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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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das Neves MDC, Teixeira AA, Garcia FM, Rennó J, da Silva AG, Cantilino A, Rosa CE, Mendes-Ribeiro JDA, Rocha R, Lobo H, Gomes IE, Ribeiro CC, Garcia FD. Eating disorders are associated with adverse obstetric and perinatal outcomes: a systematic review. ACTA ACUST UNITED AC 2021; 44:201-214. [PMID: 34008794 PMCID: PMC9041959 DOI: 10.1590/1516-4446-2020-1449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/18/2021] [Indexed: 11/22/2022]
Abstract
Objective: To systematically review the literature focusing on obstetric and perinatal outcomes in women with previous or current eating disorders (EDs) and on the consequences of maternal EDs for the offspring. Methods: The study was performed following the systematic review and meta-analysis (PRISMA) statement. PubMed, SciELO, and Cochrane databases were searched for non-interventional studies published in English or Portuguese from January 1980 to December 2020. Risk of bias was assessed using the Methods guide for effectiveness and comparative effectiveness reviews (American Agency for Healthcare Research and Quality). Results: The search yielded 441 records, and 30 articles were included. The psychiatric outcome associated with EDs in women was mainly perinatal depression. The most prevalent obstetric outcomes observed in women with EDs were vomiting, hyperemesis, bleeding, and anemia. Most studies found maternal anorexia nervosa and bulimia nervosa to be associated with low birth weight and slow fetal growth. Women with binge EDs delivered children with increased birth weight. Of the 30 studies included, methodological quality was good in seven, fair in eight, and poor in 15 studies. Conclusion: A considerable body of evidence was reviewed to assess obstetric and perinatal outcomes in EDs. Acute and lifetime EDs, especially if severe, correlated with poor perinatal, obstetric, and neonatal outcomes. Obstetricians and general practitioners should be vigilant and screen for EDs during pregnancy.
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Affiliation(s)
- Maila de C das Neves
- Comissão de Estudos e Pesquisa da Saúde Mental da Mulher, Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil.,Programa de Pós-Graduação em Neurociências, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,Núcleo de Pesquisa e Vulnerabilidade em Saúde, UFMG, Belo Horizonte, MG, Brazil.,Departamento de Saúde Mental, Faculdade de Medicina, UFMG, Belo Horizonte, MG, Brazil
| | - Ananda A Teixeira
- Núcleo de Pesquisa e Vulnerabilidade em Saúde, UFMG, Belo Horizonte, MG, Brazil
| | - Flávia M Garcia
- Núcleo de Pesquisa e Vulnerabilidade em Saúde, UFMG, Belo Horizonte, MG, Brazil
| | - Joel Rennó
- Comissão de Estudos e Pesquisa da Saúde Mental da Mulher, Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil.,Instituto de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Antônio G da Silva
- Comissão de Estudos e Pesquisa da Saúde Mental da Mulher, Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil.,Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Amaury Cantilino
- Comissão de Estudos e Pesquisa da Saúde Mental da Mulher, Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil.,Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Carlos E Rosa
- Comissão de Estudos e Pesquisa da Saúde Mental da Mulher, Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil.,Departamento de Imagens Médicas, Hematologia e Oncologia Clínica, Faculdade de Medicina de Ribeirão Preto, USP, Ribeirão Preto, SP, Brazil
| | - Jeronimo de A Mendes-Ribeiro
- Comissão de Estudos e Pesquisa da Saúde Mental da Mulher, Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil.,Associação de Psiquiatria Cyro Martins, Porto Alegre, RS, Brazil
| | - Renan Rocha
- Comissão de Estudos e Pesquisa da Saúde Mental da Mulher, Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil
| | - Hewdy Lobo
- Comissão de Estudos e Pesquisa da Saúde Mental da Mulher, Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil
| | - Igor E Gomes
- Comissão de Estudos e Pesquisa da Saúde Mental da Mulher, Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil.,Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Christiane C Ribeiro
- Comissão de Estudos e Pesquisa da Saúde Mental da Mulher, Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil
| | - Frederico D Garcia
- Programa de Pós-Graduação em Neurociências, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,Núcleo de Pesquisa e Vulnerabilidade em Saúde, UFMG, Belo Horizonte, MG, Brazil.,Departamento de Saúde Mental, Faculdade de Medicina, UFMG, Belo Horizonte, MG, Brazil.,Programa de Pós-Graduação em Medicina Molecular, Faculdade de Medicina, UFMG, Belo Horizonte, MG, Brazil
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