Download Eating Disorders in Pregnancy

Eating Disorders in Pregnancy
NuFS 124
3/8/2017
Michael Ventura
Adriana Garcia
Jane Tang
Shannen Mach
Outline
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Introduction to Pregnancy
Development of Eating Disorders (ED)
Pathophysiology of ED During Pregnancy
Anorexia Nervosa (AN)
Bulimia Nervosa (BN)
Binge Eating Disorder (BED)
Conclusion
Questions
References
Introduction
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Pregnancy is when there are changes in the
woman’s body such as shape and weight.
According to the National Eating Disorder
Association (NEDA), an average woman gains
around 25-35 lbs during pregnancy.
According to Dr. Bermudez, the chief medical
officer at Eating Recovery Center, “30% of
American women don’t gain enough weight
during pregnancy.”
Women who had eating disorders prior to
pregnancy are at a higher risk for remission
during pregnancy
Development of Eating Disorders
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Body dissatisfaction
Thin-ideal internalization
Dieting
Family social support deficits.
Anorexia- Childhood eating conflicts, struggles around meals, premature birth, low birth weight,
delivery of multiple babies at once, perfectionism.
Bulimia-Thin-ideal internalization, social pressure for thinness, body dissatisfaction, dieting/fasting,
negative affect.
Pathophysiology
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Menstrual irregularities (bulimia)
Amenorrhoea (bulimia)- absence of menstruation
Infertility(bulimia)
Difficult conceiving (anorexia)
(Risk to mothers with bulimia) Suffer dehydration, chemical imbalances or even cardiac
irregularities
Overweight due to binge eating are at greater risk of developing high blood pressure, and
gestational diabetes.
Severe depression during pregnancy, premature births, labor complications, difficulties
nursing,postpartum depression.
(Risk to the baby): poor development, premature, low birth weight for age, respiratory distress,
feeding difficulties, and other perinatal complications.
Anorexic and bulimic mothers reported problems with breastfeeding
Physical Effects / Complications
Effects on Baby
Complications
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Premature labor
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Miscarriage
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Gestational diabetes
Respiratory distress
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Preeclampsia
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Abnormal or delayed fetal growth
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Complications during labor
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Feeding difficulties
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Increased risk of cesarean birth
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Poor development
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Difficulties breastfeeding
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Cardiac irregularities
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Low head circumference
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Stillbirth or fetal death
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Low birth weight for age
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Psychological Effects on Mothers
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Postpartum depression
Anxiety or panic attacks
Low self-esteem
Poor body image
Suicidal ideations
Symptoms
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Little to no weight gain or weight loss throughout the pregnancy
Restriction of major food groups
Feeling fearful of becoming overweight
Engaging in extreme forms of exercise to burn calories
Inducing vomiting to get rid of food eaten
Chronic fatigue
Dizziness, headaches, blacking-out
Skipping or avoiding meals
Difficulty concentrating
Social avoidance of family or friends
Increased depression or anxiety
Hyperemesis- severe morning sickness
Antenatal -is when a mother has symptoms of vomiting and has a bloated abdomen, fatigue and amenorrhoea
are common in “Anorexia, Bulimia and Pregnancy”
Fetal stress due to high maternal cortisol and a decrease in plasma volume
Anorexia Nervosa
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Inadequate food intake
Intense fear of weight gain
Self-esteem overly related to body image.
Women with anorexia nervosa are underweight and are not able to gain enough weight during their pregnancy
that they risk the baby with abnormally low birth weight and related health problems.
Pregnancy is unplanned among women suffering from AN
Anorexia Nervosa is associated with other psychological problems
Etiology of Anorexia Nervosa in Pregnant Women
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“Pregnancy can be a time for intensified body image concerns and for those women who are struggling with
an eating disorder, the 40 weeks of pregnancy can cause the disorder to worsen.”
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Exact cause of Anorexia Nervosa is unknown, rather the culmination of physical, emotional and social l factors
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Extreme fear of gaining weight and strong desire to be thin despite knowing weight gain would be in the best
interest of mother and child
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Psychosocial factors:
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Low self-esteem
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Childhood sexual abuse and neglect
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Family dysfunction
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Alcohol and substance abuse
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Depression
Etiology of Anorexia Nervosa in Pregnant Women
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Social factors:
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Perceived pressure to lose weight, exercise
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Social media continued portrayal of unrealistic bodies, ideal thinness, ideal weight
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Unrealistic attainment of the perfect body
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Partner relationship satisfaction and social support
Personal traits
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Perfectionist
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Negative self-image vs. positive self-image
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Positive or Negative outlook towards pregnancy, pregnancy weight gain
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Genes, hereditary ex: twin studies and sibling adoption studies
Bulimia Nervosa
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Consuming large amount of food and followed by self-induced vomiting
Feeling out of control during binge eating
Self esteem overly related to body image
Women with Bulimia Nervosa continue to purge suffer dehydration ,
chemical imbalances, even cardiac irregularities.
Psychosocial factors associated with bulimia nervosa (Berg et al., 2008):
○ Life satisfaction, self-esteem, relationship satisfaction
Mood and anxiety symptoms are associated with onset of BN (Berg et
al., 2008)
Etiology of Bulimia Nervosa
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No official cause of Bulimia nervosa, but is believed to be caused by several factors:
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Psychological factors:
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Low self-esteem/lacking self-confidence
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Depression/Anxiety
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Problems from childhood ex: physical abuse or sexual abuse
Social factors:
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Portrayal of ideal body weight, ideal shape and thinness
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Internalization of ideal body weight, thinness and ideal body shape
Personal traits:
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Inherited genes
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Perfectionist
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Negative self-image
Binge Eating Disorder
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What is Binge Eating Disorder?
○ It is a recurrent episodes of eating in large quantities
very quickly
Social pressure to be thin, stressed, depressed
Women who are overweight and binge eat are at a higher
risk to high blood pressure and gestational diabetes.
○ According to a 2014 analysis by the Centers for
Disease Control and Prevention, the prevalence of
gestational diabetes is as high as 9.2%
Etiology of Binge Eating Disorder
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“A growing body of research has confirmed the clinical significance of BED, but the etiology
remains largely unknown. However, environmental triggers and stressful experiences have
postulated to play important roles.” (Berg et al., 2011)
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Sexual and physical abuse increased the development of BED in pregnancy
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History of depression more than doubled the risk of developing BED
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Anxiety, depression, low self-esteem and low life satisfaction were associated with BED
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Preoccupation of pregnancy weight gain was the variable most strongly related to the onset of BED during
pregnancy
Intervention
Recognizing women at increased risk is imperative
for referral to treatment or intervention programs:
● Women with an active eating disorder should
seek help as early as possible to obstetrician,
that specializes in high risk pregnancy and
eating disorders
● Women with a milder eating disorder should
turn to antenatal care
○ Suggested questions to ask at each
antenatal care:
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What is your current eating pattern? Are
you restricting your dietary intake? Do
you binge?
How do you feel about your shape and
weight?
What is your mood like? Feeling low or
anxious?
Treatment
Steps
Reproductive Treatment Recommendations for Women with
A Eating Disorder
Prior to Pregnancy
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Achieve and maintain
healthy weight
Avoid purging
Consult with
healthcare provide for
pre-conception
appointment
Meet with an RD to
start healthy
pregnancy diet
(prenatal vitamins)
Seek counseling to
address ED underlying
issues
During Pregnancy
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Schedule appointment with
health care provider for a
prenatal visit and to inform
him or her regarding the ED
Strive for healthy weight gain
Eat balanced meal with
adequate nutrients and
consult with an RD
Avoid purging
Seek counseling for ED
Post Pregnancy
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Continue counseling to improve
physical and mental health
Inform close networks of ED and
increased risk of postpartum
depression; ask if they could be
available for support after birth
Contact lactation consultant for
help with breastfeeding
Consult an RD to help with
weight management
http://americanpregnancy.org/pregnancy-health/pregnancy-and-eating-disorders/
Treatment: Pharmaceuticals
Little is known about medication use among
women with eating disorders in relation to
pregnancy
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High dose fluoxetine (60 mg daily)
has a specific anti-bulimic effect
and may help patients regain
control over their eating if
combined with self help therapy
Not very common due to chances
of complications with baby
Recovery
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Seek treatment to promote healthy outcome and educate the importance of good nutrition to
fetal development
○ Regular visit with your Obstetrician
○ Therapist
○ Nutritionist / Registered Dietitian
Support groups
○ Family
○ Significant other
Questions
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Anorexia Nervosa is an eating disorder brought on by one or more
underlying causes. Identify three possible causes a pregnant mother
might exhibit Anorexia Nervosa?
How does eating disorders physically affect the baby and the mother?
Explain.
What are some similarities and differences in reproductive
recommendations for women with an eating disorder prior to, during,
and post pregnancy?
If you were a Registered Dietitian or a health care professional, what
approach would you take to treat pregnant women with eating disorders?
References