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Maternal anorexia nervosa is associated with low infant birthweight due to common risk factors like low pre-pregnancy body mass index and nutrient deficiencies. Studies have found that women with a history of anorexia have significantly lower pre-pregnancy BMI and their infants have significantly lower birthweights compared to other groups. Low pre-pregnancy weight and poor nutritional status in anorexic women can potentially harm fetal development and increase the risk of delivering a low birthweight baby.
Maternal anorexia nervosa is associated with low infant birthweight due to common risk factors like low pre-pregnancy body mass index and nutrient deficiencies. Studies have found that women with a history of anorexia have significantly lower pre-pregnancy BMI and their infants have significantly lower birthweights compared to other groups. Low pre-pregnancy weight and poor nutritional status in anorexic women can potentially harm fetal development and increase the risk of delivering a low birthweight baby.
Maternal anorexia nervosa is associated with low infant birthweight due to common risk factors like low pre-pregnancy body mass index and nutrient deficiencies. Studies have found that women with a history of anorexia have significantly lower pre-pregnancy BMI and their infants have significantly lower birthweights compared to other groups. Low pre-pregnancy weight and poor nutritional status in anorexic women can potentially harm fetal development and increase the risk of delivering a low birthweight baby.
Nervosa and Low Infant Birthweight Brenna Alvarez Cal Poly, San Luis Obispo
Department of Food Science & Nutrition
FSN 310, Section 01, Maternal & Child Nutrition Professor Hughes
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Association Between Maternal Anorexia Nervosa And Low Infant Birthweight High levels of body image distortion produced by todays society and beauty standards have taken a heavy toll on young womens health. Some women will resort to starving themselves due to their distorted body image, which can lead to an eating disorder called anorexia nervosa. Anorexia nervosa is a serious and life threatening eating disorder depicted by fear of gaining weight and extremely low food consumption. Eating disorders are prevalent in many women of childbearing age. One in twenty women deal with a maternal eating disorder during pregnancy (Linna, et al. 2014). These women fear weight gain and greatly desire to maintain a thin body. They accomplish this through restrictive eating, excessive exercise, and sometimes even laxative abuse to lose weight. This behavior in turn produces detrimental consequences associated with the health and development of the fetus. Pregnancy requires women to be physically and emotionally strong, and those with anorexia nervosa (AN) tend to struggle with the fact that their body is going to change during pregnancy. This may cause them to continue to restrict their calorie intake and unintentionally harm their fetus. Maternal AN is strongly associated with low infant birthweight due to common risk factors involving low prepregnancy body mass index (BMI) and nutrient deficiencies. Low pre-pregnancy BMI in women who struggle with AN or who have had a history of AN can lead to low infant birthweight. They may also face other serious complications during their pregnancy and delivery. These serious complications are linked with low pre-pregnancy BMI. Adverse outcomes include premature births, low birth weight infants, and miscarriages. A study published in 2007 in the British Journal of Psychiatry called the Avon Longitudinal Study of Parents and Children (ALSPAC) focuses on specific perinatal outcomes affected by a history
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of eating disorders. Previous studies only looked at the harmful effect that eating disorders and their symptoms have on pregnancy, but this study focused on other possible mediators of effect including pre-pregnancy BMI. It was more in depth by taking into account the role of other covariates that also lead to adverse perinatal outcomes in women with a history of AN, thus resulting in stronger data. At twelve weeks gestation, a majority white British women were asked if they had any past AN, bulimia nervosa, or other psychiatric disorders through a series of postal questionnaires. Data collected from the ALSPAC study indicate women with a history of AN have significantly lower pre-pregnancy BMI compared to the other groups. The data also showed the mean infant birth weights for women who had AN were significantly lower. From the results, the ALSPAC study concluded low maternal weight pre-pregnancy or at delivery has the greatest impact on birth weight (Micali, et al. 2007). Other studies have also found that low pre-pregnancy weight in anorexic women is a main cause of low birthweight babies. A study published in 2014 in the American Journal of Obstetrics & Gynecology titled Pregnancy, Obstetric, and Perinatal Health Outcomes in Eating Disorders tried to identify the prevalence of low infant birthweight and SGA (small for gestational age) babies in women with eating disorders compared to an unexposed group of individuals. In previous studies, the subjects included women who have or previously had AN, but there was no information collected on whether they had been treated which can lead to inconclusive evidence. This study focuses on women with an eating disorder who were treated at a hospital during the years of 1995-2010. They hypothesized that women with maternal AN have a higher risk of perinatal complications, including low infant birthweight, related to malnourishment (Linna, et al. 2014).
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Community-based information on perinatal health complications was obtained for singleton births among four groups: AN, bulimia nervosa, binge eating disorder, and unexposed women. All groups were screened for low infant birthweight and SGA, including other health complications immediately before or after birth. The data was adjusted by maternal age, parity, and marital status. The results showed women with anorexia were more likely to be divorced, develop anemia, have slow fetal growth, have the shortest first stage of labor, have the lowest gestational age, have an increased risk of premature birth, and have lower birthweight babies compared to unexposed women. According to the study, low prepregnancy BMI and small weight gain have been associated extensively with infant low birthweight [because] AN is associated with restrictive eating, elevated levels of stress, and low bodyweight (Linna, 2014). Any woman who is pregnant, whether they are anorexic or not, will deal with stress, have increased body image disparities, and be emotionally and physically exhausted. Anorexia during pregnancy can make these symptoms ten times worse. (Linna, et al. 2014). In the systematic review of literature Low Birth Weight in the Offspring of Women With Anorexia Nervosa published in Epidemiologic Reviews in 2014, fourteen different studies on maternal anorexia and infant birthweight were assessed. The study calculated the accuracy of the hypothesis that babies born to AN women weigh less than babies born to unexposed women of healthy weight. The protocol they developed included a search procedure, inclusion and exclusion criteria, and a data analysis strategy. A random-effects model and confidence intervals were used to plot and analyze data. Around three hundred studies were identified and the fourteen studies selected compared the mean birth weights of babies born to anorexic women with the weight of babies born to women without anorexia. The studies were completed between 1987 and 2012. Of the fourteen studies selected, only nine studied the relationship between
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anorexia and infant birth weight without including other eating disorders. All studies showed a positive relationship between maternal anorexia and low birth weight. After analyzing the data in each study, only nine were included in the meta-analysis because they were the only studies that compared exposed groups with active AN to truly unexposed groups (Solmi, et al. 2014). Systematic reviews of literature like this one with large population-based samples help to increase our knowledge of the associations between maternal anorexia and low birth weight. Knowledge of eating disorders and their affect on pregnancy has enhanced within the past ten years. This review includes the first meta-analysis conducted on this field of study between anorexia and its harmful affects on pregnancy. Because of this, it can be of helpful use for future studies on this topic. Each study that was reviewed proved the hypothesis that the risk of delivering babies of low birth weight is more prevalent in mothers with AN. This review is successful because the studies were performed on community-based samples, and this reduces bias. In addition it could be a great source to help educate the community of the adverse pregnancy complications associated with maternal anorexia and to help prevent AN mothers with low BMI from having low birth weight babies. The findings suggest that low BMI in women with past or active anorexia is a risk factor for low infant birth weights, which supports the claim that maternal AN is associated with low infant birth weight (Solmi, et al. 2014). Self-imposed restrictive diets in women with AN result in poor nutritional status which is another risk factor for low infant birthweight. Anorexic women tend to starve themselves due to their weight obsession, and this can lead to nutritional deficiencies. Having low nutritional stores during pregnancy can potentially harm the fetus because fetal development depends on the nutritional intake of the mother. Anorexias course of illness and complications with pregnancy are described in a review titled Anorexia Nervosa: Definition, Epidemiology, and Cycle of
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Risk published in the International Journal of Eating Disorders in 2005. The published paper reviews multiple studies that focus on the patterns, causes, and effects of AN. It also highlights the adverse obstetric outcomes associated with AN. The reviewed studies indicate the prevalence of low BMI among anorexic women and their tendency for being nutritionally deficient. The researchers predicted low BMI was caused by the mothers food restriction, obsessive weight control, and the psychiatric maintenance of their comfort zone with body weight. Low BMI makes them more susceptible to having nutritional deficiencies that lead to low birthweight babies. Anorexic women with low BMI may have decreased plasma volume that in turn reduces the transfer of nutrients from mother to fetus. Deficiencies found from these studies include vitamin C, vitamin A and folate. Proper weight gain before pregnancy is vital in order to increase pre-pregnancy BMI and nutritional stores for the baby to receive enough nutrients for healthy development and proper weight gain (Bulik, et al. 2005). Low pre-pregnancy BMI and nutrient deficiencies in pregnant women with AN are strongly associated with the birth of underweight babies. Although it is common for women with anorexia to have lower chances in getting pregnant, it is still possible and the consequences can be life threatening. If the mother does not try to gain a healthy amount of weight and ensure adequate nutritional intake, the risk for having a low birthweight baby increases. Babies of low birthweight have an increased risk for developing AN or another chronic disease later on in life and an increased mortality rate during their first year of life. Because AN is also a psychological disorder, psychological treatment is just as important as physical treatment. Counseling may be necessary in order to produce a healthier state of mind. It is important for anorexic women to improve the health of both their mind and body before they get pregnant. Once this has been accomplished, they can then be ready to invest time caring for both themselves and their baby.
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References Bulik, C., Reba, L., Siega-Riz, A., Kjennerud, T. (2005). Anorexia Nervosa: Definition, Epidemiology, and Cycle of Risk. International Journal of Eating Disorders, 37: S2-S9. doi: 10.1002/eat.20107 Linna M., Raevuori, A., Haukka, J., Suvisaari, J., Suokas, J., & Gissler, M. (2014). Pregnancy, Obstetric, and Perinatal Health Outcomes in Eating Disorders. American Journal of Obstetrics and Gynecology, 211: 392.e1-392.e8. doi: 10.1016/j.ajog.2014.03.067 Micali, N., Simonoff, E., & Treasure, J. (2007). Risk of major adverse perinatal outcomes in women with eating disorders. British Journal of Psychiatry, 190: 255-259. doi: 10.1192/bjp.bp.106.020768 Solmi, F., Hannah, S., Stahl, D., Treasure, J., & Micali, N. (2014). Low Birth Weight in the Offspring of Women With Anorexia Nervosa. Epidemiologic Reviews, 36: 49-56. doi: 10.1093/epirev/mxt004
Public Health Needs Assessment Profile and Health Promotion Proposal by Theresa Lowry Lehnen Specialist Nurse Practitioner in Conjunction With Surrey University 2005