Pregnancy outcomes in women with active anorexia nervosa: a systematic review

Pan, Jeremy Ryan; Li, Tina Yutong; Tucker, Danny; Chen, Kai Yang

doi:10.1186/s40337-022-00551-8

Cited by 6 publications

(5 citation statements)

References 61 publications

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“…The results on AN and LBW are consistent with a 2014 systematic review and meta-analysis showing that AN was associated with a lower birth weight (standardised mean difference −0.19 kg [95% CI −0.25, −0.15]) [41]. The present findings are also in agreement with the systematic review by Pan et al, in which the authors concluded that SGA and LBW were some of the most reported pregnancy complications in women with active AN [40]. Low pre-pregnancy BMI is a risk factor in women with AN for delivering an LBW infant [34].…”

Section: Review / La Revuesupporting

confidence: 93%

“…The analysis of past and current AN as a single group may have also influenced the results of the analysis on PTB. A systematic review by Pan et al found that PTB was among the most commonly reported complications in pregnant women with active AN [40]. The meta-analysis shows a significant positive association between BN and PTB but not AN and PTB.…”

Section: Discussionmentioning

confidence: 99%

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Maternal Eating Disorders and Adverse Birth Outcomes: A Systematic Review and Meta-Analysis

Milembamane,

Moussa,

Twynstra

et al. 2024

Canadian Journal of Dietetic Practice and Research

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Previous systematic reviews have reported on the relationship between eating disorders (EDs) and birth outcomes, but there are no existing meta-analyses on this topic. This systematic review and meta-analysis examines the association between lifetime maternal EDs, including anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) with low birth weight (LBW), preterm birth (PTB), small for gestational age (SGA), large for gestational age (LGA), and miscarriage. Four databases were systematically searched for quantitative literature on maternal EDs that preceded birth outcomes. Eighteen studies met the inclusion criteria and were included in the review. The meta-analyses included 6 studies on miscarriage, 11 on PTB, 4 on LBW, 9 on SGA, and 4 on LGA. The Mantel–Haenszel random effects model was used to test the associations between EDs and birth outcomes. The results showed significant positive associations between AN and LBW (OR 1.74, 95% confidence interval (CI) 1.49, 2.03), AN and SGA (OR 1.39, 95% CI 1.17, 1.65), BN and PTB (OR 1.19, 95% CI 1.04, 1.36), and BED and LGA (OR 1.43 95% CI 1.18, 1.72). EDs were not significantly correlated with miscarriage. These findings reveal the importance of screening for and treating EDs in pregnant women.

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Section: Review / La Revuesupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Maternal Eating Disorders and Adverse Birth Outcomes: A Systematic Review and Meta-Analysis

Milembamane,

Moussa,

Twynstra

et al. 2024

Canadian Journal of Dietetic Practice and Research

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“…Especially, it would be of interest to determine the trajectory of weight gain depending on the aetiology of underweight, e.g., constitutive thinness, anorexia nervosa, or orthorexia. A recent systemic review suggested that active anorexia nervosa could be associated with adverse pregnancy outcomes including prematurity, intrauterine growth restriction, or low birth weight [ 21 ]. In a case series, it was shown that women with active anorexia nervosa had a lower weight gain and newborns with lower birth weight than women in remission from eating disorders [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

In Underweight Women, Insufficient Gestational Weight Gain Is Associated with Adverse Obstetric Outcomes

et al. 2022

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The pre-pregnancy BMI and the gestational weight gain are two important determinants of pregnancy outcomes. The aim of this study was to determine obstetric outcomes associated with insufficient gestational weight gain in women with a pre-pregnancy BMI < 18.5 kg/m2. This study was based on observational routinely collected data from University Hospital Maternity. The participants were allocated to the group sufficient or insufficient gestational weight gain: ≥12.5 kg and <12.5 kg respectively. Primary outcomes were the adjusted birth weight in percentiles (%) and the proportion of SGA newborns. Secondary outcomes were obstetric and perinatal outcomes. A total of 132 participants with a median age of 28 ± 8 years were included. The adjusted birth weight in percentiles was significantly lower in the insufficient gestational weight gain group (27.3 ± 45.0 vs. 46.3 ± 46.2%; p < 0.001). Moreover, the insufficient gestational weight gain is associated with a higher risk of SGA (27.0% vs. 11.6%; p = 0.03). Our study also showed increased risks of premature rupture of membranes, anaemia, and intrauterine growth restriction in women with an insufficient weight gain. Future studies should explore the risk factors associated with insufficient weight gain, in order to develop specific care for underweight pregnant women.

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“…those with eating disorders or medical disorders affecting nutrition, should be considered at increased risk and serial USS undertaken. 53…”

Section: [Evidence Level 2+]mentioning

confidence: 99%

“…Therefore, women with a low BMI at booking (below 18.5 kg/m 2 ) and who have features which indicate that the maternal stature is not physiological, e.g. those with eating disorders or medical disorders affecting nutrition, should be considered at increased risk and serial USS undertaken 53 . [Evidence level 2++]…”

Section: What Are the Risk Factors For Fetal Growth Disorders In Preg...mentioning

confidence: 99%

Investigation and Care of a Small‐for‐Gestational‐Age Fetus and a Growth Restricted Fetus (Green‐top Guideline No. 31)

Morris,

Johnstone,

Lees

et al. 2024

BJOG

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Key recommendations All women should be assessed at booking (by 14 weeks) for risk factors for fetal growth restriction (FGR) to identify those who require increased surveillance using an agreed pathway [Grade GPP]. Findings at the midtrimester anomaly scan should be incorporated into the fetal growth risk assessment and the risk assessment updated throughout pregnancy. [Grade GPP] Reduce smoking in pregnancy by identifying women who smoke with the assistance of carbon monoxide (CO) testing and ensuring in‐house treatment from a trained tobacco dependence advisor is offered to all pregnant women who smoke, using an opt‐out referral process. [Grade GPP] Women at risk of pre‐eclampsia and/or placental dysfunction should take aspirin 150 mg once daily at night from 12+0–36+0 weeks of pregnancy to reduce their chance of small‐for‐gestational‐age (SGA) and FGR. [Grade A] Uterine artery Dopplers should be carried out between 18+0 and 23+6 weeks for women at high risk of fetal growth disorders [Grade B]. In a woman with normal uterine artery Doppler and normal fetal biometry at the midtrimester scan, serial ultrasound scans for fetal biometry can commence at 32 weeks. Women with an abnormal uterine artery Doppler (mean pulsatility index > 95th centile) should commence ultrasound scans at 24+0–28+6 weeks based on individual history. [Grade B] Women who are at low risk of FGR should have serial measurement of symphysis fundal height (SFH) at each antenatal appointment after 24+0 weeks of pregnancy (no more frequently than every 2 weeks). The first measurement should be carried out by 28+6 weeks. [Grade C] Women in the moderate risk category are at risk of late onset FGR so require serial ultrasound scan assessment of fetal growth commencing at 32+0 weeks. For the majority of women, a scan interval of four weeks until birth is appropriate. [Grade B] Maternity providers should ensure that they clearly identify the reference charts to plot SFH, individual biometry and estimated fetal weight (EFW) measurements to calculate centiles. For individual biometry measurements the method used for measurement should be the same as those used in the development of the individual biometry and fetal growth chart [Grade GPP]. For EFW the Hadlock three parameter model should be used. [Grade C] Maternity providers should ensure that they have guidance that promotes the use of standard planes of acquisition and calliper placement when performing ultrasound scanning for fetal growth assessment. Quality control of images and measurements should be undertaken. [Grade C] Ultrasound biometry should be carried out every 2 weeks in fetuses identified to be SGA [Grade C]. Umbilical artery Doppler is the primary surveillance tool and should be carried out at the point of diagnosis of SGA and during follow‐up as a minimum every 2 weeks. [Grade B] In fetuses with an EFW between the 3rd and 10th centile, other features must be present for birth to be recommended prior to 39+0 weeks, either maternal (maternal medical conditions or concerns regarding fetal movements) or fetal compromise (a diagnosis of FGR based on Doppler assessment, fetal growth velocity or a concern on cardiotocography [CTG]) [Grade C]. For fetuses with an EFW or abdominal circumference less than the 10th centile where FGR has been excluded, birth or the initiation of induction of labour should be considered at 39+0 weeks after discussion with the woman and her partner/family/support network. Birth should occur by 39+6 weeks. [Grade B] Pregnancies with early FGR (prior to 32+0 weeks) should be monitored and managed with input from tertiary level units with the highest level neonatal care. Care should be multidisciplinary by neonatology and obstetricians with fetal medicine expertise, particularly when extremely preterm (before 28 weeks) [Grade GPP]. Fetal biometry in FGR should be repeated every 2 weeks [Grade B]. Assessment of fetal wellbeing can include multiple modalities but must include computerised CTG and/or ductus venous. [Grade B] In pregnancies with late FGR, birth should be initiated from 37+0 weeks to be completed by 37+6 weeks [Grade A]. Decisions for birth should be based on fetal wellbeing assessments or maternal indication. [Grade GPP]

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Pregnancy outcomes in women with active anorexia nervosa: a systematic review

Cited by 6 publications

References 61 publications

Maternal Eating Disorders and Adverse Birth Outcomes: A Systematic Review and Meta-Analysis

Maternal Eating Disorders and Adverse Birth Outcomes: A Systematic Review and Meta-Analysis

In Underweight Women, Insufficient Gestational Weight Gain Is Associated with Adverse Obstetric Outcomes

Investigation and Care of a Small‐for‐Gestational‐Age Fetus and a Growth Restricted Fetus (Green‐top Guideline No. 31)

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