Anorexia Nervosa During

Pregnancy and Fetal

Complications
FSN 310 Papathakis
Mallory Soares

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While it is common for women to worry about their body changing during pregnancy,
women with Anorexia Nervosa have an intense fear of gaining weight. Although once thought to
be rare, eating disorders during pregnancy occur in 1 in 20 women (Linna, Raevuori, Haukka,
Suvisaari, Suokas, Gissler 2014). Women reported attempting to quit their restrictive behaviors
during pregnancy to protect the growing fetus, but said that the negative thoughts about their
body intensified (Tierney, McGlone, Furber 2013). This becomes dangerous as pregnant
women with eating disorders often continue having anxieties about their weight and still engage
in dieting, laxative abuse, over-exercising and/or self-induced vomiting (Tierney, McGlone,
Furber 2013). Adequate nutrition and weight gain are crucial for a successful pregnancy.
Women with Anorexia Nervosa are diagnosed after three consecutive months of
amenorrhea. However, the woman is able to get pregnant in between the episodes when the
hypothalamic-pituitary-gonadal axis becomes reestablished (Cardwell 2013). For this reason,
most of these pregnancies are unplanned (Linna, Raevuori, Haukka, Suvisaari, Suokas, Gissler
2013). The average age of pregnant women with Anorexia Nervosa was 29.4 and they were less
likely to be married compared to unexposed women (Linna, Raevuori, Haukka, Suvisaari,
Suokas, Gissler 2014). The estimated incidence of Anorexia Nervosa during pregnancy is 1%,
however, this is increasing due to cultural drives to be thin (Cardwell 2013). The true incidence
is unknown because many pregnant women with Anorexia Nervosa hide their disorder during
pregnancy (Cardwell 2013).
These women battle with an internal conflict related to fear and guilt associated with their
self-worth and concerns about their childs health. I struggleddealing with the weight gain,
kind of between not liking it and being uncomfortable with it but also knowing that it needed to
happen to have healthy babiesit was kind of a constant struggleit was scary to be out of
control of my bodybut I did want to have a baby, and so I tried very hard to at least gain

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weight (Tierney, McGlone, Furber 2013). Restrictive eating and lack of weight gainor even
weight lossduring pregnancy can have detrimental effects on both the mother and the fetus
(Linna, Raevuori, Haukka, Suvisaari, Suokas, Gissler 2014). Over 50% of the pregnant Anorexia
Nervosa population had anemia, and were deficient in Zinc, B12, and Folate (Cardwell 2013). In
a series of interviews done by Tierney in 2013, all women admitted to unhealthy activities while
pregnant (Tierney, McGlone, Furber 2013). These women were at increased odds of premature
contractions and the elective section rate was higher in women with Anorexia Nervosa than
unexposed women (Linna, Raevuori, Haukka, Suvisaari, Suokas, Gissler 2014). Because stress is
known to induce preterm contractions and labor, the premature contractions these women are
experiencing could be related to their overall increased stress hormone levels (Linna, Raevuori,
Haukka, Suvisaari, Suokas, Gissler 2014). Women with Anorexia Nervosa during pregnancy are
at increased risk of miscarriage, pre-eclampsia, cesarean section, and post-partum depression
(Tierney, McGlone, Furber 2013). These women are also at higher risk for intrauterine growth
restriction, spontaneous abortion, and pre-term birth (Solmi, Sallis, Stahl, Treasure, Micali 2013).
Severe calorie and protein restriction may be related to the intrauterine growth restriction of the
fetus (Cardwell 2013).
There was a four-fold risk of perinatal death in women with Anorexia Nervosa when
compared to unexposed women (Linna, Raevuori, Haukka, Suvisaari, Suokas, Gissler 2014).
Fetal complications associated with Anorexia Nervosa during pregnancy include: slow fetal
growth, low birth weight babies, SGA infants, premature birth, congenital malformations, and
perinatal death (Linna, Raevuori, Haukka, Suvisaari, Suokas, Gissler 2014). These complications
could be caused by the womans low pregnancy BMI, small weight gain during pregnancy, and
fetal exposure to high Cortisol levels (Linna, Raevuori, Haukka, Suvisaari, Suokas, Gissler
2014). Low Folate and Iron intake increase the womans risk of delivering a SGA infant (Linna,

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Raevuori, Haukka, Suvisaari, Suokas, Gissler 2014). In utero nutritional deficiencies are
recognized as factors associated with developmental delays of infants and children (Cardwell
2013). Women with Anorexia Nervosa are at higher risk of delivering low birth weight babies
because of their low maternal pre-pregnancy weight (Solmi, Sallis, Stahl, Treasure, Micali 2013).
The habitual behaviors of Anorexia Nervosa may improve, remain stable, or worsen
during pregnancy (Cardwell 2013). The normal weight gain expected during pregnancy creates
further anxiety for some women struggling with Anorexia Nervosa and could cause her abnormal
behaviors to increase (Cardwell 2013). However, the womans concern for her baby may
motivate her to change her disordered eating behaviors (Tierney, McGlone, Furber 2013).
Regardless, these women should keep open communication with their physicians to ensure the
best care for their baby (Cardwell 2013).
Anorexia Nervosa is a potentially life-threatening condition that can persist for years,
ruining a womans long-term health and risking her childs health (Tierney, McGlone, Furber
2013). If a woman with this disorder is unable to change her behaviors and gain weight during
pregnancy, she should be closely monitored by her physician and try to improve intake of
calories, protein, Folate, and Iron, among other nutrients (Cardwell 2013).

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