Background: It is a common misconception that women with active anorexia nervosa (AN) are less likely to conceive. Pregnancies in women with AN are considered high risk. The purpose of this systematic review was to explore pregnancy complications in women with active AN, including maternal, fetal, and neonatal complications.
Methods: The authors conducted a systematic review in accordance with PRISMA statement guidelines with stringent selection criteria to include studies on patients with active AN during pregnancy.
Results: There were 21 studies included in our review. Anaemia, caesarean section, concurrent recreational substance use, intrauterine growth restriction, preterm birth, small-for-gestation (SGA) birth, and low birth weight were the most reported pregnancy complications in women with active AN, while the rates of gestational diabetes and postpartum haemorrhage were lower.
Discussion: Women with active AN have a different profile of pregnancy complications comparing to malnourished women and women in starvation. We recommend early discussion with women diagnosed with AN regarding their fertility and pregnancy complications. We recommend clinicians to aim to improve physical and psychological symptoms of AN as well as correction of any nutritional deficiency ideally prior to conception. Management of pregnancies in women with active AN requires regular monitoring, active involvement of obstetricians and psychiatrist. Paediatric follow-up postpartum is recommended to ensure adequate feeding, wellbeing and general health of the infants. Psychiatric follow-up is recommended for mothers due to risk of worsening symptoms of AN during perinatal period.
Keywords: Anorexia nervosa; Fetal; Maternal; Neonatal; Pregnancy; Pregnancy complications; Pregnancy outcomes.
It is a common myth that women with active anorexia nervosa are less likely to become pregnant. Generally, pregnancies in women with active anorexia nervosa are considered high risk. This review looked at pregnancy complications in women with active anorexia nervosa that affect the mothers as well as unborn and newborn babies. There are number of complications reported, most commonly, anaemia, increased chance of birth by C-section, increased risk of substance use in mothers, poor growth of unborn babies, and smaller babies at birth. Mothers with anorexia nervosa are less likely to suffer from pregnancy related diabetes and postpartum haemorrhage. Interestingly, women with active anorexia nervosa tend to have different pregnancy complications comparing to women without adequate nutrition and women in starvation. It is important to mention that although women with anorexia nervosa carry higher risk of complications during pregnancy, the risk can be reduced with the help of obstetricians and psychiatrists. After birth, paediatrician visits can help identify any issue with the baby. Symptoms of anorexia nervosa could potentially get worse after delivering a baby. It is important to continue regular visits to a psychiatrist.
© 2022. The Author(s).