Syömishäiriötä sairastavilla esiintyy suurempi painon nousu raskauden aikana, ja he tupakoivat useammin kuin terveet. Ahmimishäiriö saattaa altistaa suurentuneeseen vastasyntyneen painoon ja keisarileikkauksiin. Laihuushäiriö saattaa altistaa vastasyntyneen pienipainoisuuteen, ennenaikaisuuteen, keisarileikkauksiin ja synnytyksen käynnistykseen, mutta mikäli painon nousu raskauden aikana on riittävä, raskauteen ei näytä liittyvän suurentuneita riskejä. Noin puolella syömishäiriöt jatkuvat tai uusiutuvat postpartumissa. Synnytyksen jälkeiseen aikaan liittyy suurentunut riski masennukseen ja ahdistushäiriöön.
Kommentti: Syömishäiriötä sairastaville naisille pitäisi tarjota asiantuntevaa lääketieteellistä seurantaa ja psyykkistä tukea raskauden aikana ja synnytyksen jälkeen.
The purpose of this cross-sectional study «Linna MS, Raevuori A, Haukka J ym. Reproductive he...»1 was to assess how eating disorders are related to reproductive health outcomes in a representative patient population. Female patients (N = 2,257) treated at a eating disorder clinic during 1995-2010 were compared with age matched controls identified from the Central Population Register (N = 9,028). Patients had been diagnosed (ICD-10) with anorexia nervosa (AN, N=502), atypical AN (N=365), bulimia nervosa (BN, N=786), atypical BN (N=445) or binge eating disorder (BED, according to DSM-IV research criteria, N=149). The mean age at the beginning of the follow-up was 25.3 (IQR 20.1-28.4) yrs. The follow-up period of each patient and the controls extended from the day of the admission to the clinic until the end of the follow-up on the 31.12.2010. Register-based data on number of children, pregnancies, childbirths, induced abortions, miscarriages, and infertility treatments were used to measure reproductive health outcomes.
Being single [odds ratio (OR) 1.43; 95 % confidence interval (CI) 1.20-1.57; p<0.001] or divorced (OR 1.29, 95 %CI 1.10-1.51; p=0.002) was more common among patients than among controls, whereas being married was less common (OR 0.61, 95 %CI 0.55-0.67; p<0.001). Patients were more likely to be childless than controls (OR 1.86; 95 %CI 1.62-2.13, p < 0.001). Of all patients, 61.8 % did not have children (vs. 49.0 % in the controls). Pregnancy and childbirth rates were lower among patients than among controls but among those who had had children, the number of offsprings did not differ significantly from the controls. BN (OR 1.85; 95 % CI 1.43-2.38, p < 0.001) and atypical BN (OR 1.92; 95 % CI 1.27-2.89, p=0.002) were associated with increased risk of induced abortion compared to controls, whereas BED was associated with elevated risk of miscarriage, which occurred in 46.7 % of pregnancies vs 23.0 % in controls (OR 3.18; 95 % CI 1.52-6.66, p = 0.002). There was a nonsignificant trend toward increased risk of miscarriage in women with AN (OR 1.44; 95 % CI 0.96-2.17, p=0.08) and atypical AN (OR 1.42; 95 % CI 0.95-2.11, p=0.08). Of the control group 4.5 % had conceived with the help of infertility treatment vs 7.2 % in the whole patient group with no significant differences across the diagnostic groups.
The authors conclude that reproductive health outcomes are compromised in women with a history of eating disorders across all eating disorder types. The findings emphasize the importance of reproductive health counseling and monitoring among women with eating disorders.
This retrospective Norwegian cohort study «Bulik CM, Hoffman ER, Von Holle A ym. Unplanned pr...»2 compared the frequency with which unplanned pregnancies occur in individuals with anorexia nervosa relative to women without eating disorders in the Norwegian Mother and Child Cohort Study. In a sample of 62,060 women, 62 reported anorexia nervosa.
Women with anorexia nervosa were younger (26.2 years, standard deviation 4.76) than women with no eating disorder (29.9 years, standard deviation 4.60) at the time of birth. Significantly more women with anorexia nervosa (50.0 %) reported unplanned pregnancy than women in the referent group (18.9 %). After adjustment for maternal age and infertility treatment, the relative risk of unplanned pregnancy in individuals with anorexia nervosa was 2.11 (95 % confidence interval 1.64-2.72). Induced abortion was also significantly more common in women with anorexia nervosa than referent women (24.2 % compared with 14.6 %). The authors conclude that higher rate of unplanned pregnancy and abortion in women with anorexia nervosa is of clinical concern because absent or irregular menstruation may be misinterpreted as decreasing risk of pregnancy.
This study «Bulik CM, Von Holle A, Siega-Riz AM ym. Birth outc...»3 explored the impact of eating disorders on birth outcomes in the Norwegian Mother and Child Cohort Study. Of 35,929 pregnant women, 35 reported anorexia nervosa (AN), 304 bulimia nervosa (BN), 1,812 binge eating disorder (BED), and 36 EDNOS-purging type (EDNOS-P) in the six months before or during pregnancy. The referent comprised 33,742 women with no eating disorder.
Pre-pregnancy body mass index (BMI) was lower in AN and higher in BED than the referent. AN, BN, and BED mothers reported greater gestational weight gain, and smoking was elevated in all eating disorder groups. BED mothers had higher birth weight babies, lower risk of small for gestational age, and higher risk of large for gestational age and cesarean section than the referent. Pre-pregnancy BMI and gestational weight gain attenuated the effects.
The authors conclude that BED influences birth outcomes either directly or via higher maternal weight and gestational weight gain. The absence of differences in AN and EDNOS-P may reflect small numbers and lesser severity in population samples. Adequate gestational weight gain in AN may mitigate against adverse birth outcomes. Detecting eating disorders in pregnancy could identify modifiable factors (e.g., high gestational weight gain, binge eating, and smoking) that influence birth outcomes.
The purpose of this study «Bansil P, Kuklina EV, Whiteman MK ym. Eating disor...»4 was to describe trends in the prevalence of eating disorders among delivery hospitalizations in the United States from 1994 to 2004 and to compare hospital, demographic, and obstetrical outcomes among women with and without eating disorders. Hospital discharge data for 1994 to 2004 from the Nationwide Inpatient Sample (NIS) were used to assess the relationship between eating disorders (anorexia nervosa and bulimia nervosa) and obstetrical complications. Analyses were limited to delivery-related hospitalizations. There were an estimated 1,668 delivery hospitalizations with an eating disorder diagnosis in the United States in the 11-year period, resulting in an overall rate of 0.39 per 10,000 deliveries. After adjustment for hospital and demographic characteristics, delivery hospitalizations with an eating disorder were significantly more likely than those without an eating disorder to have fetal growth restriction (odds ratio [OR] 9.08, 95 % confidence interval [CI] 6.45-12.77), preterm labor (OR 2.78, 95 % CI 2.10-3.69), anemia (OR 1.73, 95 % CI 1.25-2.38), genitourinary tract infections (OR 1.66, 95 % CI 1.03-2.68), and labor induction (OR 1.32, 95 % CI 1.01-1.73).
Although the prevalence of eating disorders among delivery hospitalizations is lower than in the general population, the fact that women with eating disorders are at increased risk of adverse pregnancy outcomes highlights the importance of screening for and appropriate clinical care of eating disorders in pregnancy.
This retrospective study «Pasternak Y, Weintraub AY, Shoham-Vardi I ym. Obst...»5 investigate whether women with a history of eating disorders have an increased risk for adverse obstetric and perinatal outcomes.
Deliveries occurred during the years 1988-2009 in a tertiary medical center. Women lacking prenatal care and with multiple gestations were excluded from the study.
During the study period, of 117,875 singleton deliveries, 122 (0.1 %) occurred in patients with eating disorders. Eating disorders were significantly associated with fertility treatments (5.7 % vs. 2.8 %, p=0.047), intrauterine growth restriction (7.4 % vs. 2.3 %, p<0.001), term low birth weight (<2500 g) (7.4 % vs. 2.8 %, p=0.002), preterm delivery (15.6 % vs. 7.5 %, p=0.002), and cesarean delivery (25.4 % vs. 15.0 %, p=0.001). Using multivariable analyses, low birth weight (OR 2.5, 95 % CI 1.3-5.0), preterm delivery (OR 2.2, 95 % CI 1.4-3.6), and cesarean section (OR 1.9, 95 % CI 1.3-2.9) were significantly associated with eating disorders. Eating disorders are associated with increased risk of adverse pregnancy outcomes. Accordingly, careful surveillance is needed for early detection of possible complications.
The aim of this Norwegian Mother and Child Cohort Study (MoBa) «Knoph C, Von Holle A, Zerwas S ym. Course and pred...»6 was to investigate course and predictors of eating disorders in the postpartum period.
A total of 77,807 women 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.
This review article «Hoffman ER, Zerwas SC, Bulik CM. Reproductive issu...»7 summarizes key issues related to reproduction in women with anorexia nervosa. The physical and psychological demands of pregnancy and motherhood can represent an immense challenge for women already struggling with the medical and psychological stress of an eating disorder. This article highlights the importance of preconception counseling, adequate gestational weight gain, and sufficient pre- and post-natal nutrition. Postpartum issues including eating disorder symptom relapse, weight loss, breastfeeding, and risk of perinatal depression and anxiety are also discussed.
Kommentti:
Kaikissa tutkimuksissa laihuushäiriöitä sairastavien määrä oli pieni, mikä voi peittää siihen liittyvät riskit. Kaikki tutkimukset olivat retrospektiivisia.