Pregnancy Complications More Likely in Women with Anorexia Nervosa: finds Study

The study analyzed data from California live-born singletons between 2007 and 2021, using birth certificates and linked hospital discharge records to identify pregnancies with anorexia nervosa via ICD codes. It assessed a range of adverse pregnancy outcomes, including gestational diabetes, preeclampsia, and preterm birth, using Poisson regression models to calculate risks. These risks were first analyzed unadjusted, then adjusted for demographic factors, and further refined to account for anxiety, depression, substance use, and smoking. Mediation analysis was conducted to determine how much of the risk was influenced by underweight pre-pregnancy BMI and inadequate gestational weight gain.

The study led to the following findings:

• The sample included 241 pregnant people with a diagnosis of anorexia nervosa and 6,418,236 pregnant people without an eating disorder diagnosis.
• A diagnosis of anorexia nervosa during pregnancy was associated with many adverse pregnancy outcomes in unadjusted models (relative risks ranged from 1.65 [preeclampsia] to 3.56 [antepartum hemorrhage]) in comparison with people without an eating disorder diagnosis.
• In the final adjusted models, birthing people with an anorexia nervosa diagnosis were more likely to have anemia, preterm labor, oligohydramnios, severe maternal morbidity, a small for gestational age or low-birthweight infant, and preterm birth between 32 and 36 weeks with spontaneous preterm labor (adjusted relative risks ranged from 1.43 to 2.55).
• Underweight prepregnancy body mass index mediated 7.78% of the excess in preterm births and 18.00% of the excess in small for gestational-age infants.
• Gestational weight gain below the recommendation mediated 38.89% of the excess in preterm births and 40.44% of the excess in low-birthweight infants.

"The findings are crucial for clinicians managing patients with anorexia nervosa. Addressing anorexia nervosa along with any comorbid conditions and providing guidance on preconception weight and gestational weight gain can potentially enhance pregnancy outcomes for individuals with this disorder," the researchers concluded.

Reference:

Baer, R. J., Bandoli, G., Jelliffe-Pawlowski, L. L., Rhee, K. E., & Chambers, C. D. (2024). Adverse live-born pregnancy outcomes among pregnant people with anorexia nervosa. American Journal of Obstetrics and Gynecology, 231(2), 248.e1-248.e14. https://doi.org/10.1016/j.ajog.2023.11.1242