J. Bulimia symptoms and other risk behaviors during pregnancy in women with bulimia nervosa. Int J EatDisord 2004;36:220-3.
14. Morgan J, Lacey J, Sedgwick P. Impact of pregnancyon bulimia nervosa. Br J Psychiatry 1999;174:135-40.
15. Rocco P, Orbitello B, Perini L, Pera V, Ciano R, Balestrieri M. Effects of pregnancy on eating attitudes and disorders. A prospectivestudy. J Psychosom Res 2005;59:175-9.
16. Lacey H, Smith G. Bulimia nervosa: Theimpact of pregnancy on mother and baby. Br J Psychiat 1987;150:777-81.
17. Blais M, Becker A, Burwell R, Flores A, Nussbaum K, Greenwood D, et al. Pregnancy: Outcome and impactonsymptomatology in a cohort of eating-disorderedwomen. Int J EatDisord 2000;27:140-9.
18. Larsson G, Andersson-Ellström A. Experiences of pregnancy-related body shape changes and of breast-feeding in womenwith a history of eating disorders. EurEatDisordersRev 2003;11(2):116-24.
19. Stewart D, Raskin J, Garfinkel P, MacDonald O, Robinson E. Anorexia nervosa, bulimia, and pregnancy. Am J ObstetGynecol 1987;157:1194-8.
20. Conrad R, Schablewski J, Schilling G, Liedtke R. Worsening of symptoms of bulimia nervosa duringpregnancy. Psychosomatics 2003;44(1):76-8.
21. Mazzeo S, Slof-Op’t Landt M, Jones I, Mitchell K, Kendler K, Neale M, et al. Associationsamongpostpartumdepression, eatingdisorders, and perfectionism in a population-basedsample of adultwomen. Int J EatDisord 2006;39(3):202-11.
22. Franko D, Blais M, Becker A, Selwin S, Greenwood D, Flores A, et al. Pregnancycomplications and neonatal outcomes in women with eating disorders. Am J Psychiatry 2001;158(9):1461-6.
23. Abraham S, Taylor A, Conti J. Postnatal depression, eating, exercise, and vomitingbefore and duringpregnancy. Int J EatDisord 2001; 29(4):482-7.
24. Kouba S, Hällström T, Hirschberg A. Early maternal adjustment in womenwitheatingdisorders. Int J EatDisord 2008; 41(5):405-10.
25. Bulik C, Von Holle A, Siega-Riz A, Torgersen L, Lie K, Hamer R, Berg C, et al. Birthoutcomes in women with eating disorders in theNorwegianmother and childcohortstudy (MoBa). Int J EatDisord 2009; 42(1):9-18.
26. Ekéus C, Lindberg L, Lindblad F, Hjern A. Birthoutcomes and pregnancycomplications in womenwith a history of anorexia nervosa. BJOG 2006;113:925-9.
27. Willis D, Rand C. Pregnancy in bulimicwomen. ObstetGynecol 1988;71(5):708-10.
28. American Psychiatric Association. Practice guide line forthe treatment of patients with eating disorders. ThirdEdition. American PsychiatricAssociationWorkGrouponEatingDisorders. Am J Psychiatry 2006;163:7(Suppl):1-54.
29. Sollid C, Wisborg K, Hjort J, Jørgen N. Eating disorders that was diagnosed before pregnancy and pregnancy outcome. Am J Obstet Ginecol 2004;190: 206-10.
30. Micali N, Simonoff E, Treasure J. Risk of major adverse perinatal outcomes in women with eating disorders. Br J Psychiat 2007;190:255-9.
31. Kouba S, Hällström T, Lindholm C, Lindén A. Pregnancy and neonatal outcomes in women with eating disorders. Obstet Gynecol 2005;105(2):255-60.
32. Carmichael S, Shaw G, Schaffer D, Laurent C, Selvin S. Dietingbehaviors and risk of neural tubedefects. Am J Epidemiol 2003;158(12):1127-31.
33. Brinch M, Isager T, Tolstrup K. Anorexia nervosa and motherhood: Reproductional pattern and mothering behaviour of 50 women. Acta PsychiatScand 1988;77:98-104.
34. Treasure J, Russell G. Intrauterinegrowth and neonatal weightgain in babies of women with anorexia nervosa. BMJ 1988; 296(6628):1038.
35. Evans J, le Grange D. Bodysize and parenting in eating disorders: A comparative study of theattitudes of mothers to wards their children. Int J EatDisord 1995;18(1):39-48.
36. Goldman RD, Koren G. Anorexia nervosa during pregnancy. Can FamPhysician 2003; 49:425-6.
37. Vignalou J, Guedeney N. About off springs of mothers with anorexia nervosa: what about clinical practice in pediatric settings?.ArchPediatr 2006;13(5):484-7.
38. Waugh E, Bulik C. Offspring of women with eating disorders. Int J Eat Disord 1999;25:123-33.
39. Astrachan-Fletcher E, Veldhuis C, Lively N, Fowler C, Marcks B. The reciprocal effects of eating disorders and the postpartum period: a review of theliterature and recommendations for
clinical care. J Womens Health (Larchmt). 2008;17(2):227-39.
40. Garner D. Manual del EDI 2: inventario de trastornos de la conducta alimentaria. Madrid: TEA Ediciones, SA; 1998.
41. Lai BP, Tang CS, Tse WK. A longitudinal study investigating disordered eating during the transition to motherhood among Chinese women in Hong Kong. Int J EatDisord 2006; 39(4):303-11.
42. Stein A, Fairburn C. Eatinghabits and attitudes in the post partumperiod. PsychosomMed 1996;58(4):321-5.
43. Stein A, Woolley H, Cooper SD, Fairburn CG. An observational study of motherswitheatingdisorders and theirinfants. J ChildPsycholPsychiatry. 1994;35(4):733-48.
44. Abraham S, Llewellyn-Jones D. Eatingdisorders: thefacts (5th Edition). Oxford, NY: Oxford UniversityPress, Inc.; 2001.
45. Norré J, Vandereycken W, Gordts S, Lemburg R, Phillips J. Theimpact of pregnancyon anorexia nervosa and bulimia nervosa. Int J EatDisord 1989; 8: 285-295.
46. Wolfe B. Reproductive health in women with eating disorders. J ObstetGynecol& Neonatal Nurs 2005; 34: 225-263.
47. Resch M, Szendei G. Gynecologist and obstetric complications in eating disorders. Orvosi Hetilap 2002; 143(25): 1529-32.
48. Edelstein C, King B. Pregnancy and eating disorders. In: J. Yager J, Gwirtsman E, Edelstein C, editors. Special problems in managing eating disorders. Washington DC: American PsychiatricPress, Inc; 1992. p.163-184.
49. Russell G, Treasure J, Eisler I. Motherswith anorexia who under feed their children: the irrecognition and management. PsycholMed 1998; 28(1):93-108.
50. Lemburg R, Phillips J. Theimpact of pregnancyon anorexia nervosa and bulimia nervosa. Int J EatDisord 1989; 8: 285-295.
51. Levine M, Smolak L. Theprevention of eatingproblems and eatingdisorder: Theory, research, and practice. Mahwah NJ: ErlbaumAssociates; 2006.
52. Franzen U, Gerlinghoff M. Parenting by patients with eating disorders: Experienceswith a mother-childgroup. EatDisord 1997;5:5-14.
53. Woodside D, Shekter-Wolfson L. Parentingbypatientswith anorexia nervosa and bulimia nervosa. Int J Eat Disord 1990; 9: 303-309.
54. vanWezel-Meijler G, Wit J. The off spring of mothers with anorexia nervosa: a high-risk group forunder nutrition and stunting? Eur JPediatr 1989; 149:130-135.
55. Agras S, Hammer L, McNicholas F. A prospectivestudy of theinfluence of eating-disordered mothers on their children. Int J Eat Disord 1999; 25(3):253-262.
56. Herrera A, Martínez J, Fernández M. Anorexia nerviosa en el embarazo: Cuidados en la enfermería obstétrico-ginecológica. Enfermería Global 2011; 23: 147-57.
57. Brisch K. Treatingattachmentdisorders. New York: TheGuilfordPress, 2002.
58. Bulik C, Hoffman E, Von Holle A, Torgersen L, Stoltenberg, Reichborn-Kjennerud T. Unplannedpregnancy in womenwith anorexia nervosa. ObstetGynecol 2010;116:1136-40.
59. Franko D, Spurrell E. Detection and management of eating disorders during pregnancy. ObstetGynecol 2000;6:942-6.
60. Rapaport E, Florenzano R. Enfermedades psiquiátricas y aspectos psicológicos del estado grávido-puerperal. En: Pérez A, Donoso E, editores. Obstetricia. 3 ed. Santiago de Chile: Editorial Mediterráneo; 1999. p.820-30.
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