References

Bulik CM, Von Holle A, Siega-Riz AM Birth outcomes in women with eating disorders in the Norwegian Mother and Child cohort study (MoBa). Int J Eat Disord. 2009; 42:(1)9-18 https://doi.org/10.1002/eat.20578

Eating Disorders during Pregnancy and Motherhood. 2018. http://www.eatingdisordersandpregnancy.co.uk/project/eating-disorders-pregnancy-motherhood/ (accessed 1 February 2019)

Bye A, Shawe J, Bick D, Easter A, Kash-Macdonald M, Micali N. Barriers to identifying eating disorders in pregnancy and in the postnatal period: a qualitative approach. BMC Pregnancy Childbirth. 2018a; 18:(1) https://doi.org/10.1186/s12884-018-1745-x

Bye A, Mackintosh N, Sandall J, Easter A, Walker M. Supporting women with eating disorders during pregnancy and the postnatal period. Journal of Health Visiting. 2018b; 6:(5)224-228 https://doi.org/10.12968/johv.2018.6.5.224

Cantrell C, Kelley T, McDermott T. Midwifery management of the woman with an eating disorder in the antepartum period. J Midwifery Womens Health. 2009; 54:(6)503-508 https://doi.org/10.1016/j.jmwh.2009.09.006

Cook SMC, Cameron ST. Social issues of teenage pregnancy. Obstetrics, Gynaecology and Reproductive Medicine. 2017; 27:(11)327-332 https://doi.org/10.1016/j.ogrm.2017.08.005

Crow SJ, Agras WS, Crosby R, Halmi K, Mitchell JE. Eating disorder symptoms in pregnancy: A prospective study. Int J Eat Disord. 2008; 41:(3)277-9 https://doi.org/10.1002/eat.20496

Fogarty S, Elmir R, Hay P, Schmied V. The experience of women with an eating disorder in the perinatal period; A meta-ethnographic study. BMC Pregnancy Childbirth. 2018; 18:(1) https://doi.org/10.1186/s12884-018-1762-9

Franko DL, Blais MA, Becker AE Pregnancy complications and neonatal outcomes in women with eating disorders. Am J Psychiatry. 2001; 158:(9)1461-1466

Harris AA. Practical advice for caring for women with eating disorders during the perinatal period. J Midwifery Womens Health. 2010; 55:(6)579-586 https://doi.org/10.1016/j.jmwh.2010.07.008

Kimmel MC, Ferguson EH, Zerwas S, Bulik CM, Meltzer-Brody S. Obstetric and gynecologic problems associated with eating disorders. Int J Eat Disord. 2016; 49:(3)260-275 https://doi.org/10.1002/eat.22483

Krug I, Taborelli E, Sallis H, Treasure J, Micali N. A systematic review of obstetric complications as risk factors for eating disorder and a meta-analysis of delivery method and prematurity. Physiol Behav. 2013; 109:51-62 https://doi.org/10.1016/j.physbeh.2012.11.003

Linna MS, Raevuori A, Haukka J, Suvisaari JM, Suokas JT, Gissler M. Pregnancy, obstetric and perinatal health outcomes in eating disorders. Am J Obstet Gynecol. 2014; 211:(4)392.e1-8 https://doi.org/10.1016/j.ajog.2014.03.067

Little L, Lowkes E. Critical issues in the care of pregnant women with eating disorders and the impact on their children. J Midwifery Womens Health. 2000; 45:(4)301-307 https://doi.org/10.1016/S1526-9523(00)00031-3

Martos-Ordonez C. Pregnancy in women with eating disorders: a review. Br J Midwifery. 2005; 13:(7)446-448 https://doi.org/10.12968/bjom.2005.13.7.18372

Micali N, Treasure J, Simonoff E. Eating disorders symptoms in pregnancy: A longitudinal study of women with recent and past eating disorders and obesity. J Psychosom Res. 2007; 63:(3)297-303 https://doi.org/10.1016/j.jpsychores.2007.05.003

Micali N, Stemann Larsen P, Strandberg-Larsen K, Nybo Andersen A-M. Size at birth and preterm birth in women with lifetime eating disorders: a prospective population-based study. BJOG. 2016; 123:(8)1301-1310 https://doi.org/10.1111/1471-0528.13825

Maternal and child nutrition [QS98].London: NICE; 2015

Eating disorders: recognition and treatment treatment [NG69].London: NICE; 2017

Solmi F, Sallis H, Stahl D, Treasure J, Micali N. Low birth weight in the offspring of women with anorexia nervosa. Epidemiol Rev. 2014; 36:(1)49-56 https://doi.org/10.1093/epirev/mxt004

Stanner S. Nutrition pre-conception and during pregnancy, 2nd edn. In: Buttriss JL, Welch AA, Kearney JM, Lanham-New SA (eds). Chichester: John Wiley & Sons; 2018

Stringer E, Tierney SRE, Fox J, Butterfield C, Furber C. Pregnancy, motherhood and eating disorders: A qualitative study describing women's views of maternity care. Evidence Based Midwifery. 2010; 4:(8)112-121

Taborelli E, Easter A, Keefe R, Schmidt U, Treasure J, Micali N. Transition to motherhood in women with eating disorders: A qualitative study. Psychol Psychother. 2016; 89:(3)308-323 https://doi.org/10.1111/papt.12076

The Health Foundation. Actionable research materials on the effects of eating disorders on pregnancy, birth and motherhood. 2018. https://www.health.org.uk/research-projects/recognition-and-response-to-eating-disorders-in-the-perinatal-period (accessed 25 January 2019)

Ward VB. Eating disorders in pregnancy. BMJ. 2008; 336:(7635)93-96 https://doi.org/10.1136/bmj.39393.689595.BE

Watson HJ, Zerwas S, Torgersen L Maternal eating disorders and perinatal outcomes: A three-generation study in the Norwegian Mother and Child Cohort Study. J Abnorm Psychol. 2017; 126:(5)552-564 https://doi.org/10.1037/abn0000241

World Health Organization. Body Mass Index. 2019. http://www.euro.who.int/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi (accessed 25 January 2019)

Wray J, Steen M. Physical health and complications in the puerperium, 16th edn. In: Marshall J, Raynor M (eds). Edinburgh: Churchill Livingstone; 2014

Eating disorders in pregnancy: practical considerations for the midwife

02 March 2019
11 min read
Volume 27 · Issue 3

Abstract

Women who have eating disorders represent up to 8% of pregnant women today. The risks to both a mother and her baby are significant if an eating disorder is present. It is important that midwives have the knowledge, skills and confidence to enquire about eating disorders with women early in the pregnancy, and are also aware of the clinical signs of eating disorders, in order to recognise these situations. Midwives should use sensitive and compassionate communication skills when caring for women who have eating disorders, who have complex psychological feelings that may affect their behaviour. The symptoms of eating disorders may improve during pregnancy but midwives should be aware of the effects of childbirth. The postnatal phase is an important period for a mother who has an eating disorder, as her symptoms may recur, and midwives should therefore work in partnership with key members of the multidisciplinary team.

It is estimated that 5–8% of women may be experiencing an eating disorder in early pregnancy (Micali et al, 2016; Bye et al, 2018a). Eating disorders fall into four main categories: anorexia nervosa, bulimia nervosa, binge eating disorders and other specified feeding or eating disorders (OSFED). Prevalence rates of each are variable, however, and research indicates that there are similar numbers of women with anorexia nervosa, bulimia nervosa and binge eating disorders, with an increased number of those with OSFED (Bye et al, 2018a). Although eating disorders can develop at any age, midwives should be aware that the risk is highest for young men and women aged between 13–17 years (National Institute for Health and Care Excellence (NICE), 2017), and that it may therefore have an effect across a woman's childbearing years.

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