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Baer RJ, Bandoli G, Jelliffe-Pawlowski LL, Rhee KE, Chambers CD. Adverse live-born pregnancy outcomes among pregnant people with anorexia nervosa. Am J Obstet Gynecol 2024; 231:248.e1-248.e14. [PMID: 38008148 DOI: 10.1016/j.ajog.2023.11.1242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Previous findings related to the association of adverse pregnancy outcomes with anorexia nervosa are mixed. OBJECTIVE This study aimed to investigate the association of adverse live-born pregnancy outcomes with anorexia nervosa using adjustment modeling accounting for confounding factors, and a mediation analysis addressing the contribution of underweight prepregnancy body mass index and gestational weight gain to those outcomes. STUDY DESIGN The sample included California live-born singletons with births between 2007 and 2021. The administrative data set contained birth certificates linked to hospital discharge records. Anorexia nervosa diagnosis during pregnancy was obtained from International Classification of Diseases codes on hospital discharge records. Adverse pregnancy outcomes examined included gestational diabetes, gestational hypertension, preeclampsia, anemia, antepartum hemorrhage, premature rupture of membranes, premature labor, cesarean delivery, oligohydramnios, placenta previa, chorioamnionitis, placental abruption, severe maternal morbidity, small for gestational age, large for gestational age, low birthweight, and preterm birth (by timing and indication). Risk of each adverse outcome was calculated using Poisson regression models. Unadjusted risk of each adverse outcome was calculated, and then the risks were adjusted for demographic factors. The final adjusted model included demographic factors, anxiety, depression, substance use, and smoking. A mediation analysis was performed to estimate the excess risk of adverse outcomes mediated by underweight prepregnancy body mass index and gestational weight gain below the American College of Obstetricians and Gynecologists recommendation. RESULTS The sample included 241 pregnant people with a diagnosis of anorexia nervosa and 6,418,236 pregnant people without an eating disorder diagnosis. An anorexia nervosa diagnosis during pregnancy was associated with many adverse pregnancy outcomes in unadjusted models (relative risks ranged from 1.65 [preeclampsia] to 3.56 [antepartum hemorrhage]) in comparison with people without an eating disorder diagnosis. In the final adjusted models, birthing people with an anorexia nervosa diagnosis were more likely to have anemia, preterm labor, oligohydramnios, severe maternal morbidity, a small for gestational age or low-birthweight infant, and preterm birth between 32 and 36 weeks with spontaneous preterm labor (adjusted relative risks ranged from 1.43 to 2.55). Underweight prepregnancy body mass index mediated 7.78% of the excess in preterm births and 18.00% of the excess in small for gestational age infants. Gestational weight gain below the recommendation mediated 38.89% of the excess in preterm births and 40.44% of the excess in low-birthweight infants. CONCLUSION Anorexia nervosa diagnosis during pregnancy was associated with a number of clinically important adverse pregnancy outcomes in comparison with people without an eating disorder diagnosis. Adjusting for anxiety, depression, substance use, and smoking during pregnancy decreased this risk. A substantial percentage of the excess risk of adverse outcomes was mediated by an underweight prepregnancy body mass index, and an even larger proportion of excess risk was mediated by gestational weight gain below the recommendation. This information is important for clinicians to consider when caring for patients with anorexia nervosa. Considering and treating anorexia nervosa and comorbid conditions and counseling patients about mediating factors such as preconception weight and gestational weight gain may improve live-born pregnancy outcomes among people with anorexia nervosa.
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Affiliation(s)
- Rebecca J Baer
- Department of Pediatrics, University of California San Diego, San Diego, CA; California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA.
| | - Gretchen Bandoli
- Department of Pediatrics, University of California San Diego, San Diego, CA
| | - Laura L Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Kyung E Rhee
- Department of Pediatrics, University of California San Diego, San Diego, CA
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Ogawa M, Komura H, Ono Y, Nose-Ogura S, Kawai K, Terauchi M. Attitude and experience of obstetricians and gynecologists toward eating disorders assessment and management in Japan: A nationwide survey. J Obstet Gynaecol Res 2024. [PMID: 38952189 DOI: 10.1111/jog.16017] [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: 06/16/2024] [Accepted: 06/20/2024] [Indexed: 07/03/2024]
Abstract
AIM To investigate the attitudes and experiences of obstetricians and gynecologists in treating women with eating disorders (EDs) in Japan. METHODS Members of the Japan Society of Obstetrics and Gynecology were invited to participate in a web-based survey from March 1 to 31, 2022. We asked about the attitudes of obstetricians and gynecologists toward women with weight loss-related amenorrhea and their experiences in treating EDs. We also assessed the characteristics of physicians who see many ED patients. RESULTS A total of 662 ob/gyns. responded to the survey. While treating weight loss-related amenorrhea, 25.8% reported screening patients for EDs. 88.5% of respondents reported having treated ED patients. The main medical concerns described when treating pregnant women with ED were fetal growth restriction and preterm delivery. The most common type of ED encountered by participants in both perinatal and infertility care settings was anorexia nervosa. Characteristics of physicians who treated 10 or more EDs per year were being board certified in women's health care and not providing delivery services (OR = 4.809, 1.896). The most common comment regarding optimizing the management of patients with EDs in obstetrics and gynecology practice was the need to implement guidelines for ED management. CONCLUSIONS Many obstetricians and gynecologists in Japan treat patients with ED. Standardized guidelines for the management of EDs for obstetricians and gynecologists are needed.
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Affiliation(s)
- Mariko Ogawa
- Fukushima Medical Center for Children and Women, Fukushima Medical University, Fukushima, Japan
| | | | - Yoko Ono
- Tsushima Ruriko Women's Life Clinic, Chuo, Japan
| | - Sayaka Nose-Ogura
- Department of Sport Medicine and Research, Japan Institute of Sports Sciences, Kita-ku, Japan
| | - Keisuke Kawai
- Department of Psychosomatic Medicine, Kohnodai Hospital National Center for Global Health and Medicine, Ichikawa, Japan
| | - Masakazu Terauchi
- Department of Women's Health, Tokyo Medical and Dental University, Tokyo, Japan
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Torkel S, Wang R, Norman RJ, Zhao L, Liu K, Boden D, Xu W, Moran L, Cowan S. Barriers and enablers to a healthy lifestyle in people with infertility: a mixed-methods systematic review. Hum Reprod Update 2024:dmae011. [PMID: 38743500 DOI: 10.1093/humupd/dmae011] [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: 10/24/2023] [Revised: 02/20/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND While there is a recognized role of optimizing lifestyle (diet and physical activity) behaviours in the management of infertility, the best practice remains unknown and factors influencing the lifestyle of people with infertility are not well understood. OBJECTIVE AND RATIONALE This systematic review evaluated barriers and enablers to a healthy lifestyle in people with infertility, from the perspectives of people with infertility and health professionals, in order to inform optimal behavioural change strategies. SEARCH METHODS Ovid MEDLINE(R), PsycINFO, EMBASE, EBM Reviews, and CINAHL were searched from inception to 28 August 2023. Eligible studies were qualitative and quantitative primary studies that explored barriers and/or enablers to lifestyle for infertility management. Quality assessment was performed using the Centre for Evidence-Based Management Critical Appraisal of a Survey Tool and the Critical Appraisal Skills Programme Qualitative Checklist. Data were analysed by thematic analysis with themes mapped to the Capability, Opportunity, Motivation and Behaviour (COM-B) model and Theoretical Domains Framework (TDF). OUTCOMES After screening 12 326 abstracts and 99 full-texts, 27 studies were included (12 quantitative, 6 qualitative and 9 mixed-methods) with 22 studies of women with infertility (n = 2524), 11 studies of men with infertility (n = 1407), and 6 studies of health professionals (n = 372). We identified barriers and enablers relating to capability (e.g. strategies for behaviour change), opportunity (e.g. limited time, resources, and money), and motivation (e.g. interplay between lifestyle and emotional state). Based on the identified themes, suggested intervention components to integrate into lifestyle management of infertility include facilitating development of self-management skills to support lifestyle change (e.g. self-monitoring, action planning, and goal setting) and incorporating mental health strategies (e.g. providing information about the benefits of healthy lifestyle behaviours for mental health and encouraging patients to reframe healthy lifestyle behaviours as self-care strategies). WIDER IMPLICATIONS The findings have identified important factors that influence lifestyle management in people with infertility and have suggested relevant intervention components to consider when designing interventions. Given the paucity of qualitative studies identified, more research is needed to further understand the complex and interacting factors that shape lifestyle during the fertility journey.
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Affiliation(s)
- Sophia Torkel
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Rui Wang
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Robert J Norman
- Robinson Research Institute, The University of Adelaide, Adelaide, SA, Australia
| | - Lijun Zhao
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Kai Liu
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Dana Boden
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Wentong Xu
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Lisa Moran
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| | - Stephanie Cowan
- Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
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Tarchi L, Merola GP, Selvi G, Caprara E, Pecoraro V, Cassioli E, Rossi E, Petraglia F, Ricca V, Castellini G. Pregorexia: a systematic review and meta-analysis on the constructs of body image dissatisfaction and eating disturbances by gestational age in the peripartum. Eat Weight Disord 2023; 28:64. [PMID: 37526698 PMCID: PMC10393903 DOI: 10.1007/s40519-023-01595-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023] Open
Abstract
PURPOSE Pregorexia is a phenomenon posited to occur in the peripartum, characterized by an attempt to counter pregnancy's physiological changes in body shape through reduced calorie intake or increased physical activity. METHODS In this pre-registered systematic review and meta-analysis, body image dissatisfaction and eating psychopathology in the peripartum according to gestational age were formally assessed. PubMed was searched up to May 2023. Selection criteria were represented by studies on body image concerns or eating psychopathology in the peripartum (up to 1 year after delivery). The population needed to include women from the general population or among patients with a history of (or current) eating disorder. For the meta-analysis, 17 studies were included: 10 for body image dissatisfaction (2625 individuals overall), 7 for eating behaviors (2551 individuals overall). The interplay between body image and the following themes was examined in depth: the adoption of breastfeeding, peripartum depression, sociocultural influences on body image, sexual disturbances, experiencing or reporting an altered food intake. RESULTS Progressive dissatisfaction with body image during pregnancy by gestational age was observed, stably elevated for at least 12 months postpartum. Eating psychopathology was observed as elevated only at 12 months in the postpartum, but not during pregnancy. DISCUSSION The current work offers normative values of body image satisfaction and eating psychopathology in the peripartum by gestational age. The relevance of current results was discussed, in order to inform both current clinical practice and future public policies. LEVEL OF EVIDENCE Level I-Evidence obtained from: systematic reviews and meta-analyses.
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Affiliation(s)
- Livio Tarchi
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Giuseppe Pierpaolo Merola
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Giulia Selvi
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Eleonora Caprara
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Vincenzo Pecoraro
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Felice Petraglia
- Obstetrics and Gynecology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, AOU Careggi, Viale Della Maternità, Padiglione 8B, 50121, Florence, FI, Italy.
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Sommerfeldt B, Skårderud F, Kvalem IL, Gulliksen KS, Holte A. IVF-induced pregnancy and early motherhood among women with a history of severe eating disorders. Front Psychol 2023; 14:1126941. [PMID: 37138985 PMCID: PMC10149691 DOI: 10.3389/fpsyg.2023.1126941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/29/2023] [Indexed: 05/05/2023] Open
Abstract
Background There is a higher prevalence of eating disorders among women seeking in vitro fertilization (IVF). Women with a history of eating disorders may be particularly vulnerable to eating disorder relapse during IVF, pregnancy, and early motherhood. The experience of these women during this process has hardly been studied scientifically, despite its high clinical relevance. The overall aim of this study is to describe how women with a history of eating disorders experience the process of becoming a mother through IVF, pregnancy, and the postpartum period. Methods We recruited women with a history of severe anorexia nervosa who had undergone IVF (n = 7) at public family health centers in Norway. Semi-openly, the participants were interviewed extensively first during pregnancy, and then 6 months after birth. The 14 narratives were analyzed using interpretative phenomenological analyses (IPA). All participants were required to complete the Eating Disorder Examination Questionnaire (EDE-Q) and were diagnosed (DSM-5) by using the Eating Disorder Examination (EDE), during both pregnancy and postpartum. Results All participants experienced a relapse of an eating disorder during IVF. They perceived IVF, pregnancy, and early motherhood to be overwhelming, confusing, a source of severe loss of control, and a source of body alienation. There were four core phenomena that were reported that were strikingly similar across all participants: "anxiousness and fear," "shame and guilt," "sexual maladjustment," and "non-disclosure of eating problems." These phenomena persisted continuously throughout IVF, pregnancy, and motherhood. Conclusion Women with a history of severe eating disorders are highly susceptible to relapse when undergoing IVF, pregnancy, and early motherhood. The process of IVF is experienced as extremely demanding and provoking. There is evidence that eating problems, purging, over-exercising, anxiousness and fear, shame and guilt, sexual maladjustment, and non-disclosure of eating problems continue throughout IVF, pregnancy, and the early years of motherhood. Therefore, it is necessary for healthcare workers providing services to women undergoing IVF to be attentive and intervene when they suspect a history of eating disorders.
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Affiliation(s)
- Bente Sommerfeldt
- Institute of Eating Disorders, Oslo, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- *Correspondence: Bente Sommerfeldt,
| | - Finn Skårderud
- Institute of Eating Disorders, Oslo, Norway
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Ingela Lundin Kvalem
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Kjersti S. Gulliksen
- Institute of Eating Disorders, Oslo, Norway
- The Norwegian Psychological Association, Oslo, Norway
| | - Arne Holte
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Norwegian Institute of Public Health (NIPH), Oslo, Norway
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Sommerfeldt B, Skårderud F, Kvalem IL, Gulliksen KS, Holte A. Bodies out of control: Relapse and worsening of eating disorders in pregnancy. Front Psychol 2022; 13:986217. [PMID: 36248571 PMCID: PMC9554489 DOI: 10.3389/fpsyg.2022.986217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundBeing pregnant is a vulnerable period for women with a history of eating disorders. A central issue in eating disorders is searching control of one’s body and food preferences. Pregnancy implies being increasingly out of control of this. Treatment and targeted prevention start with the patient’s experience. Little is known about how women with a history of eating disorder experience being pregnant.MethodWe interviewed 24 women with a history of eating disorder at the time of pregnancy, recruited from five public pregnancy controls at local family health centers in Norway. Interviews were analyzed by means of ideal type analysis, with a particular focus on how the participants experienced pregnancy and perceived triggers in possible experiences of relapse or worsening during pregnancy. All participants completed the Eating Disorder Examination Questionnaire (EDE-Q) and were diagnosed (DSM-5) by using the Eating Disorder Examination (EDE).ResultsOn becoming pregnant, 23 of the 24 participants experienced worsening or relapse of their disorder. This occurred both at first time and after several pregnancies, and either interviewed early or late in pregnancy. Ideal type analyses indicated seven different personal features associated with worsening or relapse: the “chaotic” “rigid” “perfect” “worried” “shameful” “motherhood fearing” and “the mother with lost identity” Perceived triggers of worsening or relapse were: “loss of control” “unpredictability” “competition” “change of appearance” “shame and nausea” and “loss of identity.”ConclusionPregnancy is a vulnerable period for women with a history of eating disorders. A great variation in personal psychological dynamics seems to interact with perceived triggers in worsening or relapse of eating disorder. Our findings have important implications in understanding mechanisms of relapse in pregnancy, preventing relapse and help tailoring adequate intervention.
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Affiliation(s)
- Bente Sommerfeldt
- Institute of Eating Disorders, Oslo, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- *Correspondence: Bente Sommerfeldt,
| | - Finn Skårderud
- Institute of Eating Disorders, Oslo, Norway
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Faculty of Health and Sports Sciences, University of Agder, Kristiansand, Norway
| | - Ingela Lundin Kvalem
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Kjersti S. Gulliksen
- Institute of Eating Disorders, Oslo, Norway
- The Norwegian Psychological Association, Oslo, Norway
| | - Arne Holte
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Norwegian Institute of Public Health (NIPH), Oslo, Norway
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