CONCLUSIONSCONCLUSIONS

• Women with eating disorders, including anorexia nervosa, bulimia nervosa and eating disorders not otherwise specified, may be at increased risk for adverse pregnancy outcome when compared to women without eating disorders.

• No association between developmental delay in the infant beyond 6 months and women with eating disorders was found.

• No association in the occurence of fetal birth defects and women with eating disorders was found.

• Women with active disease should be advised to avoid pregnancy until the eating disorder is in remission to decrease the risk of unfavorable pregnancy outcomes.

What is the effect of maternal eating disorders on pregnancy outcome, What is the effect of maternal eating disorders on pregnancy outcome, birth defects and developmental delays?birth defects and developmental delays?

Kristle Neuhalfen, PA-S and Patricia Bunton, MS, PA-CDepartment of Physician Assistant

College of Health Professions, Wichita State University

INTRODUCTIONINTRODUCTION

The prenatal period is critical in determining the quality of fetal development as well as how the infant responds and develops outside of the womb after birth. Factors such as physical and emotional maternal stress and substance abuse during pregnancy have all been linked to increase risk of harm to an infant during development. During critical times of prenatal development certain physiologic structures and systems are considered to be highly plastic and easily influenced by the environment the mother provides for the fetus. After periods of plasticity have passed, certain stages in the child’s development are anatomically fixed. A birth defect is something that develops while the baby is maturing in the womb, most commonly occurs during the first 3 months of pregnancy and detected within the first year of life. Because eating disorders as outlined in the DSM-IV occur primarily in women of childbearing age, one might suspect that eating disorders and pregnancy often occur simultaneously. The literature to date concerning pregnancy outcome in women with eating disorders is not definitive.

RESULTSRESULTS

• The occurrence of congenital malformations was associated with eating disorders in two Level 3 articles and one Level 2. There was no association between found in two Level 3 articles. Congenital malformations included 1 undescended testicle, 2 ocular abnormalities with visual impairment, 3 heart defects, 1 cleft palate and 1 cleft lip.

• The most significant finding was in altered pregnancy outcomes. One Level 1, three Level 2, two Level 3 and one Level 4 articles showed an association between maternal eating disorders and altered pregnancy outcome. One Level 2 and two Level 4 did not.

• One Level 3 and one Level 4 showed an association between rates of developmental delay and eating disorders. One Level 4 showed no association with developmental delay.

DISCUSSIONDISCUSSION

The evidence evaluating the occurrence of birth defects was very weak and contained no Level 1 articles. There was not enough evidence available in the literature to make a statement concerning the occurrence of developmental delays due to lack of Level 1 studies. The majority of studies made an effort to eliminate confounding factors. There seems to be an association with maternal eating disorders and the the risk of altered pregnancy outcomes. Some studies had unequal populations of anorexia nervosa and bulimia nervosa patients, therefore results may not apply equally for both types of disorders. Further research may want to study the two disorders separately. Due to public stereotyping and shame associated with these diseases, many cases go undiagnosed, leaving many unanswered questions as to the effect of eating disorders on the unborn.

*Includes problems encountered with the infant that may effect how the body looks or works.**Includes abnormalities in the progression of developmental milestones i.e. sitting, crawling, walking and speech of single words.***Includes terminated pregnancies and spontaneous abortions.

METHODSMETHODS

This was an evidence-based literature review using the following inclusion criteria:

• Women meeting DSM-IV criteria for anorexia nervosa, bulimia nervosa and eating disorders not otherwise specified

• Studies must have made an attempt to eliminate confounding factors such as cigarette smoking or chronic disease

• All articles were published in peer reviewed journals from 1980 to presentFifteen articles met the inclusion criteria and were evaluated for the occurrence of fetal birth defects, developmental delays and adverse pregnancy outcomes.

Fetal Birth

Defects*

Delayed Developmental Progression**

AdversePregnancy Outcome***

No association with eating disorders

2 2 7

Association with eating disorders

1 1 3

Table 1: Number of articles reviewed and outcomes