Nearly 30 million Americans have had an eating disorder, which can cause them lifetimes of emotional and physical pain. Eating disorders affect people of all ages, races, and socioeconomic statuses—but women, especially those in their reproductive years, are at the greatest risk.
Although it's bad enough that women face underserved mental and physical health problems as a result of eating disorders, there’s been little research on the impact eating disorders can have on pregnancy and birth outcomes. According to new findings published Wednesday in JAMA Psychiatry, women with eating disorders are much more likely to experience either preterm birth or serious prenatal complications.
"Eating disorders are already stigmatized diseases, and to not recognize associated risks does not help these patients. I hope that our study can help acknowledging women with or at risk for [an] eating disorder, which can lead to optimized care to prevent pregnancy-related complications,” the study’s lead researcher, Ängla Mantel, a clinical epidemiologist at the Karolinsk Hospital and Institute, told VICE.
Researchers examined 1,236,777 births that took place between 2003 and 2014. 7,542 of the mothers had an eating disorder, and 1,225,321 did not. Those with eating disorders during their pregnancies had twice as great a chance of experiencing hyperemesis gravidarum—severe, persistent vomiting during pregnancy. The risk of anemia—a lack of healthy red blood cells often due to iron-deficiency—doubled for people with anorexia or an unspecified eating disorder (EDNOS). People with maternal anorexia had a 60 percent higher chance of antepartum hemorrhage, a serious complication that involves third-trimester bleeding in the genital tract. The one factor that seemed to influence the results in a meaningful way was whether the women had additional psychiatric disorders—but the other factors (smoking, age, etc. listed below) didn't have an impact, really.
All maternal eating disorders, including EDNOS, were associated with an increased risk of preterm birth; those with anorexia faced double the risk of the general population. Microcephaly—a neurological condition in which an infant’s head is smaller than usual—was three times more common for women with anorexia, 60 percent higher for those with bulimia, and 40 percent greater for those with EDNOS.
Complications were most prevalent in people who had an active eating disorder during pregnancy or around the time of conception, but those who had an eating disorder over a year prior to conception also faced heightened risks—people with inactive anorexia had bleeding complications during pregnancy at 1.5 times the rate of people who never had an eating disorder.
Many pregnant people with eating disorders don’t get the medical attention they need, often due to a lack of screening or clinical routines in place. The researchers hope their findings will encourage healthcare providers to recognize pregnant people with eating disorders as a high-risk group—and to offer them more accurate information on their health, writ large.
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