Researchers have uncovered the hidden problems and developed recommendations and principles for the multidisciplinary management of anorexia nervosa in pregnancy, according to a new study from Monash University.
The results of the study were published in the journal “The Lancet Psychiatry”. The findings include a focus on the specialized mental health, obstetric, medical and nutritional care needed to ensure optimal outcomes for women and their babies.
Pregnant women with anorexia are at greater risk of having a stillbirth, underweight baby or premature birth, but there are no clear guidelines on how doctors should handle the condition.
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Anorexia nervosa has an increased prevalence in women of childbearing age, with up to one in 200 pregnant women with the condition. It is typically associated with constraining or binging and purging behaviors, or both.
Professor Galbally says there is a dearth of studies and clinical advice on the management of pregnant women with anorexia.
“Unlike mood and anxiety disorders and psychotic disorders, little guidance and research is available for anorexia nervosa in pregnancy,” she said.
“Assessment measures used outside of pregnancy, such as the Eating Disorder Inventory, or body mass index dependence, have been shown to have limited validity in pregnancy,” he added.
“Clearly, the assessment and monitoring of measures and tools for anorexia nervosa require modification in the context of pregnancy.” Research on the management of the health of pregnant women has generally highlighted the importance of maternal prenatal nutrition, pregnancy weight gain and baby birth weight as critical risk factors and vital intervention points to improve health over time. life span, including in areas such as heart disease, diabetes and obesity.
According to the study authors, anorexia nervosa can affect obstetric and neonatal outcomes through low calorie intake, nutritional and vitamin deficiencies, stress, fasting, low body mass, and problems with placental function.
In addition, the risks of untreated or undertreated anorexia nervosa in pregnancy include psychological and psychosocial risks, including perinatal depression and anxiety.
For women with anorexia nervosa, there is an increase in reported obstetric complications. A 2020 study from Canada reported that women with anorexia nervosa in pregnancy had 1.32 times the risk of preterm birth, 1.69 times the adjusted risk of a low birth weight baby, and 1.99 times the adjusted risk of stillbirth. compared to women without anorexia nervosa in pregnancy.
“Management of anorexia nervosa requires a multidisciplinary team approach with expertise in mental health, specialist medical care, and dietetics at a minimum; in pregnancy, key specialists include obstetricians (especially specialists caring for high-risk pregnancies), physicians with experience in pregnancy, nutritionists who are also experienced in the nutritional needs of pregnancy, pediatricians, and mental health physicians with perinatal experience,” the authors recommended.
“While many of the principles developed for the management of anorexia nervosa in adults are applicable in pregnancy, they require specialized modification and adaptation to the substantial physiological, psychological, and social changes in pregnancy, and fetal growth and well-being must also be taken into account. into consideration,” the authors concluded.
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