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Eating Disorders in Pregnancy NuFS 124 3/8/2017 Michael Ventura Adriana Garcia Jane Tang Shannen Mach Outline ● ● ● ● ● ● ● ● ● 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 ● ● ● ● 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 ● ● ● ● 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 ● ● ● ● ● ● ● ● ● 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 ● Premature labor ● Miscarriage ● Gestational diabetes Respiratory distress ● Preeclampsia ● Abnormal or delayed fetal growth ● Complications during labor ● Feeding difficulties ● Increased risk of cesarean birth ● Poor development ● Difficulties breastfeeding ● Cardiac irregularities ● Low head circumference ● Stillbirth or fetal death ● Low birth weight for age ● Psychological Effects on Mothers ● ● ● ● ● Postpartum depression Anxiety or panic attacks Low self-esteem Poor body image Suicidal ideations Symptoms ● ● ● ● ● ● ● ● ● ● ● ● ● ● 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 ● ● ● ● ● ● 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 ● “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.” ● Exact cause of Anorexia Nervosa is unknown, rather the culmination of physical, emotional and social l factors ● 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 ● Psychosocial factors: ○ Low self-esteem ○ Childhood sexual abuse and neglect ○ Family dysfunction ○ Alcohol and substance abuse ○ Depression Etiology of Anorexia Nervosa in Pregnant Women ● ● Social factors: ○ Perceived pressure to lose weight, exercise ○ Social media continued portrayal of unrealistic bodies, ideal thinness, ideal weight ○ Unrealistic attainment of the perfect body ○ Partner relationship satisfaction and social support Personal traits ○ Perfectionist ○ Negative self-image vs. positive self-image ○ Positive or Negative outlook towards pregnancy, pregnancy weight gain ○ Genes, hereditary ex: twin studies and sibling adoption studies Bulimia Nervosa ● ● ● ● ● ● 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 ● No official cause of Bulimia nervosa, but is believed to be caused by several factors: ● Psychological factors: ● ● ○ Low self-esteem/lacking self-confidence ○ Depression/Anxiety ○ Problems from childhood ex: physical abuse or sexual abuse Social factors: ○ Portrayal of ideal body weight, ideal shape and thinness ○ Internalization of ideal body weight, thinness and ideal body shape Personal traits: ○ Inherited genes ○ Perfectionist ○ Negative self-image Binge Eating Disorder ● ● ● 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 ● “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) ○ Sexual and physical abuse increased the development of BED in pregnancy ○ History of depression more than doubled the risk of developing BED ○ Anxiety, depression, low self-esteem and low life satisfaction were associated with BED ○ 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: ■ ■ ■ 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 ● ● ● ● ● 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 ● ● ● ● ● 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 ● ● ● ● 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 ● ● 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 ● ● 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 ● ● ● ● 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