Reproductive Issues in Anorexia Nervosa

Elizabeth R Hoffman; Stephanie C Zerwas; Cynthia M Bulik


Expert Rev of Obstet Gynecol. 2011;6(4):403-414. 

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Expert Commentary

In summary, increased attention paid to reproductive outcomes in women with anorexia nervosa in recent years has vast implications for clinical practice and future research: from increased attention to contraceptive use and the prevention of adverse birth outcomes in these women to fostering a greater understanding of maternal–fetal relationships that may increase transgenerational transmission of eating disorders. More attentive and intensive preconception counseling for women with anorexia nervosa is essential. Not only should women with anorexia nervosa be aware of the risk of becoming pregnant despite menstrual irregularities, but they should also be well-informed of the nutritional demands of pregnancy and the potentially adverse consequences of inadequate gestational weight gain and continuation of eating disorder behaviors during pregnancy. Pregnancy in women with anorexia nervosa can create a unique therapeutic window where eating disorder symptoms remit and weight gain is viewed as acceptable. Future studies may provide more insight into potential methods to help maintain the improved eating habits developed during pregnancy and prevent the intense relapse in eating disorder symptoms that occurs postpartum in many women with current and past anorexia nervosa.

While reports of adverse birth outcomes in women with anorexia nervosa appear to be related to inadequate gestational weight gain, we know very little about the nutritional status of women with anorexia nervosa at conception, during pregnancy and in the postpartum period. Future study of potential mechanisms through which maternal nutrition status in women with anorexia nervosa could impact fetal development will be a critical step in understanding the cross-generational transmission of eating disorders and weight regulation.


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