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Doersam AF, Throm JK, Sörensen F, Martus P, Kraegeloh-Mann I, Preissl H, Micali N, Giel KE. Mother-infant feeding interactions in mothers with and without eating disorder history: Results of a structured observational study. Appetite 2024; 200:107551. [PMID: 38857768 DOI: 10.1016/j.appet.2024.107551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND A growing body of evidence suggests that children of mothers with eating disorders (EDs) have a greater risk of early feeding problems. Recognizing and reacting adequately to the infant's signals during feeding is crucial for the child's development of internal and external regulatory mechanisms of food intake. Parental EDs might affect this ability. Therefore, we investigated the quality of mother-infant interactions during feeding using video recording and a structured coding system. METHODS The data of this pilot study was collected in a prospective cohort study investigating the influence of maternal EDs on child outcomes. Twenty women with ED history and 31 control women were videotaped while feeding their infant during a main meal at ten months postpartum. The mother-infant interactions were evaluated by two raters using the Chatoor Feeding Scale. We assessed birth outcomes, the mother's ED and depression status, breastfeeding practices, infant feeding problems and infant temperament by maternal self-report. RESULTS Mothers with and without ED history scored very similar on the Feeding Scale, however mothers from the control group experienced more struggle for control with their infants during feeding (p = 0.046) and made more negative comments about the infant's food intake (p = 0.010). Mothers with ED history were more concerned about infant feeding at three months postpartum and reported significantly more problems with solid foods in their children. Birth outcomes were comparable between groups, except for lower weight-for-length birth percentiles in children of women with ED history. CONCLUSION Whilst examined mothers with ED history are more concerned about feeding their children, ED psychopathology does not affect the quality of mother-infant interaction during feeding at the transition to autonomous eating at ten months of age.
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Affiliation(s)
- Annica Franziska Doersam
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany; Centre of Excellence for Eating Disorders (KOMET), University Hospital Tuebingen, Tuebingen, Germany; German Center for Mental Health (DZPG), Tuebingen, Baden-Wuerttemberg, Germany; Graduate Training Centre of Neuroscience, International Max Planck Research School, Eberhard Karls University Tuebingen, Tuebingen, Germany.
| | - Jana Katharina Throm
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany; Centre of Excellence for Eating Disorders (KOMET), University Hospital Tuebingen, Tuebingen, Germany; German Center for Mental Health (DZPG), Tuebingen, Baden-Wuerttemberg, Germany
| | - Ferdinand Sörensen
- Graduate Training Centre of Neuroscience, International Max Planck Research School, Eberhard Karls University Tuebingen, Tuebingen, Germany; Pediatric Neurology & Developmental Medicine, University Children's Hospital Tuebingen, Tuebingen, Germany; Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tuebingen, Tuebingen, Germany
| | - Peter Martus
- Institute for Medical Biometrics and Clinical Epidemiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Ingeborg Kraegeloh-Mann
- Pediatric Neurology & Developmental Medicine, University Children's Hospital Tuebingen, Tuebingen, Germany
| | - Hubert Preissl
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the Eberhard Karls University of Tuebingen, FMEG Center, German Centre for Diabetes Research (DZD), Tuebingen, Germany; Department of Internal Medicine IV, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tuebingen, Tuebingen, Germany; Institute of Pharmaceutical Sciences, Department of Pharmacy and Biochemistry, Interfaculty Centre for Pharmacogenomics and Pharma Research at the Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Nadia Micali
- Mental Health Services of the Capital Region of Denmark, Center for Eating and Feeding Disorders Research, Psychiatric Centre Ballerup, Ballerup, Denmark; University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany; Centre of Excellence for Eating Disorders (KOMET), University Hospital Tuebingen, Tuebingen, Germany; German Center for Mental Health (DZPG), Tuebingen, Baden-Wuerttemberg, Germany
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2
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Bailey-Straebler SM, Susser LC, Cooper Z. Breastfeeding and pumping as maladaptive weight control behaviors. Int J Eat Disord 2023; 56:1683-1687. [PMID: 37260319 DOI: 10.1002/eat.24006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/02/2023]
Abstract
It is well recognized by the general public that breastfeeding expends calories. In our clinical practice, a number of postpartum women with a history of or a current eating disorder (ED) report using breastfeeding and/or pumping breast milk to influence their body shape and weight. This appears to be either a form of weight control behavior or, in some cases, a compensation for perceived overeating or binge eating. Breastfeeding and pumping have not generally been identified as maladaptive weight control behaviors, nor have they been a subject of research to date. We suggest that this practice should be investigated to determine how common it is, its potential role in maintaining EDs or contributing to relapse in the postpartum period, and to better understand other potential harms it may cause to both the mother and infant/child. PUBLIC SIGNIFICANCE: Breastfeeding and pumping may be used as maladaptive methods of weight control by women with EDs. This behavior is under-recognized in clinical practice and has received little research attention. We argue that maladaptive breastfeeding and pumping warrant further investigation, as the behaviors may play an important role in maintaining an ED or in contributing to relapse during the postpartum period and may also indirectly harm the infant/child.
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Affiliation(s)
- Suzanne M Bailey-Straebler
- Weill Cornell Medicine - New York Presbyterian Hospital, White Plains, New York, USA
- Columbia University Medical Center, New York, New York, USA
| | - Leah C Susser
- Weill Cornell Medicine - New York Presbyterian Hospital, White Plains, New York, USA
| | - Zafra Cooper
- Yale School of Medicine - New Haven, New Haven, Connecticut, USA
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3
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Martino F, Bassareo PP, Martino E, Romeo F, Calcaterra G, Perrone Filardi P, Indolfi C, Nodari S, Montemurro V, Guccione P, Salvo GD, Chessa M, Pedrinelli R, Mercuro G, Barillà F. Cardiovascular prevention in childhood: a consensus document of the Italian Society of Cardiology Working Group on Congenital Heart Disease and Cardiovascular Prevention in Paediatric Age. J Cardiovasc Med (Hagerstown) 2023; 24:492-505. [PMID: 37409595 DOI: 10.2459/jcm.0000000000001488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Cardiovascular diseases (CVD) may be manifested from a very early age. Genetic and environmental (epigenetic) factors interact to affect development and give rise to an abnormal phenotypical expression of genetic information, although not eliciting changes in the nucleotide sequence of DNA. It has been scientifically proven that increased oxidative stress (OS) caused by disease (overweight, obesity, diabetes), nutritional imbalances, unhealthy lifestyles (smoking, alcohol, substance abuse) in the mother during pregnancy may induce placental dysfunction, intrauterine growth restriction, prematurity, low birth weight, postnatal adiposity rebound, metabolic alterations and consequent onset of traditional cardiovascular risk factors. OS represents the cornerstone in the onset of atherosclerosis and manifestation of CVD following an extended asymptomatic period. OS activates platelets and monocytes eliciting the release of pro-inflammatory, pro-atherogenic and pro-oxidising substances resulting in endothelial dysfunction, decrease in flow-mediated arterial dilatation and increase in carotid intima-media thickness. The prevention of CVD is defined as primordial (aimed at preventing risk factors development), primary (aimed at early identification and treatment of risk factors), secondary (aimed at reducing risk of future events in patients who have already manifested a cardiovascular event), and tertiary (aimed at limiting the complex outcome of disease). Atherosclerosis prevention should be implemented as early as possible. Appropriate screening should be carried out to identify children at high risk who are apparently healthy and implement measures including dietary and lifestyle changes, addition of nutritional supplements and, lastly, pharmacological treatment if risk profiles fail to normalise. Reinstating endothelial function during the reversible stage of atherosclerosis is crucial.
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Affiliation(s)
- Francesco Martino
- Department of Internal Clinical, Anesthesiological and Cardiovascular Sciences, La Sapienza University, Rome, Italy
| | - Pier Paolo Bassareo
- University College of Dublin, School of Medicine, Mater Misericordiae University Hospital and Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Eliana Martino
- Department of Internal Clinical, Anesthesiological and Cardiovascular Sciences, La Sapienza University, Rome, Italy
| | | | | | | | - Ciro Indolfi
- Division of Cardiology, Research Centre for Cardiovascular Diseases, Magna Graecia University, Catanzaro
| | - Savina Nodari
- Department of Medical Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili, Brescia
| | | | - Paolo Guccione
- Department of Cardiology, Cardiac Surgery, Cardio-pulmonary Transplantation, IRCCS Bambino Gesu'Paediatric Hospital, Rome
| | - Giovanni Di Salvo
- Division of Paediatric Cardiology, Department of Women's and Children's Health, University of Padua, Padua
| | - Massimo Chessa
- ACHD UNIT, Pediatric and Adult Congenital Heart Centre, IRCCS-Policlinico San Donato, San Donato Milanese, Vita Salute San Raffaele University, Milan
| | - Roberto Pedrinelli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa
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Dutta S, Deshmukh P. Association of Eating Disorders in Prenatal and Perinatal Women and Its Complications in Their Offspring. Cureus 2022; 14:e31429. [DOI: 10.7759/cureus.31429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/12/2022] [Indexed: 11/15/2022] Open
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Kapa HM, Litteral JL, Keim SA, Jackson JL, Schofield KA, Crerand CE. Body Image Dissatisfaction, Breastfeeding Experiences, and Self-Efficacy in Postpartum Women with and Without Eating Disorder Symptoms. J Hum Lact 2022; 38:633-643. [PMID: 35139671 DOI: 10.1177/08903344221076529] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Women during the postpartum period undergo significant changes which affect body image, eating behaviors, and, potentially, breastfeeding. There is limited research about relationships among these variables, particularly related to breastfeeding experiences and self-efficacy. RESEARCH AIMS To determine: (1) the associations between eating disorder symptoms and body image, breastfeeding self-efficacy, and breastfeeding experiences; and (2) the differences in body image, breastfeeding self-efficacy, breastfeeding experiences, and breastfeeding status of postpartum women with and without clinically significant eating disorder symptoms. METHODS A secondary data analysis using a 2-group correlational, cross-sectional online survey design was used. Participants with infants 2-6 months old who had breastfed their infant at least once (N = 204) were recruited nationally to complete a cross-sectional survey assessing breastfeeding and postpartum physical and mental health using validated measures. Linear and logistic regression evaluated differences between participants with and without eating disorder symptoms regarding their body image, breastfeeding experience and self-efficacy, and breastfeeding status (continued vs. discontinued) at 2 months postpartum. RESULTS Clinical eating disorder symptoms were reported by 9.8% (n = 20). Participants with clinical eating disorder symptoms reported lower appearance evaluations (B = -0.53, 95% CI [-0.93, -0.14]) and body image satisfaction (B = -0.55, 95% CI [-0.87, -0.23]); reduced odds of breastfeeding at 2 months postpartum (AOR = 0.15, 95% CI [0.04, 0.56]); and lower breastfeeding self-efficacy (B = -7.70, 95% CI [-14.82, -0.58] relative to participants without clinical symptoms. No differences between groups were observed for breastfeeding experiences. CONCLUSIONS Participants with clinically significant eating disorder symptoms are at risk for early breastfeeding discontinuation and lower breastfeeding self-efficacy. Our findings have implications for future research and clinical care practices, including screening for body image concerns and eating disorder symptoms and supporting breastfeeding self-efficacy.
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Affiliation(s)
- Hillary M Kapa
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Jennifer L Litteral
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Sarah A Keim
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Jamie L Jackson
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Kyle A Schofield
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Canice E Crerand
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Plastic Surgery, College of Medicine, The Ohio State University, Columbus, OH, USA
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Galbally M, Himmerich H, Senaratne S, Fitzgerald P, Frost J, Woods N, Dickinson JE. Management of anorexia nervosa in pregnancy: a systematic and state-of-the-art review. Lancet Psychiatry 2022; 9:402-412. [PMID: 35339207 DOI: 10.1016/s2215-0366(22)00031-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 12/20/2022]
Abstract
Anorexia nervosa is a potentially severe, chronic, and relapsing mental disorder that is more common in women and girls during the reproductive years (usually defined as those aged 12-51 years). It is associated with suicide and mortality linked with the physical consequences of starvation. Although anorexia nervosa is a disorder of low prevalence, and even lower prevalence in pregnancy, it is associated with substantial risks for the mother and infant when under-recognised and undermanaged. Despite the complexity and risk of managing anorexia nervosa in pregnancy, few studies are available to guide care. We conducted a systematic review, identifying only eight studies that addressed the management of anorexia nervosa in pregnancy. These studies were case studies or case reports examining narrow aspects of management. Subsequently, we conducted a state-of-the-art review across research in relevant disciplines and areas of expertise for managing anorexia nervosa in pregnancy and synthesised the findings into recommendations and principles for multidisciplinary management of anorexia nervosa in pregnancy. These recommendations included a focus on the specialist mental health, obstetric, medical, and nutritional care required to ensure optimal outcomes for women and their infants. Despite the complexity and risks, a gap exists in the comprehensive guidelines and recommendations for managing anorexia nervosa in pregnancy. This Review provides multidisciplinary recommendations for clinical care in this area. Managing anorexia nervosa in pregnancy is an area of clinical care that requires a multidisciplinary approach and includes those experienced in managing high-risk pregnancies.
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Affiliation(s)
- Megan Galbally
- School of Clinical Sciences, Monash University, Clayton, VIC, Australia; Health Futures Institute, Murdoch University, Murdoch, WA, Australia; School of Medicine, University of Notre Dame, Fremantle, WA, Australia; Division of Obstetrics and Gynaecology, University of Western Australia, Crawley, WA, Australia.
| | | | | | | | | | - Nicole Woods
- Community Advisory Council, Women and Newborn Health Service, King Edward Memorial Hospital, Subiaco, WA, Australia
| | - Jan E Dickinson
- Division of Obstetrics and Gynaecology, University of Western Australia, Crawley, WA, Australia; King Edward Memorial Hospital, Subiaco, WA, Australia
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Bovbjerg ML, Horan H. Current Resources for Evidence-Based Practice, January 2022. J Obstet Gynecol Neonatal Nurs 2021; 51:101-112. [PMID: 34921766 DOI: 10.1016/j.jogn.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of breastfeeding while employed and commentaries on reviews focused on mammography test characteristics and sexual health for gynecologic cancer survivors. It also includes a quick update on a USPSTF review for aspirin as pre-eclampsia prophylaxis.
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Doersam AF, Moser J, Throm J, Weiss M, Zipfel S, Micali N, Preissl H, Giel KE. Maternal eating disorder severity is associated with increased latency of foetal auditory event-related brain responses. EUROPEAN EATING DISORDERS REVIEW 2021; 30:75-81. [PMID: 34713530 DOI: 10.1002/erv.2870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/22/2021] [Accepted: 10/06/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Maternal eating disorders (EDs) are associated with adverse pregnancy and child outcomes. There is limited research investigating the influence of maternal EDs on foetal brain development. METHOD Using foetal magnetoencephalography (fMEG), an auditory sequence was presented for 10 min to assess brain response latencies in foetuses of mothers with (n = 12) and without (n = 11) a history of anorexia nervosa (AN) in the third trimester of pregnancy. ED history and severity were assessed using the structured clinical expert interview eating disorder examination (EDE) and the self-report questionnaire EDE-Q. RESULTS Foetuses of mothers with AN showed delayed foetal brain responses to auditory stimulation compared to foetuses of control women. Self-reported ED symptom severity explained 34% of variance in foetal brain response latencies in the AN group. CONCLUSIONS ED pathology was strongly associated with foetal brain response latencies in the third trimester with longer latencies in foetuses of women with a history of AN reporting more ED symptoms. Follow-up on the children is pivotal to investigate if fMEG outcomes are associated with later child development.
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Affiliation(s)
- Annica Franziska Doersam
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), University of Tuebingen, Tuebingen, Germany.,Graduate Training Centre of Neuroscience, International Max Planck Research School, University of Tuebingen, Tuebingen, Germany
| | - Julia Moser
- Graduate Training Centre of Neuroscience, International Max Planck Research School, University of Tuebingen, Tuebingen, Germany.,Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tuebingen, fMEG Center, Tuebingen, Germany.,German Centre for Diabetes Research (DZD), Tuebingen, Germany
| | - Jana Throm
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), University of Tuebingen, Tuebingen, Germany
| | - Magdalene Weiss
- Department of Obstetrics and Gynecology, University Hospital Tuebingen, Tuebingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), University of Tuebingen, Tuebingen, Germany
| | - Nadia Micali
- Department of Psychiatry, University of Geneva, Geneva, Switzerland.,University College London, Great Ormond Street Institute of Child Health, London, UK.,Department of Pediatrics, Obstetrics and Gynecology, University of Geneva, Geneva, Switzerland
| | - Hubert Preissl
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tuebingen, fMEG Center, Tuebingen, Germany.,German Centre for Diabetes Research (DZD), Tuebingen, Germany.,Department of Internal Medicine IV: Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tuebingen, Tuebingen, Baden-Wuerttemberg, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tuebingen, Tuebingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), University of Tuebingen, Tuebingen, Germany
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