Abstract
Anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) present high-risk situations during pregnancy. These conditions have been associated with inadequate or inconsistent energy and nutrient intakes, notably total energy; folate; vitamins B6, B12, and A; calcium; iron; and zinc. Electrolyte imbalances are also of concern. Inadequate or excessive weight gain, spontaneous abortion, intrauterine growth restriction, preterm delivery, and low birth weight, among other adverse outcomes, have been reported in pregnant women with eating disorders and their offspring. Screening and assessment of women for AN, BN, or BED during prenatal clinic visits is recommended. An interdisciplinary approach to care during pregnancy, the postpartum period, and beyond is critical to the successful management of eating disorders and optimal pregnancy outcomes.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Stein AD, Ravelli AC, Lumey LH. Famine, third–trimester pregnancy weight gain, and intrauterine growth: the Dutch Famine Birth Cohort Study. Hum Biol. 1995;67:135–50.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association Publishing; 2013.
Smink FRE, van Hoeken D, Hoek HW. Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep. 2012;14:406–14.
Harrington BC, Jimerson M, Haxton C, Jimerson DC. Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. Am Fam Physician. 2015;91:46–52.
Bulik CM, Sullivan PF, Wade TD, Kendler KS. Twin studies of eating disorders: a review. Int J Eat Disord. 2000;27:1–20.
Trace SE, Baker JH, Penas-Lledo E, Bulik CM. The genetics of eating disorders. Annu Rev Clin Psychol. 2013;9:589–620.
Hinney A, Volckmar AL. Genetics of eating disorders. Curr Psychiatry Rep. 2013;15:423.e1–9.
Micali N, Field AF, Treasure JL, Evans DM. Are obesity risk genes associated with binge eating in adolescence? Obesity. 2015;23:1729–36.
Culbert KM, Racine SE, Klump KL. Research review: what have we learned about the causes of eating disorders–a synthesis of sociocultural, psychological, and biological research. J Child Psychol Psychiatry. 2015;56:1141–64.
Wolfe BE. Reproductive health in women with eating disorders. J Obstet Gynecol Neonatal Nurs. 2005;34:255–63.
Patel P, Wheatcroft R, Park RJ, Stein A. The children of mothers with eating disorders. Clin Child Fam Psychol Rev. 2002;5:1–19.
Rodino IS, Byrne S, Sanders KA. Disordered eating attitudes and exercise in women undergoing fertility treatment. Aust N Z J Obstet Gynaecol. 2016;56:82–7.
Stewart DE, Robinson E, Goldbloom DS, Wright C. Infertility and eating disorders. Am J Obstet Gynecol. 1990;163:1196–9.
Easter A, Bye A, Taborelli E, Corfield F, Schmidt U, Treasure J, Micali N. Recognising the symptoms: how common are eating disorders in pregnancy? Eur Eat Disord Rev. 2013;21(4):340.
Kimmel MC, Ferguson EH, Zerwas S, Bulik CM, Meltzer-Brody S. Obstetric and gynecologic problems associated with eating disorders. Int J Eat Disord. 2015;49(3):260–75.
Crow SJ, Thuras P, Keel PK, Mitchell JE. Long-term menstrual and reproductive function in patients with bulimia nervosa. Am J Psychiatry. 2002;159:1048–50.
Johnson AA, Knight EM, Edwards CH, Oyemade UJ, Cole OJ, Westney OE, et al. Dietary intakes, anthropometric measurements and pregnancy outcomes. J Nutr. 1994;124(Suppl 6):936S–42S.
Abrams BF, Laros RK. Prepregnancy weight, weight gain, and birth weight. Am J Obstet Gynecol. 1986;154:503–9.
van der Ster Wallin G, Norring C, Holmgren S. Binge eating versus nonpurged eating in bulimics: is there a carbohydrate craving after all? Acta Psychiatr Scand. 1994;89:376–81.
Hadigan CM, Kissileff HR, Walsh BT. Patterns of food selection during meals in women with bulimia. Am J Clin Nutr. 1989;50:759–66.
Coleman MD, Nickols-Richardson SM. Urinary ketones reflect serum ketone concentration but do not relate to weight loss in overweight premenopausal women following a low-carbohydrate/high-protein diet. J Am Diet Assoc. 2005;105:608–11.
Abraham S. Sexuality and reproduction in bulimia nervosa patients over 10 years. J Psychosom Res. 1998;44:491–502.
Jackson AA. Nutrients, growth, and the development of programmed metabolic function. Adv Exp Med Biol. 2000;478:41–55.
Food and Nutrition Board, Institute of Medicine. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington, DC: National Academies Press; 2005.
Bakan R, Birmingham CL, Aeberhardt L, Goldner EM. Dietary zinc intake of vegetarian and nonvegetarian patients with anorexia nervosa. Int J Eat Disord. 1993;13:229–33.
Siega-Riz AM, Haugen M, Meltzer HM, Von Holle A, Hamer R, Torgersen L, et al. Nutrient and food group intakes of women with and without bulimia nervosa and binge eating disorder during pregnancy. Am J Clin Nutr. 2008;87:1346–55.
Raymond NC, Neumeyer B, Warren CS, Lee SS, Peterson CB. Energy intake patterns in obese women with binge eating disorder. Obes Res. 2003;11:869–79.
Carmichael SL, Shaw GM, Schaffer DM, Laurent C, Selvin S. Dieting behaviors and risk of neural tube defects. Am J Epidemiol. 2003;158:1127–31.
Hadigan CM, Anderson EJ, Miller KK, Hubbard JL, Herzog DB, Klibanski A, et al. Assessment of macronutrient and micronutrient intake in women with anorexia nervosa. Int J Eat Disord. 2000;28:284–92.
Boland B, Beguin C, Zech F, Desager JP, Lambert M. Serum beta-carotene in anorexia nervosa patients: a case-control study. Int J Eat Disord. 2001;30:299–305.
Cross NA, Hillman LS, Allen SH, Krause GF, Vieira NE. Calcium homeostasis and bone metabolism during pregnancy, lactation, and postweaning: a longitudinal study. Am J Clin Nutr. 1995;61:514–23.
Ward A, Brown N, Treasure J. Persistent osteopenia after recovery from anorexia nervosa. Int J Eat Disord. 1997;22:71–5.
Gendall KA, Sullivan PE, Joyce PR, Carter FA, Bulik CM. The nutrient intake of women with bulimia nervosa. Int J Eat Disord. 1997;21:115–27.
Micali N, De Stavola B, dos-Santos-Silva I, Steenweg-de Graaff J, Jansen PW, et al. Perinatal outcomes and gestational weight gain in women with eating disorders: a population-based cohort study. BJOG. 2012;119:1493–502.
Linna MS, Raevuori A, Haukka J, Suvisaari JM, Suokas JT, Gissler M. Reproductive health outcomes in eating disorders. Int J Eat Disord. 2013;46:826–33.
Nunes MAA, Pinheiro AP, Camey SA, Schmidt MI. Binge eating during pregnancy and birth outcomes: a cohort study in a disadvantaged population in Brazil. Int J Eat Disord. 2012;45:827–31.
Milner G, O’Leary MM. Anorexia nervosa occurring in pregnancy. Acta Psychiatr Scand. 1988;77:491–2.
Sengupta-Giridharan R, Settatree RS, Jones A. Complex long-term eating disorder, Bartter’s syndrome and pregnancy: a rare combination. Aust N Z J Obstet Gynaecol. 2003;43(5):384.
Bulik CM, Sullivan PF, Fear JL, Pickering A, Dawn A, McCullin M. Fertility and reproduction in women with anorexia nervosa: a controlled study. J Clin Psychiatry. 1999;60:130–5.
Hart T, Kase N, Kimball CP. Induction of ovulation and pregnancy in patients with anorexia nervosa. Am J Obstet Gynecol. 1970;108(4):580.
Ho E. Anorexia nervosa in pregnancy. Nurs Mirror. 1985;160:40–2.
Strimling BS. Infant of a pregnancy complicated by anorexia nervosa. Am J Dis Child. 1984;138:68–9.
Treasure JL, Russell GF. Intrauterine growth and neonatal weight gain in babies of women with anorexia nervosa. Br Med J. 1988;296:1038.
Weinfeld RH, Dubay M, Burchell RC, Millerick JD, Kennedy AT. Pregnancy associated with anorexia and starvation. Am J Obstet Gynecol. 1977;129:698–9.
Linna MS, Raevuori A, Haukka J, Suvisaari JM, Suokas JT, Gissler M. Pregnancy, obstetric, and perinatal health outcomes in eating disorders. Am J Obstet Gynecol. 2014;211:392.e1–8.
Zauderer CR. Eating disorders and pregnancy: supporting the anorexic or bulimic expectant mother. MCN Am J Matern Child Nurs. 2012;37:48–55.
Ahmed S, Balakrishnan V, Minogue M, Ryan CA, McKiernan J. Sudden maternal death in pregnancy complicated by anorexia nervosa. J Obstet Gynaecol. 1999;19:529–31.
Benton-Hardy LR, Lock J. Pregnancy and early parenthood: factors in the development of anorexia nervosa? Int J Eat Disord. 1998;24:223–6.
Conrad R, Schablewski J, Schilling G, Liedtke R. Worsening of symptoms of bulimia nervosa during pregnancy. Psychosomatics. 2001;44:76–8.
Feingold M, Kaminer Y, Lyons K, Chaudhury AK, Costigan K, Cetrulo CL. Bulimia nervosa in pregnancy: a case report. Obstet Gynecol. 1988;1:1025–7.
Hollifield J, Hobdy J. The course of pregnancy complicated by bulimia. Psychotherapy. 1990;27:249–55.
Lacey JH, Smith G. Bulimia nervosa. The impact of pregnancy on mother and baby. Br J Psychiatry. 1987;150:777–81.
Price WA, Giannini AJ, Loiselle RH. Bulimia precipitated by pregnancy. J Clin Psychiatry. 1986;7:275–6.
Ramchandani D, Whedon B. The effect of pregnancy on bulimia. Int J Eat Disord. 1988;7:845–8.
Stewart DE, Raskin J, Garfinkel PE, MacDonald OL, Robinson GE. Anorexia nervosa, bulimia, and pregnancy. Am J Obstet Gynecol. 1987;157:1194–8.
Coker EL, Mitchell-Wong LA, Abraham SF. Is pregnancy a trigger for recovery from an eating disorder? Acta Obstet Gynecol Scand. 2013;92:1407–13.
Siega-Riz AM, Von Holle A, Haugen M, Meltzer HM, Hamer R, Torgersen L, et al. Gestational weight gain of women with eating disorders in the Norwegian pregnancy cohort. Int J Eat Disord. 2011;44:428–34.
Mitchell JE, Seim HC, Glotter D, Soll EA, Pyle RL. A retrospective study of pregnancy in bulimia nervosa. Int J Eat Disord. 1991;10:209–14.
Morgan JF, Lacey JH, Chung E. Risk of postnatal depression, miscarriage, and preterm birth in bulimia nervosa: retrospective controlled study. Psychosom Med. 2006;68:487–92.
Conti J, Abraham S, Taylor A. Eating behavior and pregnancy outcome. J Psychosom Res. 1998;44:465–77.
Bulik CM, Von Holle A, Siega-Riz AM, Torgersen L, Lie KK, Hamer RM, et al. Birth outcomes in women with eating disorders in the Norwegian mother and child cohort study (MoBa). Int J Eat Disord. 2009;42:9–18.
Lemberg R, Phillips J. The impact of pregnancy on anorexia nervosa and bulimia. Int J Eat Disord. 1989;8:285–95.
Namir S, Melman KN, Yager J. Pregnancy in restricter-type anorexia nervosa: a study of six women. Int J Eat Disord. 1986;5:837–45.
Willis DC, Rand CSW. Pregnancy in bulimic women. Obstet Gynecol. 1988;71:708–10.
Koubaa S, Hallstrom T, Lindholm C, Hirschberg AL. Pregnancy and neonatal outcomes in women with eating disorders. Obstet Gynecol. 2005;105:255–60.
Franko DL, Blais MA, Becker AE, Delinsky SS, Greenwood DN, Flores AT, et al. Pregnancy complications and neonatal outcomes in women with eating disorders. Am J Psychiatry. 2001;158:1461–6.
Micali N, Simonoff E, Treasure J. Risk of major adverse perinatal outcomes in women with eating disorders. Br J Psychiatry. 2007;190:255–9.
Sollid CP, Wisborg K, Hjort J, Secher NJ. Eating disorder that was diagnosed before pregnancy and pregnancy outcome. Am J Obstet Gynecol. 2004;190:206–10.
Waugh E, Bulik CM. Offspring of women with eating disorders. Int J Eat Disord. 1999;25:123–33.
Koubaa S, Hallstrom T, Hagenas L, Hirschberg AL. Retarded head growth and neurocognitive development in infants of mothers with a history of eating disorders: longitudinal cohort study. BJOG. 2013;120:1413–22.
Perrin EM, Von Holle A, Zerwas S, Skinner AC, Reba-Harrelson L, Hamer RM, et al. Weight-for-length trajectories in the first year of life in children of mothers with eating disorders in a large Norwegian cohort. Int J Eat Disord. 2015;48:406–14.
Morrill ES, Nickols-Richardson SM. Bulimia nervosa during pregnancy: a review. J Am Diet Assoc. 2001;101:448–54.
Crow SJ, Keel PK, Thuras P, Mitchell JE. Bulimia symptoms and other risk behaviors during pregnancy in women with bulimia nervosa. Int J Eat Disord. 2004;36:220–3.
Swann RA, Von Holle A, Torgersen L, Gendall K, Reichborn-Kjennerud T, Bulik CM. Attitudes toward weight gain during pregnancy: results from the Norwegian mother and child cohort study (MoBa). Int J Eat Disord. 2009;42:394–401.
Nunes MA, Pinheiro AP, Hoffmann JF, Schmidt MI. Eating disorders symptoms in pregnancy and postpartum: a prospective study in a disadvantaged population in Brazil. Int J Eat Disord. 2014;47:426–30.
Broussard B. Psychological and behavioral traits associated with eating disorders and pregnancy: a pilot study. J Midwifery Womens Health. 2012;57:61–6.
Knoph C, Von Holle A, Zerwas S, Torgersen L, Tambs K, Stoltenberg C, et al. Course and predictors of maternal eating disorders in the postpartum period. Int J Eat Disord. 2013;46:355–68.
Crow SJ, Agras WS, Crosby R, Halmi K, Mitchell JE. Eating disorder symptoms in pregnancy: a prospective study. Int J Eat Disord. 2008;41:277–9.
Watson HJ, Von Holle A, Hamer RM, Berg CN, Torgersen L, Magnus P, et al. Remission, continuation, and incidence of eating disorders during early pregnancy: a validation study on a population-based birth cohort. Psychol Med. 2013;43:1723–34.
Blais MA, Becker AE, Burwell RA, Flores AT, Nussbaum KM, Greenwood DN, et al. Pregnancy: outcome and impact on symptomatology in a cohort of eating-disordered women. Int J Eat Disord. 2000;27:140–9.
Morgan JF, Lacey JH, Sedgwick PM. Impact of pregnancy on bulimia nervosa. Br J Psychiatry. 1999;174:135–40.
Micali N, Treasure J, Simonoff E. Eating disorders symptoms in pregnancy: a longitudinal study of women with recent and past eating disorders and obesity. J Psychosom Res. 2007;63:297–303.
Bulik CM, Von Holle A, Hamer R, Berg CK, Torgersen L, Magnus P, et al. Patterns of remission, continuation and incidence of broadly defined eating disorders during early pregnancy in the Norwegian mother and child cohort study (MoBa). Psychol Med. 2007;37:1109–18.
Berg CN, Torgersen L, Von Holle A, Hamer RM, Bulik CM, Reichborn-Kjennerud T. Factors associated with binge eating disorder in pregnancy. Int J Eat Disord. 2011;44:124–33.
Soares RM, Nunes MA, Schmidt MI, Giacomello A, Manzolli P, Camey S, et al. Inappropriate eating behaviors during pregnancy: prevalence and associated factors among pregnant women attending primary care in southern Brazil. Int J Eat Disord. 2009;42:387–93.
Abraham S, Taylor A, Conti J. Postnatal depression, eating, exercise, and vomiting before and during pregnancy. Int J Eat Disord. 2001;29:482–7.
Mazzeo SE, Slof-Op’t Landt MCT, Jones I, Mitchell K, Kendler KS, Neale MC, et al. Associations among postpartum depression, eating disorders, and perfectionism in a population-based sample of adult women. Int J Eat Disord. 2006;39:202–11.
Carter FA, McIntosh VVW, Joyce PR, Frampton CM, Bulik CM. Bulimia nervosa, childbirth, and psychopathology. J Psychosom Res. 2003;55:357–61.
Leddy MA, Jones C, Morgan MA, Schulkin J. Eating disorders and obstetric–gynecologic care. J Women’s Health. 2009;8:1395–401.
Abraham S. Obstetricians and maternal body weight and eating disorders during pregnancy. J Psychosom Obstet Gynaecol. 2001;22:159–63.
Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: a new screening tool for eating disorders. Western J Med. 2000;172:164–5.
Dellava JE, Von Holle A, Torgersen L, Reichborn-Kjennerud T, Haugen M, Meltzer HM, et al. Dietary supplement use immediately before and during pregnancy in Norwegian women with eating disorders. Int J Eat Disord. 2011;44:325–32.
Wilfley DE, Schwartz MB, Spurrell EB, Fairburn CG. Using the eating disorder examination to identify the specific psychopathology of binge eating disorder. Int J Eat Disord. 2000;27:259–69.
Tierney S, McGlone C, Furber C. What can qualitative studies tell us about the experiences of women who are pregnant that have an eating disorder? Midwifery. 2013;29:542–9.
Additional Resources
Hoffman ER, Zerwas SC, Bulik CM. Reproductive issues in anorexia nervosa. Expert Rev. Obstet Gynecol. 2011;6:403–14.
Micali N, Northstone K, Emmett P, Naumann U, Treasure JL. Nutritional intake and dietary patterns in pregnancy: a longitudinal study of women with lifetime eating disorders. Br J Nutr. 2012;108:2093–9.
Rocco PL, Orbitello B, Perini L, Pera V, Ciano RP, Balestrieri M. Effects of pregnancy on eating attitudes and disorders: a prospective study. J Psychosom Res. 2005;59:175–9.
The Academy of Nutrition and Dietetics: www.eatright.org
The American Psychiatric Association: www.psychiatry.org
Anorexia Nervosa and Related Eating Disorders, Inc.: www.anred.com
National Association of Anorexia Nervosa and Associated Disorders: www.anad.org
National Eating Disorders Association: www.nationaleatingdisorders.org
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this chapter
Cite this chapter
Nickols-Richardson, S.M. (2018). Anorexia Nervosa, Bulimia Nervosa, and Binge-Eating Disorder During Pregnancy. In: Lammi-Keefe, C., Couch, S., Kirwan, J. (eds) Handbook of Nutrition and Pregnancy. Nutrition and Health. Humana Press, Cham. https://doi.org/10.1007/978-3-319-90988-2_14
Download citation
DOI: https://doi.org/10.1007/978-3-319-90988-2_14
Published:
Publisher Name: Humana Press, Cham
Print ISBN: 978-3-319-90986-8
Online ISBN: 978-3-319-90988-2
eBook Packages: MedicineMedicine (R0)