Identification and Treatment in Obstetrical Patients

The impact of maternal eating disorders on breastfeeding practices: a systematic review

Breastfeeding is an effective way to protect and promote the health of the infant and mother. Cultural, social, economic, medical, or psychological factors might interfere with successful breastfeeding. Therefore, maternal eating disorders (EDs) may have detrimental effects on the decision of breastfeeding initiation and on its continuation. There is limited knowledge about the breastfeeding practices of mothers with EDs. We performed a systematic review to generate more evidence in this area. A search was conducted in PubMed and PsycINFO, and several journals were hand searched for relevant publications. Of N = 3904 hits, 13 full texts were included in the qualitative analysis. The findings on total duration of BF between mothers with and without EDs were mixed, but women with EDs showed more negative experiences and emotional problems during BF. There was not enough evidence to conclude on breastfeeding initiation, or on the duration of exclusive breastfeeding. Maternal EDs might have a negative impact on BF practices with possible negative effects on the maternal-child feeding environment. Further studies with comparable data and information on the women's partners' attitudes about breastfeeding are needed.

A case of chronic anorexia nervosa with child-bearing by in vitro fertilization necessitating comprehensive team support

Generalists should be aware of the issues surrounding pregnancy in patients with anorexia nervosa and discuss well with patients and their families before in vitro fertilization.

Practical advice for caring for women with eating disorders during the perinatal period

Pregnancy is a critical time for women struggling with disordered eating and weight concerns. For the majority of women with eating disorders, symptoms improve during pregnancy. Other women, particularly those with either subclinical or binge eating disorders, are at risk for an escalation of pathologic behaviors, putting both mother and fetus at risk for negative birth outcomes. Routinely screening for eating disorders will help identify those women who will most benefit from specialized care. Attention must be paid to possible harmful comorbid behaviors found in women with eating disorders, such as smoking, alcohol use, abusing laxatives or herbal supplements, and self-injurious behavior. This article reviews the mixed research findings of the impact of eating disorders upon pregnancy and identifies key times in prenatal care where nutritional counseling and specific interventions will increase the likelihood of positive pregnancy outcomes. The postpartum period is another critical time for provider intervention that may lower women's risks for eating disorder relapse, postpartum depression, and breastfeeding difficulties.

Anorexia nervosa and pregnancy: having a baby when you are dying to be thin--case report and proposed treatment guidelines

OBJECTIVE

Pregnant women with anorexia nervosa (AN) are at risk for multiple complications to both the woman and fetus. This report examines when to obtain a psychiatric evaluation or admission to an inpatient psychiatric unit to ensure the safety of both the woman and fetus.

METHOD

A case report of a pregnant woman with AN describes the risks of extreme weight loss during pregnancy and the deleterious effects on the fetus's viability and mother's health.

RESULTS

Psychiatric intervention was not requested until late in gestation, when the patient's mental status and low weight had already deteriorated to a point of high risk to both the mother and fetus.

DISCUSSION

We propose the development of treatment guidelines for the pregnant patient with AN to ensure the delivery of optimal care for both the mother and the fetus.