Abstract
Introduction: Eating disorders (EDs) have increased globally in women of childbearing age, related to the concern for body shape promoted in industrialized countries. Pregnancy may exacerbate a previous ED or conversely may be a chance for improving eating patterns due to the mother's concern for the unborn baby. EDs may impact pregnancy evolution and increase the risk of adverse outcomes such as miscarriage, preterm delivery, poor fetal growth, or malformations, but the knowledge on this topic is limited.Methods: We performed a systematic review of studies on humans in order to clarify the mechanisms underpinning the adverse pregnancy outcomes in patients with EDs.Results: Although unfavorable fetal development could be multifactorial, maternal malnutrition, altered hormonal pathways, low pre-pregnancy body mass index, and poor gestational weight gain, combined with maternal psychopathology and stress, may impair the evolution of pregnancy. Environmental factors such as malnutrition or substance of abuse may also induce epigenetic changes in the fetal epigenome, which mark lifelong health concerns in offspring.Conclusions: The precocious detection of dysfunctional eating behaviors in the pre-pregnancy period and an early multidisciplinary approach comprised of nutritional support, psychotherapeutic techniques, and the use of psychotropics if necessary, would prevent lifelong morbidity for both mother and fetus. Further prospective studies with large sample sizes are needed in order to design a structured intervention during every stage of pregnancy and in the postpartum period.
Highlights
Eating disorders (EDs) have increased globally in women of childbearing age, related to the concern for body shape promoted in industrialized countries
Hospitalization records eating disorders (EDs) pregnant women had a - ED had Greater risk of Lower birth weight (BW)(OR, 2.2; 95% confidence interval (CI), 1.4–3.2), preterm diagnosed before pregnancy and a higher rate of delivery (OR, 1.7; 95% CI, 1.1–2.6), small for gestational age (SGA) (OR, 1.8; 95% CI, 1.3–2.4)
Delivery hospitalizations with an ED were significantly more likely than those without an ED to have fetal growth restriction, preterm labor, anemia, genitourinary tract infections, and labor induction
Summary
Eating disorders (EDs) have increased globally in women of childbearing age, related to the concern for body shape promoted in industrialized countries. Pregnancy is an exceptional condition that implicates intense psychological and biological transformations, which may change the perception of body shape, as well as influence modifications in eating patterns. Anorexia Nervosa (AN) is characterized by a restriction of energy intake, leading to significant weight loss, intense anxiety around gaining weight, and a distorted perception of body weight and shape, associated with perfectionism and overcontrol. Binge-eating disorder (BED) is defined by recurrent episodes of binge eating more rapidly than normal, which are followed by feeling uncomfortable, disgusted, depressed, or guilty as a result, it is not associated with compensatory behaviors to prevent weight gain. Patients with chronic EDs often change between types of EDs (most commonly between AN and BN)
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