Obstetric and gynecologic problems associated with eating disorders

Abstract

Objective This article summarizes the literature on obstetric and gynecologic complications associated with eating disorders. Method We performed a comprehensive search of the current literature on obstetric and gynecologic complications associated with eating disorders using PubMed. More recent randomized-controlled trials and larger data sets received priority. We also chose those that we felt would be the most relevant to providers. Results Common obstetric and gynecologic complications for women with eating disorders include infertility, unplanned pregnancy, miscarriage, poor nutrition during pregnancy, having a baby with small head circumference, postpartum depression and anxiety, sexual dysfunction and complications in the treatment for gynecologic cancers. There are also unique associations by eating disorder diagnosis, such as earlier cessation of breastfeeding in anorexia nervosa; increased polycystic ovarian syndrome in bulimia nervosa; and complications of obesity as a result of binge eating disorder. Discussion We focus on possible biological and psychosocial factors underpinning risk for poor obstetric and gynecological outcomes in eating disorders. Understanding these factors may improve both our understanding of the reproductive needs of women with eating disorders and their medical outcomes. We also highlight the importance of building multidisciplinary teams to provide comprehensive care to women with eating disorders during the reproductive years.

Variation in reproductive outcomes of women with histories of bulimia nervosa, anorexia nervosa, or eating disorder not otherwise specified relative to the general population and closest‐aged sisters

“…There is a well-documented link between eating disorders (ED), reduced fecundability, and infertility (Bulik, Sullivan, Fear, Pickering, & McCullin, 1999; Kimmel, Ferguson, Zerwas, Bulik, & Meltzer-Brody, 2016). Many women seeking fertility treatment have a history of ED psychopathology (Freizinger, Franko, Dacey, Okun, & Domar, 2010), and women with prior or current EDs are more likely to express difficulty becoming pregnant (Easter, Treasure, & Micali, 2011).…”

“…EDs are associated with mental and physical health comorbidities (Hudson et al, 2007; Piran & Robinson, 2011), and increased risk of suicide and mortality among women of childbearing age (Arcelus, Mitchell, Wales, & Nielsen, 2011; Pisetsky, Thornton, Lichtenstein, Pedersen, & Bulik, 2013; Preti, Rocchi, Sisti, Camboni, & Miotto, 2011). The negative relationship between EDs and reproductive health is attributable to the adverse physical health outcomes of EDs, including extreme low or high bodyweight, and irregular or absent menstruation (Kimmel et al, 2016; Mustelin et al, 2015; Poyastro Pinheiro et al, 2007; Winkler, Frølich, Schulpen, & Støving, 2017). …”

Long‐term outcome of anorexia nervosa: Results from a large clinical longitudinal study

“…Our review suggests the following variables, all measured at the beginning of treatment, as possible predictors for the longer term poor outcome of AN: a high degree of ED-specific psychopathology; a high degree of general psychopathology; a longer duration of the course of eating disorder/chronicity; a lower body mass index (BMI); and a higher age. Most studies focus on the medical implications of amenorrhea (Attia & Roberto, 2009), but a recent review points out the relevance of regular menses and child-bearing for quality of life (Kimmel, Ferguson, Zerwas, Bulik, & Meltzer-Brody, 2016). According to DSM-5 (American Psychiatric Association, 2013) criteria, amenorrhea is no longer a diagnostic criterion for AN.…”

Impact of eating disorders on obstetric outcomes in a large clinical sample: A comparison with the HUNT study

“…Some population-based studies, however, largely indicate no differences between women with EDs compared to controls in obstetric outcomes (Bulik et al, 2009;Ekéus, Lindberg, Lindblad, & Hjern, 2006;Micali et al, 2012). This inconsistency may be due to low statistical power or less severe illness in population samples compared to clinical samples (Kimmel, Ferguson, Zerwas, Bulik, & Meltzer-Brody, 2016). Studies using data from clinical cohorts with linkage to medical birth registries with possible mediating factors are scarce, and findings may clarify existing inconsistencies.…”