Takaisin

Raskauden vaikutus syömishäiriöihin

Näytönastekatsaukset
Laure Morin-Papunen
18.9.2014

Näytön aste: B

Yleensä syömishäiriöt jatkuvat lievempinä raskauden aikana, mutta yli puolella palautuvat entiselleen synnytyksen jälkeen.

The objective of the study «Micali N, Treasure J, Simonoff E. Eating disorders...»1 was to determine the impact of pregnancy on eating disorders (ED) symptoms using data from a large prospective, community-based cohort study.

Patients: Women (12 254) were classified according to whether they had a recent or past history of ED, were obese before pregnancy, or constituted part of the general population control group. Self-induced vomiting (SIV), laxative use, exercise behavior, and appraisals about weight gain during pregnancy were investigated, as well as dieting, and shape and weight concern before and during pregnancy.

Outcomes: Women with a recent episode of ED dieted, used laxatives, reported SIV, and exercised more than other groups during pregnancy. They were also more likely to report ED cognitions in pregnancy and their weight and shape concern scores remained high during pregnancy. Women with past ED were also more likely than controls to have some ED behaviors and/or concerns about weight gain during pregnancy.

Conclusions: Women with a recent ED continued to have some ED symptoms in pregnancy, albeit fewer compared to before pregnancy.

  • Tutkimuksen laatu: kelvollinen
  • Sovellettavuus suomalaiseen väestöön: kohtalainen

In a prospective study «Crow SJ, Agras WS, Crosby R ym. Eating disorder sy...»2 forty-two participants became pregnant during 4-year follow-up of 385 women with full or subthreshold anorexia nervosa, bulimia nervosa, or binge eating disorder. Participants completed the Eating Disorders Examination (EDE) at 6-month intervals. Mixed modeling procedures were used to examine change in eating disorder cognitions, binge eating, and purging. Results: EDE restraint, EDE shape concerns, EDE weight concerns, binge eating, and purging diminished from prepartum to intrapartum, but returned to approximately baseline levels postpartum.

Conclusion: Eating disorder symptoms improved during pregnancy, but worsened postpartum. These results highlight pregnancy as a potential time for eating disorder interventions.

  • Tutkimuksen laatu: kelvollinen
  • Sovellettavuus suomalaiseen väestöön: kohtalainen

The aim of this large retrospective Norwegian cohort study «Knoph C, Von Holle A, Zerwas S ym. Course and pred...»3 was to investigate course and predictors of eating disorders in the postpartum period. A total of 77,807 women, participating in the Norwegian Mother and Child Cohort Study (MoBa), completed questionnaires during pregnancy including items covering DSM-IV criteria for prepregnancy anorexia nervosa (AN, N = 72), bulimia nervosa (BN, N = 672), eating disorder not otherwise specified (EDNOS-P, N = 92), and binge eating disorder (BED, N = 2698). Additional questionnaires were completed at 18 and 36 months postpartum.

Proportions of women remitting at 18 months and 36 months postpartum were 50 % and 59 % for AN, 39 % and 30 % for BN, 46 % and 57 % for EDNOS-P, and 45 % and 42 % for BED, respectively. However, disordered eating persisted in a substantial proportion of women meeting criteria for either full or subthreshold eating disorders. BN during pregnancy increased the risk for continuation of BN. BMI and psychological distress were significantly associated with course of BED.

This is the first large-scale population-based study on course of eating disorders in the postpartum period. The results indicated that disordered eating persists in a substantial proportion of women with prepregnancy eating disorders. Health care professionals working with women in this phase of life need to pay specific attention to eating disorder symptoms and behaviors.

  • Tutkimuksen laatu: tasokas
  • Sovellettavuus suomalaiseen väestöön: hyvä

Kommentit

«Micali N, Treasure J, Simonoff E. Eating disorders...»1: Koska syömishäiriödiagnoosi perustuu kirjalliseen kyselyyn raskausviikoilla 12, 18 ja 32, tulosten luotettavuus jää epävarmaksi.

«Crow SJ, Agras WS, Crosby R ym. Eating disorder sy...»2: Potilasmäärät ovat pieniä. Diagnoosi perustuu kyselyyn (katso edellinen kommentti).

«Knoph C, Von Holle A, Zerwas S ym. Course and pred...»3: Diagnoosi perustui kyselyyn.

Kirjallisuutta

  1. 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 «PMID: 17719368»PubMed
  2. Crow SJ, Agras WS, Crosby R ym. Eating disorder symptoms in pregnancy: a prospective study. Int J Eat Disord 2008;41:277-9 «PMID: 18027861»PubMed
  3. Knoph C, Von Holle A, Zerwas S ym. Course and predictors of maternal eating disorders in the postpartum period. Int J Eat Disord 2013;46:355-68 «PMID: 23307499»PubMed