Pregnant Patients with History of ED at Higher Risk of Depression, C-section

Pregnant patients with current or past eating disorders should be carefully monitored during and after pregnancy because they are at greater risk of postpartum depression and delivery by cesarean section, according to Dr. Debra L. Franko and colleagues at Massachusetts General Hospital, Boston (Am J Psychiatry; 2001 158:1461).

The initial study group included 246 women with anorexia nervosa or bulimia nervosa participating in a longitudinal study. Of this group, 49 women who were pregnant were divided into two groups, those with eating disorders symptoms and those without. The women were interviewed at approximately 6-month intervals over the course of the study. The participants were categorized by diagnoses at the time they entered the longitudinal study and in the 9 months before conception.

Live births occurred in 2 women with anorexia nervosa with occasional purging, 16 women with anorexia with binge eating or purging, and 31 women with bulimia nervosa. Twenty-two of the live births occurred among women who had an active eating disorder (full or partial) when they became pregnant.

Three infants had birth defects

Most women with eating disorders had uneventful pregnancies and delivered healthy babies. The mean length of pregnancy was 38.7 weeks and the mean birth weight was 7.6 lb. Apgar scores at 1 and 5 minutes after birth were 8.2 and 9.0, respectively.

On the downside, 3 newborns (6 %) had birth defects, which included an undescended right testicle, persistent hyperplastic primary vitreous, and a ventricular septal defect. Two of the three mothers had a history of binge eating and purging and alcohol abuse. A history of alcohol or drug abuse before pregnancy was found in 11 of 22 pregnancies among women who had symptoms of an eating disorder. Only 5 of 25 asymptomatic women reported substance abuse.

Twelve women (26% of the group) underwent cesarean section; most of these women were in the symptomatic group. A quarter of this group had had a prior cesarean section.

Postpartum depression: Three times the normal rate

More than a third (35%) of the women reported postpartum depression. In the general population, the prevalence of clinical depression in the postpartum period is estimated to be between 3% and 12%. In this study, the rate was three times higher. Half of the patients with symptoms of eating disorders reported postpartum depression that was confirmed by medical records. This might have been due to the mothers’ lifetime history of affective disorders. Another theory is that the vulnerability to postpartum depression may have been increased by medical complications from the eating disorders, including dehydration and electrolyte instability.