Intensive Prenatal Care Is A Necessity For Pregnant Anorexic Patients

Because of dramatic advances in fertility technology, women with anorexia nervosa, even those who are at low body weight and amenorrheic, may be able to conceive. According to the results of a new study, these women will also need intense prenatal care because they face a higher-than-normal risk of obstetric complications, particularly miscarriage (J Clin Psychiatry 60:130, 1999).

Cynthia M. Bulik, Ph.D., and colleagues found that intensive prenatal care was essential not only for women with active anorexia nervosa, but also for those whose disease is in remission. It is possible, according to the authors, that normal weight gain during pregnancy may rekindle concerns about shape and weight in all women with anorexia nervosa, and this may contribute to inadequate prenatal energy and nutrient intakes, leading to miscarriage, low birth weight or premature infants, and other birth complications.

Dr. Bulik and colleagues examined fertility and reproductive histories for 66 women with a history of anorexia nervosa and 98 women randomly selected from electoral rolls. The 98 controls were then matched with women with anorexia nervosa by gender and age range.

A higher rate of miscarriage

Women with a history of anorexia nervosa had nearly twice as many miscarriages as controls (30% versus 16%, respectively.) However, the rate of miscarriage did not differ between women who were actively anorexic during pregnancy and those who had anorexia nervosa in the past. Cesarean section was also significantly more common among women with anorexia nervosa than among control women.

Although no cause was identified, other investigators, such as Fahy (Psychol Med 21:577, 1991) and Stewart (Am J Obstet Gynecol 157:1194, 1987) have found that women with AN are more likely to have difficult labor that requires intervention. Dr. Bulik and co-authors surmised that: (1) having had anorexia nervosa at any time in life has a negative effect on reproduction, or that (2) women who have been anorexic in the past continue to engaged in some of the same behaviors while pregnant.

The infants of women with a lifetime history of anorexia nervosa were significantly smaller at birth than infants of the control group. This might have been due to lower intake during pregnancy, leading to lower birth weight; women with a restrictive pattern of AN had smaller infants than women with a history of AN and bulimic eating patterns.

In addition to prenatal care, including nutritional counseling and support during prenatal weight gain, the authors recommend that expectant mothers with a history of anorexia nervosa also be given clear and accurate information about the nature and timing of weight gain during pregnancy and about postpartum weight loss.