Antenatal and Postnatal Psychopathology Among Women with Current and Past Eating Disorders: Longitudinal Patterns (original) (raw)
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European Psychiatry, 2011
Background: This study investigated the effect of past depression, past and current eating disorders (ED) on perinatal anxiety and depression in a large general population cohort of pregnant women, the Avon Longitudinal Study of Parents and Children (ALSPAC). Methods: Anxiety and depression were measured during and after pregnancy in 10,887 women using the Crown-Crisp Experiential Inventory and Edinburgh Postnatal Depression Scale. Women were grouped according to depression and ED history: past ED with (n = 123) and without past depression (n = 50), pregnancy ED symptoms with (n = 77) and without past depression (n = 159), past depression only (n = 818) and controls (n = 9,660). We compared the course of depression and anxiety with linear mixed-effect regression models; and probable depressive and anxiety disorders using logistic regression. Results: Women with both past depression and past/current ED had high anxiety and depression across time perinatally; this was most marked in the group with pregnancy ED symptoms and past depression (b coefficient:5.1 (95% CI: 4.1-6.1), p b 0.0001), especially at 8 months post-partum. At 18 weeks in pregnancy all women (apart from those with past ED only) had a higher risk for a probable depressive and anxiety disorder compared to controls. At 8 months post-partum pregnancy ED symptoms and/or past depression conferred the highest risk for a probable depressive and anxiety disorder. Limitations: Data were based on self-report. There was some selective attrition. Conclusions: Pregnancy ED symptoms and past depression have an additive effect in increasing the risk for depression and anxiety perinatally. Screening at risk women for anxiety and depression in the perinatal period might be beneficial.
Journal of Affective Disorders, 2011
Background: This study investigated the effect of past depression, past and current eating disorders (ED) on perinatal anxiety and depression in a large general population cohort of pregnant women, the Avon Longitudinal Study of Parents and Children (ALSPAC). Methods: Anxiety and depression were measured during and after pregnancy in 10,887 women using the Crown-Crisp Experiential Inventory and Edinburgh Postnatal Depression Scale. Women were grouped according to depression and ED history: past ED with (n = 123) and without past depression (n = 50), pregnancy ED symptoms with (n = 77) and without past depression (n = 159), past depression only (n = 818) and controls (n = 9,660). We compared the course of depression and anxiety with linear mixed-effect regression models; and probable depressive and anxiety disorders using logistic regression. Results: Women with both past depression and past/current ED had high anxiety and depression across time perinatally; this was most marked in the group with pregnancy ED symptoms and past depression (b coefficient:5.1 (95% CI: 4.1-6.1), p b 0.0001), especially at 8 months post-partum. At 18 weeks in pregnancy all women (apart from those with past ED only) had a higher risk for a probable depressive and anxiety disorder compared to controls. At 8 months post-partum pregnancy ED symptoms and/or past depression conferred the highest risk for a probable depressive and anxiety disorder. Limitations: Data were based on self-report. There was some selective attrition. Conclusions: Pregnancy ED symptoms and past depression have an additive effect in increasing the risk for depression and anxiety perinatally. Screening at risk women for anxiety and depression in the perinatal period might be beneficial.
Journal of Psychosomatic Research, 2007
Objective: To determine the impact of pregnancy on eating disorders (ED) symptoms using data from a large prospective, community-based cohort study. Methods: Women (12,254) were classified according to whether they had a recent or past history of ED, were obese before pregnancy, or constituted part of the general population control group. We evaluated self-induced vomiting (SIV), laxative use, exercise behavior, and appraisals about weight gain during pregnancy, as well as dieting, and shape and weight concern before and during pregnancy. Results: Women with a recent episode of ED dieted, used laxatives, reported SIV, and exercised more than other groups during pregnancy. They were also more likely to report ED cognitions in pregnancy and their weight and shape concern scores remained high during pregnancy. Women with past ED were also more likely than controls to have some ED behaviors and/ or concerns about weight gain during pregnancy. Conclusions: Women with a recent ED continued to have some ED symptoms in pregnancy, albeit fewer compared to before pregnancy. Although at a lower level, women with a past history of ED also had ED symptoms in pregnancy. Screening for ED symptoms during pregnancy may provide a useful opportunity for engagement in treatment and to reduce behaviors that might be detrimental to the foetus. D
Pregnancy, obstetric, and perinatal health outcomes in eating disorders
American Journal of Obstetrics and Gynecology, 2014
Authors JTS and JMS have been involved in a research collaboration with Janssen-Cilag. Author JTS has received fees for giving expert opinions to Lightlake Sinclair and attended one international conference supported by Janssen-Cilag. Author JMS has received a lecturing fee from AstraZeneca. Author JH has been in research collaboration with Janssen-Cilag and Eli Lilly, and has been a member of the expert advisory group for Astellas. Author AR attended a medical seminar supported by Janssen-Cilag. Authors ML and MG have no conflicts of interest to report.
Journal of Womens Health, 2008
This paper examines the areas of psychological and physiological concern when working with patients who have eating disorders as they move through the postpartum period. These concerns include infant feeding, maternal-child bonding, and postpartum adjustment. The combination of psychological stressors of new motherhood and body image concerns intensified by the residual bodily changes of pregnancy may predispose women to have an exacerbation in eating disordered symptoms as well as the development of postpartum mood disorders. Depression can lead mothers to be nonresponsive, inconsistent, or rejecting of the infant, placing the mother-baby attachment at risk. The added existence of an eating disorder compounds these risks, with medical and psychological risks becoming increasingly apparent. Healthcare providers (e.g., primary care physician, obstetric provider) are more likely to have contact with women during the postpartum period, making such providers instrumental in the screening and referral process. A multidisciplinary approach is recommended for treating eating disorders and related conditions. Unfortunately, there is little information about the efficacy and appropriateness of standard eating disorder treatments for women in the postpartum period. In addition to reviewing the literature, guidance is offered on how to assess and treat patients with eating disorders in general as well as considerations specific to the postpartum period.
Eating disorder symptoms pre- and postpartum
Archives of Women's Mental Health, 2016
The study aimed to investigate symptoms of disordered eating pre-and postpartum using a standardised and widely used measure of eating disorder (ED) psychopathology. A consecutive series of women attending either prenatal (N = 426) or postnatal (N = 345) clinics in metropolitan Stockholm were assessed using the Eating Disorder Examination Questionnaire (EDE-Q). Assessments were conducted at either the first visit to prenatal clinics (10-12 weeks of pregnancy) or 6 to 8 months postpartum. An optimised shortened version of the EDE-Q was best suited for studying eating disorders pre-and postpartum. Using the optimised version of the instrument with 14 items and a cutoff score of ≥2.8, it was estimated that 5.3 % of prepartum and 12.8 % of postpartum mothers were suffering from clinical eating disorders. Seriously disordered eating behaviour during, and especially after, pregnancy may be more common than previously thought. It is imperative that health services focus increased attention on these problems by raising awareness, developing and extending specialist services, as well as through implementing educational programmes and training directed toward frontline healthcare services.
Obstetric and Perinatal Outcomes in Women with Eating Disorders
Journal of Women's Health, 2012
Background: We wished to investigate whether women with a history of eating disorders have an increased risk for adverse obstetric and perinatal outcomes. Study design: A retrospective study was conducted comparing pregnancy complications in patients with and without eating disorders. Deliveries occurred during the years 1988-2009 in a tertiary medical center. Women lacking prenatal care and with multiple gestations were excluded from the study. Stratified analyses were performed using multivariable logistic regression models. Odds ratios (OR) and their 95% confidence interval (CI) were computed. A p value < 0.05 was considered statistically significant. Results: During the study period, of 117,875 singleton deliveries, 122 (0.1%) occurred in patients with eating disorders. Eating disorders were significantly associated with fertility treatments (5.7% vs. 2.8%, p = 0.047), intrauterine growth restriction (7.4% vs. 2.3%, p < 0.001), term low birth weight ( < 2500g) (7.4% vs. 2.8%, p = 0.002), preterm delivery (15.6% vs. 7.5%, p = 0.002), and cesarean delivery (25.4% vs. 15.0%, p = 0.001). Using multivariable analyses, low birth weight (OR 2.5, 95% CI 1.3-5.0), preterm delivery (OR 2.2, 95% CI 1.4-3.6), and cesarean section (OR 1.9, 95% CI 1.3-2.9) were significantly associated with eating disorders. Conclusions: Eating disorders are associated with increased risk of adverse pregnancy outcomes. Accordingly, careful surveillance is needed for early detection of possible complications.
Gestational and Postpartum Weight Change Patterns in Mothers with Eating Disorders
European Eating Disorders Review, 2014
Background-Although pregnancy can be associated with adaptive changes in weight and eating behavior for women with eating disorders, less is known about whether these changes are maintained in the postpartum period. We used a longitudinal design to examine gestational and postpartum weight trajectories in mothers with and without eating disorders in the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health. Methods-Fifty-six women reported anorexia nervosa (AN), 636 bulimia nervosa (BN), 3,327 binge eating disorder (BED), and 69 EDNOS purging type (EDNOS-P). The referent group included 61,233 mothers with no eating disorder. We used a mixed effects model to predict weight change over time by eating disorder subtype.
Recognising the Symptoms: How Common Are Eating Disorders in Pregnancy?
European Eating Disorders Review, 2013
Objectives: This study aimed to investigate eating disorder diagnostic status and related symptoms in early pregnancy. Methods: Pregnant women (n=739), attending their first routine antenatal scan, were assessed using an adapted version of the Eating Disorder Diagnostic Scale (EDDS). Prevalence estimates and eating disorder symptoms were assessed during the first 3 months of pregnancy and, retrospectively, in the 6 to 12 months prior to pregnancy. Results: During pregnancy 7.5% of women met diagnostic criteria for an eating disorder, compared to prepregnancy prevalence of 9.2%. Approximately one quarter (23.4%) of women reported high weight and shape concern during pregnancy; binge eating was endorsed by 8.8%, and 2.3% of women engaged in regular compensatory behaviours. Conclusions: Eating disorders are more common than previously thought in pregnancy. There is a clinical need for increased understanding of eating disorder symptomatology during pregnancy and for appropriate screening tools to be incorporated into antenatal care.
The effects of eating disorders in pregnancy on mother and baby: a review
Psychiatria Danubina, 2019
The psychological and physiological interaction between anorexia and the pregnant state has a large intrapartum and postpartum impact on mother and baby. Current research has attempted to discern the short and long term effects of eating disorders (EDs) on pregnancy as well as mother and baby-related sequelae; however little is understood about which management strategies are likely to prove most successful in mitigating these risks. The incidence and effect of low pre-pregnancy body mass index (BMI) on obstetric outcomes, and possible health complications in the future child, has attracted widespread attention. Especially concerning is the fact that it has long been known that the incidence of EDs in women of childbearing age is not only the highest out of all age categories but also is on an increasing trajectory. This paper aims to highlight the recent evidence underpinning the management of pregnant women with EDs in the light of the discussed short and long term effects of the ...