Women with lifetime anorexia and bulimia were investigated against a general population of women to assess the impact of their eating disorder.
The study looked at 11,088 women from the Avon Longitudinal Study of Parents and Children (ALSPAC). Women were asked to complete questionnaires at 12 and 18 weeks gestation.
Of the total number of women, 171 (1.5%) had anorexia at some point in their life, 199 (1.8%) had bulimia and an additional 82 (0.7%) had suffered from both conditions. The remaining 10,636 (96%) formed the general population comparison group.
A higher proportion of women (39.5%) with a history of anorexia and bulimia took longer than six months to conceive compared to the general population (25%). However, they were no more likely to take longer than 12 months to conceive than the general population.
The study found that women with anorexia and bulimia were more than twice as likely (6.2%) than the general population (2.7%) to have received treatment or help to conceive their current pregnancy.
However, when asked at 18 weeks gestation, women with anorexia were more likely to report that their current pregnancy was unintentional. In this group of women 41.5% said their pregnancy was unplanned compared to 28.6% of women in the general population. Compared with this finding, women with anorexia and bulimia were more than twice as likely to consider that ‘motherhood means personal sacrifice’ (adjusted odds ratio 23, 95% CI 1.3-4.1).
The majority of women reported feeling overjoyed/pleased when they discovered that they were pregnant (71%). However, eating disorders were linked to negative feelings about pregnancy. Further analysis has shown that women with anorexia and bulimia were more than twice as likely (9.8%) than the general population (3.8%) to report feeling unhappy when they found out they were pregnant.
Lead author, Abigail Easter, Institute of Psychiatry, King’s College London, said:
“This research highlights that there are risks to fertility associated with eating disorders. However, the high rates of unplanned pregnancies in women with a history of anorexia suggest that women may be underestimating their chances of conceiving.
“Pregnancy can be a difficult time for women with eating disorders and this is the first time feelings about pregnancy have been looked at amongst this group of women.
“Women planning a pregnancy should ideally seek treatment for their eating disorder symptoms prior to conception and health professionals should be aware of eating disorders when assessing fertility and providing treatment for this.”
Dr Nadia Micali, Institute of Child Health, UCL and lead investigator added:
“Health professionals are often unaware of the effects of eating disorders on pregnancy and fertility. Women with a history of anorexia for example are more likely to have unplanned pregnancies. This has now been replicated in three large studies and has important repercussions on the level of antenatal and postnatal care they will need.”
Professor Philip Steer, BJOG editor-in-chief said:
“Eating disorders have important clinical consequences, especially in women. This research shows that more women with eating disorders are unprepared for pregnancy and will therefore require more support during the antenatal and postnatal period.”
For interviews with the authors please contact Seil Collins, Press Officer, Institute of Psychiatry, King’s College London: firstname.lastname@example.org, 020 7848 5377
For more information about BJOG please contact Naomi Weston, PR Officer, Royal College of Obstetricians and Gynaecologists: email@example.com, 020 7772 6357
For case studies please contact Mary George at the eating disorders charity Beat on 07804 589404.
BJOG: An International Journal of Obstetrics and Gynaecology is owned by the Royal College of Obstetricians and Gynaecologists (RCOG) but is editorially independent and published monthly by Wiley-Blackwell. The journal features original, peer-reviewed, high-quality medical research in all areas of obstetrics and gynaecology worldwide. Please quote ‘BJOG' or ‘BJOG: An International Journal of Obstetrics and Gynaecology' when referring to the journal and include the website: www.bjog.org as a hidden link online.
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Easter A, Treasure J, Micali N. Fertility and prenatal attitudes towards pregnancy in women with eating disorders: results from the Avon Longitudinal Study of Parents and Children. BJOG 2011; DOI: 10.1111/j.1471-0528.2011.03077.x.