Advertisement
Article| Volume 46, ISSUE 3, P588-596, March 2023

Download started.

Ok

Pregnancy outcomes in women with anorexia nervosa: a population-based study and analysis of a matched cohort

Published:December 10, 2022DOI:https://doi.org/10.1016/j.rbmo.2022.12.006

      Abstract

      Research question

      What implications does anorexia nervosa have on pregnancy outcomes in a US population?

      Design

      A retrospective, population-based study using data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample. A dataset of all deliveries between 2004 and 2014 inclusively was created. The population was divided into women with anorexia nervosa (n = 214) and women without anorexia nervosa (n = 9,096,574), and a cohort matched 1:4 with anorexia nervosa for age, race, medical insurance type and income quartile. Delivery and neonatal outcomes were compared between the two matched groups and with the control group of deliveries. A multivariable logistic regression analysis, controlling for statistically significant baseline characteristics, explored associations between anorexia nervosa and delivery, and neonatal outcomes.

      Results

      Compared with the entire group, women diagnosed with anorexia nervosa were more likely to be white, smokers, of higher income or diagnosed with another psychiatric disorder. In the unmatched comparison, women with anorexia nervosa had a higher frequency of preterm delivery (adjusted odds ratio [aOR] 2.98 CI 1.86 to 4.76, P < 0.001), placental abruption (aOR 3.41 CI 1.38 to 8.40, P = 0.008) and small for gestational age (SGA) neonates (aOR 5.32 CI 3.12 to 9.09, P < 0.001). In the matched comparison, preterm delivery (aOR 5.31, CI 3.02 to 9.32, P < 0.001) and SGA neonates were significantly higher in the anorexia nervosa group (aOR 4.69 CI 2.6 to 8.41, P < 0.001), providing results similar to the unmatched comparison.

      Conclusion

      Healthcare providers, specifically fertility specialists, should be aware of the magnitude of adverse outcomes related to pregnancy in women with anorexia nervosa.

      KEYWORDS

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Reproductive BioMedicine Online
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders.
        Fifth Edition (DSM-5). American Psychiatric Association, Arlington, VA2013
        • Ante Z.
        • Luu T.M.
        • Healy-Profitós J.
        • He S.
        • Taddeo D.
        • Lo E.
        • Auger N.
        Pregnancy outcomes in women with anorexia nervosa.
        Int. J. Eat. Disord. 2020; 53: 403-412https://doi.org/10.1002/EAT.23251
        • Anzengruber D.
        • Klump K.L.
        • Thornton L.
        • Brandt H.
        • Crawford S.
        • Fichter M.M.
        • Halmi K.A.
        • Johnson C.
        • Kaplan A.S.
        • LaVia M.
        • Mitchell J.
        • Strober M.
        • Woodside D.B.
        • Rotondo A.
        • Berrettini W.H.
        • Kaye W.H.
        • Bulik C.M.
        Smoking in eating disorders.
        Eat. Behav. 2006; 7: 291-299https://doi.org/10.1016/J.EATBEH.2006.06.005
        • Bulik C.M.
        • von Holle A.
        • Siega-Riz A.M.
        • Torgersen L.
        • Lie K.K.
        • Hamer R.M.
        • Berg C.K.
        • Sullivan P.
        • Reichborn-Kjennerud T.
        Birth Outcomes in Women with Eating Disorders in the Norwegian Mother and Child Cohort Study (MoBa).
        Int. J. Eat. Disord. 2009; 42: 9https://doi.org/10.1002/EAT.20578
        • Eagles J.M.
        • Lee A.J.
        • Raja E.A.
        • Millar H.R.
        • Bhattacharya S.
        Pregnancy outcomes of women with and without a history of anorexia nervosa.
        Psychol. Med. 2012; 42: 2651-2660https://doi.org/10.1017/S0033291712000414
        • Eik-Nes T.T.
        • Horn J.
        • Strohmaier S.
        • Holmen T.L.
        • Micali N.
        • Bjørnelv S.
        Impact of eating disorders on obstetric outcomes in a large clinical sample: A comparison with the HUNT study.
        International Journal of Eating Disorders. 2018; 51: 1134-1143https://doi.org/10.1002/EAT.22916
        • Ekéus C.
        • Lindberg L.
        • Lindblad F.
        • Hjern A.
        Birth outcomes and pregnancy complications in women with a history of anorexia nervosa.
        BJOG. 2006; 113: 925-929https://doi.org/10.1111/J.1471-0528.2006.01012.X
        • Feferkorn I.
        • Badeghiesh A.
        • Baghlaf H.
        • Dahan M.H.
        The relation between cigarette smoking with delivery outcomes. anorexia nervosa evaluation of a database of more than nine million deliveries.
        J. Perinat. Med. 2021; https://doi.org/10.1515/JPM-2021-0053
        • Golden N.H.
        • Mehler P.S.
        Atypical anorexia nervosa can be just as bad.
        Cleve. Clin. J. Med. 2020; 87: 172-174https://doi.org/10.3949/CCJM.87A.19146
        • Hecht LM.
        • Hadwiger A.
        • Patel S.
        • Hecht BR.
        • Loree A.
        • Ahmedani BK.
        • Miller-Matero LR.
        Disordered eating and eating disorders among women seeking fertility treatment: A systematic review.
        Arch. Womens Ment. Health. 2021; https://doi.org/10.1007/S00737-021-01156-X
      1. ICD - ICD-9-CM - International Classification of Diseases, Ninth Revision, Clinical Modification [WWW Document], n.d. URL https://www.cdc.gov/nchs/icd/icd9cm.htm (accessed 9.28.22).

        • Keski-Rahkonen A.
        • Hoek HW.
        • Susser ES.
        • Linna MS.
        • Sihvola E.
        • Raevuori A.
        • Bulik CM.
        • Kaprio J.
        • Rissanen A.
        Epidemiology and course of anorexia nervosa in the community.
        Am. J. Psychiatry. 2007; 164: 1259-1265https://doi.org/10.1176/APPI.AJP.2007.06081388
        • Kumarasamy V.
        • Mitchell M.D.
        • Bloomfield F.H.
        • Oliver M.H.
        • Campbell M.E.
        • Challis J.R.G.
        • Harding J.E.
        Effects of periconceptional undernutrition on the initiation of parturition in sheep.
        Am. J. Physiol. Regul. Integr. Comp. Physiol. 2005; 288: 67-72https://doi.org/10.1152/AJPREGU.00357.2004/ASSET/IMAGES/LARGE/ZH60010524830003.JPEG
        • Linna M.S.
        • Raevuori A.
        • Haukka J.
        • Suvisaari J.M.
        • Suokas J.T.
        • Gissler M.
        Pregnancy, obstetric, and perinatal health outcomes in eating disorders.
        Am. J. Obstet. Gynecol. 2014; 211 (392.e1-392.e8)https://doi.org/10.1016/J.AJOG.2014.03.067
        • Lockwood C.J.
        Stress-associated preterm delivery: the role of corticotropin-releasing hormone.
        Am. J. Obstet. Gynecol. 1999; 180https://doi.org/10.1016/S0002-9378(99)70713-1
        • Mantel Ä.
        • Hirschberg A.L.
        • Stephansson O.
        Association of Maternal Eating Disorders With Pregnancy and Neonatal Outcomes.
        JAMA. Psychiatry. 2020; 77: 285https://doi.org/10.1001/JAMAPSYCHIATRY.2019.3664
        • Micali N.
        • de Stavola B.
        • Dos-Santos-Silva I.
        • Steenweg-De Graaff J.
        • Jansen P.W.
        • Jaddoe V.W.V.
        • Hofman A.
        • Verhulst F.C.
        • Steegers E.A.P.
        • Tiemeier H.
        Perinatal outcomes and gestational weight gain in women with eating disorders: a population-based cohort study.
        BJOG. 2012; 119: 1493-1502https://doi.org/10.1111/J.1471-0528.2012.03467.X
        • Micali N.
        • Simonoff E.
        • Treasure J.
        Risk of major adverse perinatal outcomes in women with eating disorders.
        The British Journal of Psychiatry. 2007; 190: 255-259https://doi.org/10.1192/BJP.BP.106.020768
        • Rodino IS.
        • Byrne SM.
        • Sanders KA.
        Eating disorders in the context of preconception care: fertility specialists’ knowledge, attitudes, and clinical practices.
        Fertil. Steril. 2017; 107: 494-501https://doi.org/10.1016/J.FERTNSTERT.2016.10.036
        • Sollid C.P.
        • Wisborg K.
        • Hjort J.
        • Secher N.J.
        Eating disorder that was diagnosed before pregnancy and pregnancy outcome.
        Am. J. Obstet. Gynecol. 2004; 190: 206-210https://doi.org/10.1016/S0002-9378(03)00900-1
        • Stein Z.
        • Susser M.
        The Dutch famine, 1944-1945, and the reproductive process. I. Effects on six indices at birth.
        Pediatr. Res. 1975; 9: 70-76https://doi.org/10.1203/00006450-197502000-00003
        • Udo T.
        • Grilo CM.
        Prevalence and Correlates of DSM-5-Defined Eating Disorders in a Nationally Representative Sample of U.S. Adults.
        Biol. Psychiatry. 2018; 84: 345-354https://doi.org/10.1016/J.BIOPSYCH.2018.03.014
        • Wiseman C.v.
        • Turco R.M.
        • Sunday S.R.
        • Halmi K.A.
        Smoking and body image concerns in adolescent girls.
        Int. J. Eat. Disord. 1998; 24: 429-433https://doi.org/10.1002/(sici)1098-108x(199812)24:4<429::aid-eat10>3.0.co;2-d

      Biography

      Dr Ido Feferkorn is a graduate of the Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa Israel. He completed his residency at Carmel Medical Center in Haifa and a fellowship in reproductive endocrinology and infertility at McGill University Health Center. He currently works at Tel-Aviv Medical Center.
      Key message
      Fertility specialists should be aware of the increased risk of small for gestational age neonates, preterm delivery and placental abruption in pregnant women with anorexia nervosa.