Eating Disorders During Gestation: Implications for Mother's Health, Fetal Outcomes, and Epigenetic Changes

Abstract

Introduction: Eating disorders (EDs) have increased globally in women of childbearing age, related to the concern for body shape promoted in industrialized countries. Pregnancy may exacerbate a previous ED or conversely may be a chance for improving eating patterns due to the mother's concern for the unborn baby. EDs may impact pregnancy evolution and increase the risk of adverse outcomes such as miscarriage, preterm delivery, poor fetal growth, or malformations, but the knowledge on this topic is limited. Methods: We performed a systematic review of studies on humans in order to clarify the mechanisms underpinning the adverse pregnancy outcomes in patients with EDs. Results: Although unfavorable fetal development could be multifactorial, maternal malnutrition, altered hormonal pathways, low pre-pregnancy body mass index, and poor gestational weight gain, combined with maternal psychopathology and stress, may impair the evolution of pregnancy. Environmental factors such as malnutrition or substance of abuse may also induce epigenetic changes in the fetal epigenome, which mark lifelong health concerns in offspring. Conclusions: The precocious detection of dysfunctional eating behaviors in the pre-pregnancy period and an early multidisciplinary approach comprised of nutritional support, psychotherapeutic techniques, and the use of psychotropics if necessary, would prevent lifelong morbidity for both mother and fetus. Further prospective studies with large sample sizes are needed in order to design a structured intervention during every stage of pregnancy and in the postpartum period.

Prevalence and phenotype of eating disorders in assisted reproduction: a systematic review

“…These proposals are in line with international recommendations that emphasize the importance of early psychiatric care in order to reduce the risk of post-partum symptoms [ 5 , 16 ]. It has been described that the symptoms of EDs remain present in pregnant women with an easing of symptoms during the first trimester and a potential upsurge at the end of pregnancy or postpartum [ 11 , 33 , 44 ]. While Yli-Kulha et al report significantly fewer cases of hospitalization after a pregnancy resulting from fertility treatment, these results should be qualified by the reluctance to consent to hospitalization that separates the mother and child at an early stage.…”

Systematic Review of Literature on Eating Disorders During Pregnancy—Risk and Consequences for Mother and Child

“…They distinguish between patients who (1) completely stop restrictive behaviour, (2) in whom a partial reduction in the severity of symptoms can be observed, (3) in whom symptoms remain at the same level as before pregnancy, and (4) a group of patients in whom symptoms worsen or possibly changes in the nature of symptoms develop—(e.g., from binge/purge type to binge-only type). For women who experience symptom reduction and health improvement in pregnancy, the desire to ensure the safety of the baby and a concern for the developing foetus constitute the protective factor ( 6 ). Claydon et al ( 16 ) and Clark et al ( 24 ) indicate that even foetal movements and kicks were protective factors against the negative body image.…”

“…The period of pregnancy and puerperium is a period of immense changes taking place in the woman's body—including the greatest changes in body appearance since puberty ( 6 ). The time of pregnancy is also a period of greater sensitivity to negative self-perception, which contributes to the deterioration of self-esteem ( 7 ).…”

“…Therefore, the impact of pregnancy on both the course of ED and the effect of ED on maternal and foetal well-being ought to be considered an issue of great importance. Sebastiani et al indicate that the prevalence of eating disorders in pregnant women may reach 5–7.5% ( 6 ) and that the occurrence of these disorders has undoubtedly adverse effects on the course of pregnancy, childbirth and the condition of the child after birth, which becomes a significant interdisciplinary problem and is of equal interest to researchers in fields of psychiatry, obstetrics and neonatology.…”

Impact of epigenetics on human health and possible tool for remediation

“…These alterations can start as early in the embryonic development and well into adult livelihood [20,52]. They are time dependent as well as on the trajectory of an individual's lifestyle where diet, substance abuse to addictions and environmental exposures like occupational hazards [1,4,35,39,48]. Aberrations in the epigenetic network can spatially induct definitive changes and establish as well as dictate the outcome of several diseases.…”