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Sommerfeldt B, Skårderud F, Kvalem IL, Gulliksen KS, Holte A. IVF-induced pregnancy and early motherhood among women with a history of severe eating disorders. Front Psychol 2023; 14:1126941. [PMID: 37138985 PMCID: PMC10149691 DOI: 10.3389/fpsyg.2023.1126941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/29/2023] [Indexed: 05/05/2023] Open
Abstract
Background There is a higher prevalence of eating disorders among women seeking in vitro fertilization (IVF). Women with a history of eating disorders may be particularly vulnerable to eating disorder relapse during IVF, pregnancy, and early motherhood. The experience of these women during this process has hardly been studied scientifically, despite its high clinical relevance. The overall aim of this study is to describe how women with a history of eating disorders experience the process of becoming a mother through IVF, pregnancy, and the postpartum period. Methods We recruited women with a history of severe anorexia nervosa who had undergone IVF (n = 7) at public family health centers in Norway. Semi-openly, the participants were interviewed extensively first during pregnancy, and then 6 months after birth. The 14 narratives were analyzed using interpretative phenomenological analyses (IPA). All participants were required to complete the Eating Disorder Examination Questionnaire (EDE-Q) and were diagnosed (DSM-5) by using the Eating Disorder Examination (EDE), during both pregnancy and postpartum. Results All participants experienced a relapse of an eating disorder during IVF. They perceived IVF, pregnancy, and early motherhood to be overwhelming, confusing, a source of severe loss of control, and a source of body alienation. There were four core phenomena that were reported that were strikingly similar across all participants: "anxiousness and fear," "shame and guilt," "sexual maladjustment," and "non-disclosure of eating problems." These phenomena persisted continuously throughout IVF, pregnancy, and motherhood. Conclusion Women with a history of severe eating disorders are highly susceptible to relapse when undergoing IVF, pregnancy, and early motherhood. The process of IVF is experienced as extremely demanding and provoking. There is evidence that eating problems, purging, over-exercising, anxiousness and fear, shame and guilt, sexual maladjustment, and non-disclosure of eating problems continue throughout IVF, pregnancy, and the early years of motherhood. Therefore, it is necessary for healthcare workers providing services to women undergoing IVF to be attentive and intervene when they suspect a history of eating disorders.
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Affiliation(s)
- Bente Sommerfeldt
- Institute of Eating Disorders, Oslo, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- *Correspondence: Bente Sommerfeldt,
| | - Finn Skårderud
- Institute of Eating Disorders, Oslo, Norway
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Ingela Lundin Kvalem
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Kjersti S. Gulliksen
- Institute of Eating Disorders, Oslo, Norway
- The Norwegian Psychological Association, Oslo, Norway
| | - Arne Holte
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
- Norwegian Institute of Public Health (NIPH), Oslo, Norway
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Saldanha N, Fisher M. Menstrual disorders in adolescents and young adults with eating disorders. Curr Probl Pediatr Adolesc Health Care 2022; 52:101240. [PMID: 35909056 DOI: 10.1016/j.cppeds.2022.101240] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Although amenorrhea is no longer a specific criterion required to make the diagnosis of anorexia nervosa (AN), the relationship between restrictive eating and menstrual status remains important in the diagnosis, treatment, and consequences for patients with eating disorders. Clinicians should understand the relationship between menstrual irregularities and malnutrition due to eating disorders, as it may be possible to intervene sooner if the diagnosis is made earlier. Treatment of AN (in those who are underweight) and atypical AN (in those who are not underweight) is aimed at cessation of restrictive thoughts and behaviors, restoration of appropriate nutrition and weight, and normal functioning of the body. While eating disorder thoughts and behaviors are helped by both therapy and nutrition, regular functioning of the body, including regular menstruation, is linked to both appropriate nutrition and weight. Patients who are not underweight based on their body mass index (BMI) may still have oligo/amenorrhea due to their caloric restriction; thus any patient who has irregular menses should have a detailed dietary evaluation as part of their workup. Timely diagnosis and treatment of patients with eating disorders and amenorrhea is important due to the impact on bone mass accrual for adolescents who have prolonged amenorrhea. Menstrual abnormalities may also be seen in patients with bulimia nervosa (BN).
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Affiliation(s)
- Nadia Saldanha
- Division of Adolescent Medicine, Cohen Children's Medical Center, Northwell Health, 410 Lakeville Road, Suite 108, New Hyde Park, New York 11042, USA; Donald and Barbara Zucker, School of Medicine at Hofstra / Northwell, Hempstead, New York, USA.
| | - Martin Fisher
- Division of Adolescent Medicine, Cohen Children's Medical Center, Northwell Health, 410 Lakeville Road, Suite 108, New Hyde Park, New York 11042, USA; Donald and Barbara Zucker, School of Medicine at Hofstra / Northwell, Hempstead, New York, USA
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3
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Letranchant A, Nicolas I, Corcos M. Anorexia nervosa, fertility and medically assisted reproduction. ANNALES D'ENDOCRINOLOGIE 2022; 83:191-195. [DOI: 10.1016/j.ando.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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4
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Schonewille NN, Rijkers N, Berenschot A, Lijmer JG, van den Heuvel OA, Broekman BFP. Psychiatric vulnerability and the risk for unintended pregnancies, a systematic review and meta-analysis. BMC Pregnancy Childbirth 2022; 22:153. [PMID: 35216573 PMCID: PMC8876535 DOI: 10.1186/s12884-022-04452-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background Unintended pregnancies (UPs) are a global health problem as they contribute to adverse maternal and offspring outcomes, which underscores the need for prevention. As psychiatric vulnerability has previously been linked to sexual risk behavior, planning capacities and compliance with contraception methods, we aim to explore whether it is a risk factor for UPs. Methods Electronic databases were searched in November 2020. All articles in English language with data on women with age ≥ 18 with a psychiatric diagnosis at time of conception and reported pregnancy intention were included, irrespective of obstetric outcome (fetal loss, livebirth, or abortion). Studies on women with intellectual disabilities were excluded. We used the National Institutes of Health tool for assessment of bias in individual studies and the Grading of Recommendations Assessment, Development and Evaluation method for assessment of quality of the primary outcome. Findings Eleven studies reporting on psychiatric vulnerability and UPs were included. The participants of these studies were diagnosed with mood, anxiety, psychotic, substance use, conduct and eating disorders. The studies that have been conducted show that women with a psychiatric vulnerability (n = 2650) have an overall higher risk of UPs compared to women without a psychiatric vulnerability (n = 16,031) (OR 1.34, CI 1.08–1.67) and an overall weighed prevalence of UPs of 65% (CI 0.43–0.82) (n = 3881). Interpretation Studies conducted on psychiatric vulnerability and UPs are sparse and many (common) psychiatric vulnerabilities have not yet been studied in relation to UPs. The quality of the included studies was rated fair to poor due to difficulties with measuring the outcome pregnancy intention (use of various methods of assessment and use of retrospective study designs with risk of bias) and absence of a control group in most of the studies. The findings suggest an increased risk of UPs in women with psychiatric vulnerability. As UPs have important consequences for mother and child, discussing family planning in women with psychiatric vulnerabilities is of utmost importance. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04452-1.
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Affiliation(s)
- N N Schonewille
- Department Psychiatry and Medical Psychology, OLVG, Oosterpark 9, 1091 AC, Amsterdam, Netherlands.
| | - N Rijkers
- Department Psychiatry and Medical Psychology, OLVG, Oosterpark 9, 1091 AC, Amsterdam, Netherlands
| | - A Berenschot
- Medical Library, OLVG, Oosterpark 9, 1091 AC, Amsterdam, Netherlands
| | - J G Lijmer
- Department Psychiatry and Medical Psychology, OLVG, Oosterpark 9, 1091 AC, Amsterdam, Netherlands
| | - O A van den Heuvel
- Department Psychiatry and Department Anatomy & Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Boelelaan 1118, 1081 HV, Amsterdam, Netherlands
| | - B F P Broekman
- Department Psychiatry and Medical Psychology, OLVG, Oosterpark 9, 1091 AC, Amsterdam, Netherlands.,Department Psychiatry, Vrije Universiteit Amsterdam, Amsterdam UMC, Boelelaan 1118, 1081 HV, Amsterdam, Netherlands
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5
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Le Floch M, Crohin A, Duverger P, Picard A, Legendre G, Riquin E. Prevalence and phenotype of eating disorders in assisted reproduction: a systematic review. Reprod Health 2022; 19:38. [PMID: 35130918 PMCID: PMC8822730 DOI: 10.1186/s12978-022-01341-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/12/2022] [Indexed: 12/02/2022] Open
Abstract
Background Eating disorders (EDs) are common conditions that mainly affect women of reproductive age and have a major impact on fertility. Our systematic review focuses on the prevalence of EDs in patients in the process of assisted reproductive technique (ART) and describes the phenotypes of EDs identified. Methods Our systematic review is based on the PRISMA criteria. Articles were collected using the Medline/Pubmed, Web Of Science and Cochrane databases. The articles chosen had to mention the prevalence of ED in infertile patients undergoing ART and be cohort or case–control studies assessing the prevalence of ED during fertility treatment. Main findings Fifteen articles were included in this review. The prevalence of active ED varied between 0.13 and 44% depending on the types considered in each study. The main phenotypes described were EDNOS (eating disorder not otherwise specified) and binge eating disorders (BED) occurring in women with a normal body mass index (BMI) and a history of ED. Mainly subthreshold forms with cognitive distortions were described. Conclusion This review highlights a 6 times higher prevalence of EDs in infertile patients undergoing fertility treatment compared to regular pregnant women. However, diagnosing these conditions is complex. As a result, it is essential that professionals in contact with this population are alert to symptoms consistent with these conditions in order to refer them to specialized psychiatric care. Eating disorders are frequent pathologies that primarily affect women of childbearing age. Numerous articles reveal an increased risk for the mother and the child in case of an active disorder during pregnancy. We conducted a systematic review to determine the prevalence and phenotypes of eating disorders in infertile subjects undergoing fertility treatment. The results of the fifteen articles included show a prevalence six times higher than in pregnant women in the general population. Subjects with eating disorders have normal body mass indexes. The active forms are mainly characterized by episodes of binge eating disorders or other unspecified forms. Studies also describe incomplete forms characterized by the presence of dysfunctional thoughts around shape and weight without associated compensatory behavior. Professionals working in the field of reproductive medicine and providing fertility treatment have a major role to play in identifying and referring these subjects at risk to specialized care.
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Affiliation(s)
- Marine Le Floch
- Department of Child and Adolescent Psychiatry, Centre Hospitalier Universitaire d'Angers, Angers, France. .,Pediatric Psychiatry Department, University Hospital of Angers, 4, Rue Larrey, 49933, Angers Cedex 9, France.
| | - Anaïs Crohin
- Department of Child and Adolescent Psychiatry, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Philippe Duverger
- Department of Child and Adolescent Psychiatry, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Aline Picard
- Department of Perinatal Psychiatry, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Guillaume Legendre
- Department of Obstetrics and Gynecology and Medically Assisted Reproduction, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Elise Riquin
- Department of Child and Adolescent Psychiatry, Centre Hospitalier Universitaire d'Angers, Angers, France.,University of Angers, University of Nantes, LPPL, SFR Confluences, 49000, Angers, France.,University Service of the Fondation Santé des Étudiants de France, Sablé sur Sarthe Clinic, Paris, France
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Taştekin Ouyaba A, Çiçekoğlu Öztürk P. The effect of the information-motivation-behavioral skills (IMB) model variables on orthorexia nervosa behaviors of pregnant women. Eat Weight Disord 2022; 27:361-372. [PMID: 34097285 DOI: 10.1007/s40519-021-01237-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE This study aims to test the effect of the components of the Information-Motivation-Behavioral Skills Model on Orthorexia Nervosa (ON) behavior of pregnant women and health outcomes using a hypothetical model. METHODS The study is cross-sectional research and was carried out with 350 pregnant women who had the Non-Stress Test in the obstetrics outpatient clinic of a university hospital. The participants were selected using the convenience sampling method. The data were collected with a questionnaire. Data were analyzed using the structural equation model. RESULTS It was found that 26.6% of pregnant women had an ON tendency. High information for obsession with obsession with healthy eating causes more ON behaviors (β = - 0.25, p < 0.001). The higher motivation for obsession with healthy eating obsession (β = 0.73, p < 0.01) and a higher tendency to ON behaviors (β = - 0.16, p < 0.05) are associated with better health outcomes. CONCLUSION Our findings show that high levels of information and motivation about the obsession with healthy eating effect ON tendency and health outcomes. The findings are significant in that they lead and guide the interventions for the detection, prevention, and treatment of ON during pregnancy. LEVEL OF EVIDENCE Level V, cross-sectional study.
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Affiliation(s)
- Ayşe Taştekin Ouyaba
- Obstetrics and Gynecology Nursing, Faculty of Health Sciences, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey.
| | - Pınar Çiçekoğlu Öztürk
- Psychiatric Nursing, Fethiye Faculty of Health Sciences, Muğla Sıtkı Kocman University, Muğla, Turkey
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Curran KA, Pitt PD. The Reproductive Impact of Eating Disorders in Adolescents. Semin Reprod Med 2022; 40:79-86. [PMID: 35073591 DOI: 10.1055/s-0042-1742326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Eating disorders are common, chronic illnesses that frequently arise during adolescence. Because of the impact on nutrition, individuals with eating disorders have significant health consequences, including effects on reproductive health. Adolescent women with eating disorders frequently have menstrual irregularities, though the causes of these abnormalities are complex and vary depending on the type of eating disorder. Teens with eating disorders may have changes in current and future fertility, and eating disorders during pregnancy can have medical and psychologic impacts for both mother and child. Though not well researched, eating disorders in men can affect reproductive health and potentially impact fertility. Lastly, eating disorders in adolescents can have significantly deleterious, irreversible effects on bone health.
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Affiliation(s)
- Kelly A Curran
- Section of Adolescent Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Paulette D Pitt
- Department of Education and Psychology, East Central University, Ada, Oklahoma
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8
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Prevention of eating disorders in specialty care. NUTR HOSP 2022; 39:129-137. [DOI: 10.20960/nh.04188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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9
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Sollid C, Clausen L, Maimburg RD. The first 20 weeks of pregnancy is a high-risk period for eating disorder relapse. Int J Eat Disord 2021; 54:2132-2142. [PMID: 34581449 DOI: 10.1002/eat.23620] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/26/2021] [Accepted: 09/15/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Eating disorders (ED) are associated with adverse pregnancy outcome and pregnancy is associated with both relapse and remission of ED. Knowledge is lacking on the risk of ED relapse during pregnancy and the postpartum period for women in stable remission. This study examined the occurrence of perinatal ED relapse as well as obstetric and postpartum outcome in women with at least a 6-month ED remission before pregnancy. METHOD A total of 122 women in stable remission before pregnancy were included in a prospective longitudinal study. Changes in ED symptoms based on the Eating Disorder Examination were systematically evaluated at each antenatal visit and in the postpartum period. RESULTS A total of 30 (25%) women relapsed. Twenty women relapsed within the first 20 weeks of pregnancy and eight in the early weeks postpartum. Severe postpartum depression symptoms (33%) were frequent in women with ED relapse; hyperemesis gravidarum (30%) was frequently present independent of the woman's relapse status. DISCUSSION To prevent relapse of ED and possible consequences, attention to relapse in women in stable remission is especially important in early pregnancy and in the postpartum period.
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Affiliation(s)
- Charlotte Sollid
- Perinatal Epidemiological Research Unit, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Loa Clausen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Rikke Damkjaer Maimburg
- Perinatal Epidemiological Research Unit, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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10
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Laru J, Nedelec R, Koivuaho E, Ojaniemi M, Järvelin MR, Tapanainen JS, Franks S, Tolvanen M, Piltonen TT, Sebert S, Morin-Papunen L. BMI in childhood and adolescence is associated with impaired reproductive function-a population-based cohort study from birth to age 50 years. Hum Reprod 2021; 36:2948-2961. [PMID: 34364312 PMCID: PMC8643422 DOI: 10.1093/humrep/deab164] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 06/08/2021] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What is the association between childhood and adolescent BMI and reproductive capacity in women? SUMMARY ANSWER Adolescent girls with obesity had an increased risk of infertility and childlessness in adulthood independently of their marital status or the presence of polycystic ovary syndrome (PCOS). WHAT IS KNOWN ALREADY Girls with obesity (BMI (kg/m2)>95th percentile) more often exhibit menstrual irregularities and infertility problems as compared to those with normal weight, and premenarcheal girls with obesity have an increased risk of childlessness and infertility in adulthood. Follow-up studies on the relation between childhood and adolescence growth patterns and fertility or parity throughout the reproductive life span are limited. STUDY DESIGN, SIZE, DURATION A prospective, population-based cohort study (the Northern Finland birth cohort 1966) was performed with 5889 women born in 1966 and followed from birth to age 50 years. Postal questionnaires at ages 31 and 46 years addressed questions on reproductive capacity evaluated by decreased fecundability, need for infertility assessment and treatment by 46 years of age. Childlessness and number of children by age 50 years were recovered from registers. Women who did not report ever having attempted to achieve pregnancy (n = 1507) were excluded. The final study population included 4382 women who attempted to achieve pregnancy before age 46 years. PARTICIPANTS/MATERIALS, SETTING, METHODS Data on BMI were collected by trained personnel at all stages. We assessed association with both prospectively measured BMI at various time points and with early adiposity phenotypes derived from linear mixed models including the timing and the BMI at adiposity peak (AP) and adiposity rebound (AR). Self-reported infertility assessments and treatments were assessed at ages 31 and 46 years. Data on deliveries were collected from the national birth register. Decreased fecundability was defined at age 31 years as time to achieve pregnancy over 12 months. Logistic regression analyses were conducted with adjustments for marital status, education level and smoking at age 31 years. Women with PCOS were excluded from stratification-based sensitivity analyses. Obesity at a specific age group was defined by having at least one BMI value above the 95th percentile during the related period. MAIN RESULTS AND THE ROLE OF CHANCE BMI at the age of AR (5-7 years) was not associated with fertility outcomes after adjustments, but girls with AR <5.1 years had a higher risk of remaining childless compared to girls with AR over 5.1 years (adjusted odds ratio (OR): 1.45 (1.10-1.92)). At ages 7-10 and 11-15 years, obesity was associated with decreased fecundability (adjusted OR 2.05 (1.26-3.35) and 2.04 (1.21-3.44), respectively) and a lower number of children. At age 11-15 years, both overweight and obesity were associated with a higher risk of childlessness (adjusted OR 1.56 (1.06-2.27), 1.77 (1.02-3.07), respectively), even after excluding women with PCOS. Underweight at age 11-15 years was associated with an increased risk for infertility treatment (adjusted OR 1.55 (1.02-2.36)) and a tendency for an increased risk for infertility assessment (adjusted OR 1.43 (0.97-2.10)) after excluding women with PCOS. LIMITATIONS, REASON FOR CAUTION Despite a high participation rate throughout the follow-up, some growth data for children over the different age groups were missing. Infertility outcomes were self-reported. A potential over-diagnosis of obesity may have reduced the significance of the association between childhood obesity and fertility outcomes, and the diagnosis of PCOS was self-reported. WIDER IMPLICATIONS OF THE FINDINGS This study supports previous results showing that girls with obesity in late childhood and in adolescence displayed reduced fertility and an increased risk of remaining childless in adulthood, independently of marital history and PCOS in adulthood. These findings corroborate the body of evidence for a causal relation between early adiposity and the reproductive functions in women. We recommend reinforcing the prevention of obesity in school-age girls to reduce the risk of impaired reproductive functions. STUDY FUNDING/COMPETING INTEREST(S) NFBC1966 received financial support from University of Oulu Grant no. 65354, Oulu University Hospital Grant no. 2/97, 8/97, Ministry of Health and Social Affairs Grant no. 23/251/97, 160/97, 190/97, National Institute for Health and Welfare, Helsinki Grant no. 54121, Regional Institute of Occupational Health, Oulu, Finland Grant no. 50621, 54231. The Finnish Medical Foundation, the North Ostrobothnia Regional Fund, the Academy of Finland (project grants 315921, 104781, 120315, 129269, 1114194, 24300796), Center of Excellence in Complex Disease Genetics and SALVE, the Sigrid Juselius Foundation, Biocenter Oulu, University Hospital Oulu and University of Oulu (75617), Jalmari ja Rauha Ahokkaan säätiö, The Finnish Medical Foundation, Medical Research Center Oulu, National Institute for Health Research (UK). M. R. J., S. S. and R. N. received funding by the Academy of Finland (#268336) and the European Union's Horizon 2020 research and innovation program (under Grant agreement no. 633595 for the DynaHEALTH action and GA 733206 for LifeCycle). The funders had no role in study design, in the collection, analysis and interpretation of the data, in the writing of the article and in the decision to submit it for publication. The authors have no conflict of interest to disclose. TRIAL REGISTRATION NUMBER N/A.
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Grants
- 54121 Department of Health
- Medical Research Council
- University of Oulu
- Oulu University Hospital
- Ministry of Health and Social Affairs
- National Institute for Health and Welfare, Helsinki
- Regional Institute of Occupational Health, Oulu, Finland
- The Finnish Medical Foundation, the North Ostrobothnia Regional Fund, the Academy of Finland
- Center of Excellence in Complex Disease Genetics and SALVE, the Sigrid Juselius Foundation, Biocenter Oulu, University Hospital Oulu and University of Oulu
- Jalmari ja Rauha Ahokkaan säätiö
- The Finnish Medical Foundation, Medical Research Center Oulu, National Institute for Health Research (UK)
- Academy of Finland
- European Union’s Horizon 2020 research and innovation program
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Affiliation(s)
- J Laru
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
| | - R Nedelec
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - E Koivuaho
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
| | - M Ojaniemi
- Department of Children and Adolescents, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
| | - M -R Järvelin
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Department of Life Sciences, College of Health and Life Sciences, Brunel University London, London, UK
- Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - J S Tapanainen
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - S Franks
- Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - M Tolvanen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - T T Piltonen
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
| | - S Sebert
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - L Morin-Papunen
- Department of Obstetrics and Gynaecology, University of Oulu and Oulu University Hospital, Medical Research Center, PEDEGO Research Unit, Oulu, Finland
- Correspondence address. PEDEGO Research Unit, Department of Obstetrics and Gynecology, Medical Research Center, Oulu University Hospital, University of Oulu, Kajaanintie 50, BOX 5000, 90014 Oulu, Finland. Tel: +358 8 3154109; E-mail: https://orcid.org/0000-0001-5987-7534
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Milano W, Ambrosio P, Carizzone F, De Biasio V, Foia MG, Saetta B, Milano MF, Capasso A. Menstrual Disorders Related to Eating Disorders. Endocr Metab Immune Disord Drug Targets 2021; 22:471-480. [PMID: 34182917 DOI: 10.2174/1871530321666210625145345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/27/2021] [Accepted: 04/06/2021] [Indexed: 11/22/2022]
Abstract
Eating disorders (ED) are associated with multiple physical complications that strongly affect the physical health of these young and fragile patients and can also cause significant mortality, the highest among psychiatric pathologies. Among the various organic complications, albeit still little known, the gynecological implications, up to infertility, are very widespread. Among adolescent and adult patients, gynecological symptoms can be very widespread and range from menstrual irregularities to amenorrhea, from vaginitis to ovarian polycystosis, up to complications during the gestational phase and postpartum, in addition to the possible consequences on the unborn child. Among the most frequent and significant gynecological disorders in women with ED, there are menstrual irregularities that may occur with oligomenorrhea or even amenorrhea. , Although no longer part of the DSM-5 diagnostic criteria for defining anorexia nervosa (AN), this symptom must be considered a very relevant event in the overall evaluation of young women and adolescents with eating disorders. Functional hypothalamic amenorrhea in ED patients is related to psychological distress, excessive exercise, disordered eating, or a combination of these factors, which results in suppression of the hypothalamic-pituitary-ovarian axis, and consequently, hypoestrogenism. This paper has the objective to summarize the causes and the mechanism underlying menstrual disorders and provide a better understanding of the correlation between the reproductive system and the mechanisms that regulate food intake and eating habits. In addition, early recognition of risk factors for eating disorders for gynecological implications can help put more accurate assessments of patients to prevent potentially fatal complications. The importance of the involvement of specialist gynecologists in the multidisciplinary team that has to follow patients with eating disorders is also discussed.
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Affiliation(s)
- Walter Milano
- UOSD Eating Disorder Unit, Mental Health Department ASL Napoli 2 Nord, 80027 Napoli, Italy
| | - Paola Ambrosio
- UOSD Eating Disorder Unit, Mental Health Department ASL Napoli 2 Nord, 80027 Napoli, Italy
| | - Francesca Carizzone
- UOSD Eating Disorder Unit, Mental Health Department ASL Napoli 2 Nord, 80027 Napoli, Italy
| | - Valeria De Biasio
- UOSD Eating Disorder Unit, Mental Health Department ASL Napoli 2 Nord, 80027 Napoli, Italy
| | - Maria Gabriella Foia
- UOSD Eating Disorder Unit, Mental Health Department ASL Napoli 2 Nord, 80027 Napoli, Italy
| | - Biancamaria Saetta
- UOSD Eating Disorder Unit, Mental Health Department ASL Napoli 2 Nord, 80027 Napoli, Italy
| | | | - Anna Capasso
- Department of Pharmacy , University of Salerno, Fisciano, 84084 Salerno, Italy
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12
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Lantzouni E, Grady R. Eating Disorders in Children and Adolescents: A Practical Review and Update for Pediatric Gynecologists. J Pediatr Adolesc Gynecol 2021; 34:281-287. [PMID: 33486085 DOI: 10.1016/j.jpag.2021.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/14/2021] [Indexed: 01/14/2023]
Abstract
Eating disorders (EDs) are common among female adolescents and young adults and can have serious and diverse health consequences. Pediatric gynecology providers have the opportunity to play a vital role in the recognition of EDs in this population. Early medical detection and referral for appropriate evidence-based treatment can lead to better health outcomes for youth. In this article we aim to increase the awareness of the pediatric gynecologist of typical and subtle presentations of EDs, provide guidance for screening, discuss common and serious medical complications, and review treatment considerations for gynecologic issues in patients with EDs.
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Affiliation(s)
- Eleni Lantzouni
- The Craig Dalsimer Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Rosheen Grady
- Division of Adolescent Medicine, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
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13
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Parental eating disorders: A systematic review of parenting attitudes, behaviours, and parent-child interactions. Clin Psychol Rev 2021; 88:102031. [PMID: 34246839 DOI: 10.1016/j.cpr.2021.102031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/01/2021] [Accepted: 04/14/2021] [Indexed: 11/22/2022]
Abstract
A substantial proportion of adults with eating disorders are parents. Studies suggest these parents may experience a range of parenting challenges, and their children may be at an increased risk for the development of eating disorders themselves. With parenting practices being one potential environmental mechanism for the intergenerational transmission of eating disorders, we systematically searched Scopus, Web of Science, PubMed, MEDLINE, PsychINFO, and PsychArticles for controlled studies in which parenting attitudes, behaviours, and parent-child interactions were examined for parents with and without probable eating disorders. 26,512 abstracts were screened, and 167 full-text manuscripts were retrieved, with 33 studies meeting the review inclusion criteria. Studies suggest that parents with eating disorders experience higher levels of parenting stress than control parents, and may on average be more intrusive, less sensitive, and provide less structuring/facilitation in non-feeding interactions with their children. These parents also appear, on average, to experience increased concern about their children's weight, and parent-child mealtime interactions may be problematic and characterised by high levels of conflict. Suggestions for future research are made with a view to enhancing understandings of the intergenerational transmission of eating disorders, which may lead to the identification of intervention targets for parents with eating disorders and their children.
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Barbosa-Magalhaes I, Corcos M, Galey J, Perdigao-Cotta S, Papastathi C, de Crecy M, Nicolas I, Lamas C, Christin-Maître S, Pham-Scottez A. Prevalence of lifetime eating disorders in infertile women seeking pregnancy with pulsatile gonadotropin-releasing hormone therapy. Eat Weight Disord 2021; 26:709-715. [PMID: 32239478 DOI: 10.1007/s40519-020-00893-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 03/18/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Relationships between weight and fertility are well known. The aim of this study is to assess the prevalence of lifetime eating disorder (ED) in a sample of infertile women seeking a specific infertility treatment, pulsatile gonadotropin-releasing hormone (pGnRH) treatment, and to compare it to the prevalence of lifetime ED in a sample of infertile women seeking other types of assisted reproductive technology (ART) treatments. DESIGN Non-randomized, observational study including infertile female patients. Two-group design including consecutive women treated with GnRH pump (pGnRH) or with other types of ART. SETTING Multi-centric infertility centers, France METHODS: Twenty one consecutive women treated with pGnRH treatment were compared to 21 consecutive women receiving other types of infertility treatment. Diagnosis of ED was based on DSM-IV and the Composite International Diagnostic Interview (CIDI). RESULTS Twenty patients (95.2%) from the sample of women treated with pulsatile GnRH treatment and 5 patients (23.8%) from the patients receiving other types of infertility treatment met the criteria of lifetime ED diagnosis (p < 0.000). CONCLUSION This study highlights the fact that the prevalence of ED is considerably higher in women receiving GnRH pulsatile treatment, when compared to women receiving other kinds of infertility treatment. In our study population ED were under-diagnosed, particularly in women receiving pulsatile GnRH treatment. Fertility clinicians should use reliable diagnostic tools to identify promptly ED in women presenting with hypothalamic amenorrhea and difficulties in conceiving. Level III: Evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
| | - Maurice Corcos
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France.,Paris Descartes University, Paris, France
| | - Julie Galey
- Department of Assisted Reproductive Technology, Institut Mutualiste Montsouris, Paris, France
| | - Simone Perdigao-Cotta
- Department of Assisted Reproductive Technology, Institut Mutualiste Montsouris, Paris, France
| | - Chrysoula Papastathi
- Department of Endocrinology and Nutrition, Pourtales Hospital, Neuchâtel, Switzerland
| | - Marie de Crecy
- , 120, avenue Gabriel-Péri, 91700, Sainte-Geneviève-des-Bois, France
| | - Isabelle Nicolas
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Claire Lamas
- Department of Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Sophie Christin-Maître
- Department of Endocrinology, Diabetes and Reproductive Endocrinology, Saint-Antoine Hospital, Paris, France.,Sorbonne University, Paris, France
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15
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Toffol E, But A, Heikinheimo O, Latvala A, Partonen T, Haukka J. Associations between hormonal contraception use, sociodemographic factors and mental health: a nationwide, register-based, matched case-control study. BMJ Open 2020; 10:e040072. [PMID: 33060091 PMCID: PMC7566729 DOI: 10.1136/bmjopen-2020-040072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Sociodemographic and mental health characteristics are associated with contraceptive choices. We aimed to describe the sociodemographic, reproductive and mental health characteristics of all fertile-aged women in Finland who used hormonal contraception (HC) in 2017. DESIGN A nationwide, register-based study. SETTING All women living in Finland in 2017; data from the Care Register of Health Care, Medical Birth Register, Population Register Centre, Prescription Centre, Register of Induced Abortions. PARTICIPANTS All women aged 15-49 with one redeemed HC prescription in 2017 (n=294 356), and a same-sized, age-matched and residence-matched, control group of non-users. OUTCOMES Rates of HC use; associations between HC use and mental disorders, sociodemographic and reproductive characteristics. RESULTS 25.8% of women aged 15-49 years used HC. Women with the lowest socioeconomic levels had lower odds of using HC than women with upper-level statuses (OR, 95% CI students: 0.97, 0.94 to 0.99; entitled to pension: 0.66, 0.63 to 0.69; other: 0.87, 0.85 to 0.89; unknown: 0.90, 0.85 to 0.90). Women with the highest education (secondary: 1.46, 1.43 to 1.48; tertiary: 1.64, 1.58 to 1.70; academic: 1.60, 1.56 to 1.63) and income (second quarter: 1.57, 1.54 to 1.60; third quarter: 1.85, 1.82 to 1.89; fourth quarter: 2.01, 1.97 to 2.06), and unmarried women had higher odds of using HC than women with the lowest education and income levels, and married (0.61, 0.60 to 0.62), divorced (0.86, 0.84 to 0.88), widowed (0.73, 0.65 to 0.83) or other marital status women (0.26, 0.22 to 0.30).Parous women (0.70, 0.69 to 0.71), those with previous induced abortion(s) (0.91, 0.89 to 0.92) or recent eating (0.68, 0.62 to 0.75) or personality (0.89, 0.79 to 0.97) disorders had lower odds of HC use. Absolute risk differences between women with and without mental disorders ranged from 3.1% (anxiety disorders) to 10.1% (eating disorders). CONCLUSIONS A quarter of the fertile-aged women use HC in Finland. Sociodemographic disparities persist in relation to HC use, although of small effect size. HC use is less common among women suffering from severe to moderate psychiatric disorders, especially eating disorders.
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Affiliation(s)
- Elena Toffol
- Department of Public Health, University of Helsinki, Faculty of Medicine, Helsinki, Finland
| | - Anna But
- Department of Public Health, University of Helsinki, Faculty of Medicine, Helsinki, Finland
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Latvala
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland
| | - Timo Partonen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jari Haukka
- Department of Public Health, University of Helsinki, Faculty of Medicine, Helsinki, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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16
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Baskin R, Galligan R, Meyer D. Disordered eating from pregnancy to the postpartum period: The role of psychosocial and mental health factors. Appetite 2020; 156:104862. [PMID: 32905822 DOI: 10.1016/j.appet.2020.104862] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
The postpartum period has been identified as high-risk period for the increase of disordered eating. This study examined the psychosocial factors-attitudes to motherhood, self-compassion and relationship satisfaction- and mental health factors-depressive and anxiety symptoms-associated with this increase. One hundred and fourteen women completed online questionnaires about their eating behaviours between: 18-24 weeks gestation (T1), 30-32 weeks gestation (T2) and 8-10 weeks postpartum (T3). A cluster analysis examined the change of disordered eating from T2 to T3. Multinomial logistic regressions examined which demographic, psychosocial and mental health factors were associated with disordered eating cluster groups, as individual factors and as a combined model of predictors at T1, T2 and T3. Four cluster groups were identified: 'lower disordered eating', 'increasing risk', 'sub-clinical' and 'clinical'. All psychosocial and mental health predictors were individually associated with a risk group, when compared to the lower disordered eating group. However, when combined, only multiparity and higher depressive symptoms were associated with the sub-clinical group. Multiparity, higher pre-pregnancy body mass index and lower self-compassion were associated with the increasing risk group. This study introduces self-compassion as a psychosocial factor worthy of further investigation and application in the field of perinatal disordered eating, with promising avenues for antenatal intervention.
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Affiliation(s)
- Rachel Baskin
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.
| | - Roslyn Galligan
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.
| | - Denny Meyer
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.
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17
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Martínez-Olcina M, Rubio-Arias JA, Reche-García C, Leyva-Vela B, Hernández-García M, Hernández-Morante JJ, Martínez-Rodríguez A. Eating Disorders in Pregnant and Breastfeeding Women: A Systematic Review. ACTA ACUST UNITED AC 2020; 56:medicina56070352. [PMID: 32679923 PMCID: PMC7404459 DOI: 10.3390/medicina56070352] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 11/16/2022]
Abstract
Background: Pregnancy is a stage associated with various biopsychosocial changes. These changes, along with concerns about keeping an adequate weight, can modulate an individual's risk for psychological disorders, especially eating disorders (EDs). The aim of this review was to investigate the prevalence, associated risks, and consequences of eating disorders in pregnancy and in breastfeeding mothers. Materials and Methods: A systematic review was carried out following the PRISMA guidelines in the scientific databases: PubMed, Web of Science, Scopus, and PsycINFO. Search terms related to EDs, pregnancy, and breastfeeding were used. The evaluation of the methodological quality of the studies was carried out using different scales; CASP (Checklist for Cohort Study), NICE (Methodology Checklist for Cohort Study), ARHQ (Methodology Checklist for Cross-Sectional), and NOS (Newcastle-Ottawa Scale for Cohort). Results: From 2920 studies, 16 were selected to study EDs in pregnant women and 2 studies in nursing mothers. Most of the studies used questionnaires and scales as tools for the diagnosis of EDs. Binge eating, anxiety, and depression were the most common comorbidities of EDs, accompanied in most cases by excessive concern about weight gain. The consequences of EDs are diverse. The prevalence of EDs in this population is estimated to be 1 out of 20. Conclusions: Eating disorders are related to anxiety and depression and have negative consequences for both mothers and fetuses (cesarean, miscarriages, premature births). More research on the field to determine the risk factors for EDs in the population of pregnant and lactating women is needed.
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Affiliation(s)
- María Martínez-Olcina
- Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain; (M.M.-O.); (M.H.-G.)
| | - Jacobo A. Rubio-Arias
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Polytechnic University of Madrid, 28040 Madrid, Spain;
| | - Cristina Reche-García
- Faculty of Nursing, San Antonio Catholic University of Murcia, 30107 Murcia, Spain;
- Correspondence:
| | - Belén Leyva-Vela
- Department of Health, Vinalopó University Hospital, 03293 Elche, Spain;
| | - María Hernández-García
- Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain; (M.M.-O.); (M.H.-G.)
| | | | - Alejandro Martínez-Rodríguez
- Department of Analytical Chemistry, Nutrition and Food Science, Faculty of Sciences, University of Alicante, 03690 Alicante, Spain;
- Alicante Institute for Health and Biomedical Research (ISABIAL Foundation), 03010 Alicante, Spain
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18
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Abstract
Anorexia nervosa is an eating disorder with peak onset in adolescence, which carries the highest mortality rate of all psychiatric illnesses. It is commonly comorbid with other physical and mental health problems, yet training on management of people with eating disorders and working knowledge of clinicians working with underweight adolescents is inconsistent. This review of anorexia nervosa in adolescents provides an overview of the presentation, aetiology and treatment of this disorder, with a particular focus on the assessment and management of physical health risks, including refeeding syndrome.
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Affiliation(s)
| | - Lee D Hudson
- UCL Great Ormond Street Institute of Child Health, London, UK
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19
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Baskin R, Meyer D, Galligan R. Psychosocial factors, mental health symptoms, and disordered eating during pregnancy. Int J Eat Disord 2020; 53:873-882. [PMID: 32199037 DOI: 10.1002/eat.23264] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The impact of disordered eating extends beyond women with a diagnosed eating disorder. Scarce research to date has investigated disordered eating in a general perinatal population, including the complex interplay between psychosocial factors, mental health symptoms, and disordered eating at numerous pregnancy periods. Specifically, maternal attitudes and relationship satisfaction are psychosocial factors that have been identified as a gap in the literature. METHOD Pregnant women completed an online questionnaire between 18 and 24 weeks gestation (T1, n = 258) and again between 30 and 32 weeks gestation (T2, n = 159). Structural equation modeling was used to test an interrelated model of psychosocial factors-attitudes to pregnancy, attitudes to motherhood, and relationship satisfaction-and disordered eating, mediated by either depressive or anxiety symptoms. Invariance testing examined whether model weights differed between primiparous and multiparous women at each time point. RESULTS While at T1 and T2, there were significant direct associations between psychosocial factors and disordered eating, only at T2 were the associations between psychosocial factors and disordered eating mediated by depressive and anxiety symptoms. Furthermore, at T2, multiparous women were at greater risk of an association between maladaptive attitudes to pregnancy and motherhood, depressive symptoms, and disordered eating. DISCUSSION The present study highlights the need to investigate the relationships between psychosocial factors and disordered eating, while accounting for the unique antenatal needs of women during different pregnancy periods and across differing parity. The mediating effect of depressive and anxiety symptoms have implications for future research and clinical care.
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Affiliation(s)
- Rachel Baskin
- Department of Psychological Sciences, Swinburne University, Hawthorn, Victoria, Australia
| | - Denny Meyer
- Centre for Mental Health, Swinburne University, Hawthorn, Victoria, Australia
| | - Roslyn Galligan
- Department of Psychological Sciences, Swinburne University, Hawthorn, Victoria, Australia
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20
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Boutari C, Pappas PD, Mintziori G, Nigdelis MP, Athanasiadis L, Goulis DG, Mantzoros CS. The effect of underweight on female and male reproduction. Metabolism 2020; 107:154229. [PMID: 32289345 DOI: 10.1016/j.metabol.2020.154229] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/13/2022]
Abstract
Chronic energy deficiency can impair the hypothalamic-pituitary-gonadal (HPG) axis and lead to hypothalamic anovulation in underweight women. This review presents the syndromes related to underweight status that are associated with infertility, summarizes the underlying mechanisms, and reviews the available treatment options. Eating disorders, such as anorexia nervosa (AN), constitute the most common cause of infertility in underweight women, who, in addition, experience miscarriages, and sexual dysfunction. The relative energy deficiency in sports (RED-S; former terminology: athlete's triad) involves menstrual dysfunction due to low energy availability, which results in anovulation. Moreover, lipodystrophies, malnutrition, starvation, systematic illnesses (malignancies, endocrinopathies, infectious diseases, advanced chronic diseases, neurologic illnesses), and the utilization of drugs can cause excessive weight loss. They may result in fertility problems due to the loss of adipose tissue and the subsequent hormonal disturbances. Each of these conditions requires multidisciplinary management. Nutritional counseling should target the restoration of energy balance by increasing intake and reducing output. Medical treatment, recommended only for patients who did not respond to standard treatment, may include antipsychotics, antidepressants, or leptin administration. Finally, psychiatric treatment is considered an integral part of the standard treatment.
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Affiliation(s)
- Chrysoula Boutari
- Department of Medicine, Boston VA Healthcare System and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Panagiotis D Pappas
- Unit of Reproductive Endocrinology, 1(st) Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Gesthimani Mintziori
- Unit of Reproductive Endocrinology, 1(st) Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Meletios P Nigdelis
- Unit of Reproductive Endocrinology, 1(st) Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Loukas Athanasiadis
- 3(rd) Department of Psychiatry, Medical School, Aristotle University of Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1(st) Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Christos S Mantzoros
- Department of Medicine, Boston VA Healthcare System and Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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21
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Murphy K, Simonds LM, Spokes N. Disclosure in therapy by clients with eating difficulties: a Q-Methodology study. Eat Disord 2020; 28:32-46. [PMID: 30676885 DOI: 10.1080/10640266.2018.1560239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Disclosure by those with eating difficulties is of considerable importance to clinicians and researchers. The aim of the present study was to explore variability in factors considered likely to influence the decision to disclose during psychological therapy by people who experience such difficulties. Thirty-seven participants recruited through a UK-based eating disorder charity completed a Q-sort task. This invited them to sort 47 statements onto a grid reflecting what would make them more or less likely to disclose in therapy. The thirty-seven Q-sorts were analysed using PQ method software. This resulted in the extraction of three factors explaining 41 percent of the variance. Participants loading on the first factor considered maintaining an eating disorder identity as most influential whilst participants loading on the second factor considered the therapeutic relationship as most influential. Those loading on the third factor considered personal readiness and feelings of security as most influential. This study suggests that clinicians need to assess influences on the decision to disclose for individual clients and to modify the early stages of intervention accordingly. Future research could assess the utility of using the Q-sort process and materials in this study as a way to elicit influences on disclosure decisions.
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Affiliation(s)
- Karen Murphy
- School of Psychology, University of Surrey, Guildford UK.,Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Naomi Spokes
- Tavistock and Portman NHS Foundation Trust, City and Hackney Primary Care Psychotherapy Consultation Service (PCPCS), London, UK
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22
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Martins AD, Jarak I, Morais T, Carvalho RA, Oliveira PF, Monteiro MP, Alves MG. Caloric restriction alters the hormonal profile and testicular metabolome, resulting in alterations of sperm head morphology. Am J Physiol Endocrinol Metab 2020; 318:E33-E43. [PMID: 31770015 DOI: 10.1152/ajpendo.00355.2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Energy homeostasis is crucial for all physiological processes. Thus, when there is low energy intake, negative health effects may arise, including in reproductive function. We propose to study whether caloric restriction (CR) changes testicular metabolic profile and ultimately sperm quality. Male Wistar rats (n = 12) were randomized into a CR group fed with 30% fewer calories than weight-matched, ad libitum-fed animals (control group). Circulating hormonal profile, testicular glucagon-like peptide-1 (GLP-1), ghrelin and leptin receptors expression, and sperm parameters were analyzed. Testicular metabolite abundance and glycolysis-related enzymes were studied by NMR and Western blot, respectively. Oxidative stress markers were analyzed in testicular tissue and spermatozoa. Expressions of mitochondrial complexes and mitochondrial biogenesis in testes were determined. CR induced changes in body weight along with altered GLP-1, ghrelin, and leptin circulating levels. In testes, CR led to changes in receptor expression that followed those of the hormone levels; modified testicular metabolome, particularly amino acid content; and decreased oxidative stress-induced damage in testis and spermatozoa, although sperm head defects increased. In sum, CR induced changes in body weight, altering circulating hormonal profile and testicular metabolome and increasing sperm head defects. Ultimately, our data highlight that conditions of CR may compromise male fertility.
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Affiliation(s)
- Ana D Martins
- Department of Microscopy, Laboratory of Cell Biology, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar (UMIB-ICBAS), University of Porto, Porto, Portugal
| | - Ivana Jarak
- Department of Microscopy, Laboratory of Cell Biology, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar (UMIB-ICBAS), University of Porto, Porto, Portugal
| | - Tiago Morais
- Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar (UMIB-ICBAS), University of Porto, Porto, Portugal
- Department of Anatomy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Rui A Carvalho
- Department of Life Sciences, University of Coimbra, Coimbra, Portugal
- REQUIMTE/LAQV, Group of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, Portugal
| | - Pedro F Oliveira
- Department of Microscopy, Laboratory of Cell Biology, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar (UMIB-ICBAS), University of Porto, Porto, Portugal
- Department of Genetics, Faculty of Medicine, University of Porto, Porto, Portugal
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Mariana P Monteiro
- Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar (UMIB-ICBAS), University of Porto, Porto, Portugal
- Department of Anatomy, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
- Obesity and Bariatric Services and Centre for Obesity Research, University College of London Hospitals, UCL, London, United Kingdom
| | - Marco G Alves
- Department of Microscopy, Laboratory of Cell Biology, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar (UMIB-ICBAS), University of Porto, Porto, Portugal
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23
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Sebastiani G, Andreu-Fernández V, Herranz Barbero A, Aldecoa-Bilbao V, Miracle X, Meler Barrabes E, Balada Ibañez A, Astals-Vizcaino M, Ferrero-Martínez S, Gómez-Roig MD, García-Algar O. Eating Disorders During Gestation: Implications for Mother's Health, Fetal Outcomes, and Epigenetic Changes. Front Pediatr 2020; 8:587. [PMID: 33042925 PMCID: PMC7527592 DOI: 10.3389/fped.2020.00587] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction: Eating disorders (EDs) have increased globally in women of childbearing age, related to the concern for body shape promoted in industrialized countries. Pregnancy may exacerbate a previous ED or conversely may be a chance for improving eating patterns due to the mother's concern for the unborn baby. EDs may impact pregnancy evolution and increase the risk of adverse outcomes such as miscarriage, preterm delivery, poor fetal growth, or malformations, but the knowledge on this topic is limited. Methods: We performed a systematic review of studies on humans in order to clarify the mechanisms underpinning the adverse pregnancy outcomes in patients with EDs. Results: Although unfavorable fetal development could be multifactorial, maternal malnutrition, altered hormonal pathways, low pre-pregnancy body mass index, and poor gestational weight gain, combined with maternal psychopathology and stress, may impair the evolution of pregnancy. Environmental factors such as malnutrition or substance of abuse may also induce epigenetic changes in the fetal epigenome, which mark lifelong health concerns in offspring. Conclusions: The precocious detection of dysfunctional eating behaviors in the pre-pregnancy period and an early multidisciplinary approach comprised of nutritional support, psychotherapeutic techniques, and the use of psychotropics if necessary, would prevent lifelong morbidity for both mother and fetus. Further prospective studies with large sample sizes are needed in order to design a structured intervention during every stage of pregnancy and in the postpartum period.
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Affiliation(s)
- Giorgia Sebastiani
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Vicente Andreu-Fernández
- Grup de Recerca Infancia i Entorn (GRIE), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Valencian International University (VIU), Valencia, Spain
| | - Ana Herranz Barbero
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Victoria Aldecoa-Bilbao
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Xavier Miracle
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Eva Meler Barrabes
- Fetal i+D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Arantxa Balada Ibañez
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Marta Astals-Vizcaino
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Silvia Ferrero-Martínez
- Hospital Sant Joan de Déu, Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - María Dolores Gómez-Roig
- Hospital Sant Joan de Déu, Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Oscar García-Algar
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain.,Grup de Recerca Infancia i Entorn (GRIE), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Castellini G, Lelli L, Cassioli E, Ricca V. Relationships between eating disorder psychopathology, sexual hormones and sexual behaviours. Mol Cell Endocrinol 2019; 497:110429. [PMID: 31026479 DOI: 10.1016/j.mce.2019.04.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 04/09/2019] [Accepted: 04/12/2019] [Indexed: 11/17/2022]
Abstract
A growing body of evidences demonstrated that sexuality is an important topic in the clinical research of eating disorders (EDs), due to its association with specific psychopathological features, and etiological factors. The present review took into consideration the complex relationship between sexual behaviours, hormonal alterations and EDs psychopathology. Studies pertaining sexual behaviours in EDs were divided into those focusing on sexual dysfunctions, and those related to risky sexual behaviours. The limited number of studies on sexual dysfunctions, reported a controversial association with weight status and hormonal alterations, and a clear relationship with severity of specific psychopathology (e.g. body image disturbance). Risky sexual behaviours have been associated with impulsivity and dissociation, as well as with abnormal stress response. Finally, both restriction and uncontrolled eating have been found to be responsible for several complex metabolic alterations, determining varied sexual and gynecologic problems, such as amenorrhea, hypogonadism, genital vascular problems, infertility, and miscarriage, although it is also possible that alterations in feeding and stress hormones contribute to altered eating behaviour.
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Affiliation(s)
- Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences. University of Florence, Italy
| | - Lorenzo Lelli
- Psychiatry Unit, Department of Health Sciences. University of Florence, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences. University of Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences. University of Florence, Italy.
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25
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Ozkan T, Gibson J, Evans L. The Triality of Strain, Self-Control, and Eating Disorders. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2019; 63:1384-1408. [PMID: 30608011 DOI: 10.1177/0306624x18823460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study examines the potential relationship between eating disorders and antisocial behaviors through the lenses of the general theory of crime and general strain theory. We utilized the data from the National Longitudinal Study of Adolescent to Adult Health, a longitudinal study of a nationally representative sample of juveniles in grades 7 to 12 in the United States between 1994 and 2008. We constructed three separate measures of eating disorders and examined their relationships with both petty theft and aggressive behaviors. Results indicated that previous traumatic experiences (such as sexual abuse) are consistent risk factors for eating disorders, and that eating disorders can increase antisocial involvements. Moreover, eating disorders can diminish self-control and agitate depressed moods, which may increase the likelihood of both petty theft and violent conduct, and this effect can extend to later adulthood as well.
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26
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Baskin R, Galligan R. Disordered eating and the perinatal period: A systematic review and best evidence synthesis of mental health and psychosocial correlates. EUROPEAN EATING DISORDERS REVIEW 2019; 27:462-480. [DOI: 10.1002/erv.2675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 03/07/2019] [Accepted: 03/10/2019] [Indexed: 02/01/2023]
Affiliation(s)
- Rachel Baskin
- Department of Psychological SciencesSwinburne University Hawthorn, Melbourne Australia
| | - Roslyn Galligan
- Department of Psychological SciencesSwinburne University Hawthorn, Melbourne Australia
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27
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Clinical management of females seeking fertility treatment and of pregnant females with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2019; 27:215-223. [DOI: 10.1002/erv.2667] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/10/2019] [Accepted: 01/17/2019] [Indexed: 11/07/2022]
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28
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Støving RK. MECHANISMS IN ENDOCRINOLOGY: Anorexia nervosa and endocrinology: a clinical update. Eur J Endocrinol 2019; 180:R9-R27. [PMID: 30400050 PMCID: PMC6347284 DOI: 10.1530/eje-18-0596] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/25/2018] [Indexed: 12/17/2022]
Abstract
Anorexia nervosa is a syndrome, that is collections of symptoms, which is not defined by its etiology. The severe cases are intractable. The syndrome is associated with multiple, profound endocrine alterations which may be adaptive, reactive or etiologic. Adaptive changes potentially may be inappropriate in clinical settings such as inpatient intensive re-nutrition or in a setting with somatic comorbidity. Electrolyte levels must be closely monitored during the refeeding process, and the need for weight gain must be balanced against potentially fatal refeeding complications. An important focus of clinical research should be to identify biomarkers associated with different stages of weight loss and re-nutrition combined with psychometric data. Besides well-established peripheral endocrine actions, several hormones also are released directly to different brain areas, where they may exert behavioral and psychogenic actions that could offer therapeutic targets. We need reliable biomarkers for predicting outcome and to ensure safe re-nutrition, however, first of all we need them to explore the metabolism in anorexia nervosa to open new avenues with therapeutic targets. A breakthrough in our understanding and treatment of this whimsical disease remains. Considering this, the aim of the present review is to provide an updated overview of the many endocrine changes in a clinical perspective.
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Affiliation(s)
- René Klinkby Støving
- Nutrition Clinic, Center for Eating Disorders, Odense University Hospital
- Endocrine Elite Research Centre, Institute of Clinical Research, University of South Denmark, Faculty of Health Sciences
- Psychiatric Services in the Region of Southern Denmark, Odense, Denmark
- Correspondence should be addressed to R K Støving;
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29
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Waking up every day in a body that is not yours: a qualitative research inquiry into the intersection between eating disorders and pregnancy. BMC Pregnancy Childbirth 2018; 18:463. [PMID: 30497443 PMCID: PMC6267071 DOI: 10.1186/s12884-018-2105-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Women with eating disorders are more likely to negatively react to finding out they are pregnant, although this difference in attitudes between women with eating disorders and controls disappears at 18-weeks' gestation. Those with anorexia also are twice as likely to have an unplanned pregnancy and those with bulimia have a 30-fold increased chance compared with healthy controls. Therefore, due to these considerations, pregnancy and the transition to motherhood can be an extremely challenging time for these women both psychologically and physically. The purpose of this qualitative descriptive study was to understand the intersection between eating disorders and pregnancy from the lived experience of women who have been pregnant or want to or do not want to become pregnant. METHODS A total of 15 women with a current or past history of an eating disorder were recruited, including nine women who have had previous pregnancies as well as six nonparous women. Interviews were the primary unit of data collection, in addition to document analysis of diaries or blogs. Data analysis was based on verbatim transcripts from audio recordings. NVIVO 11© was used to manage the data from these interviews and thematic analysis was then conducted for emergence of major and sub themes. RESULTS A total of six themes emerged from the iterative process of coding and categorizing. They were: Control, Disclosure to Others, Battle between Mothering & Eating Disorder, Fear of Intergenerational Transmission, Weight and Body Image Concerns, and Coping Strategies. One theme, Battle between Mothering & Eating Disorder also had three sub-themes: Decision to Have Child, Emotions Towards Pregnancy, and Focus on Child/Greater Good. CONCLUSIONS It is hoped that quotes and themes derived from this study will help inform both prenatal and postnatal care and interventions, as well as addressing intergenerational transmission concerns among mothers with eating disorders.
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Eik-Nes TT, Horn J, Strohmaier S, Holmen TL, Micali N, Bjørnelv S. Impact of eating disorders on obstetric outcomes in a large clinical sample: A comparison with the HUNT study. Int J Eat Disord 2018; 51:1134-1143. [PMID: 30189108 DOI: 10.1002/eat.22916] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/08/2018] [Accepted: 06/08/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Current evidence from clinical studies suggests that having an active eating disorder (ED) during pregnancy is associated with unfavorable obstetric outcomes. However, the role of a lifetime diagnosis of ED is not fully understood. Variations in findings suggest a need for additional studies of maternal ED. This study aims to identify associations between a lifetime ED and obstetric outcomes. METHOD Data from a hospital patient register and a population-based study (The HUNT Study) were linked to the Medical Birth Registry in Norway. Register based information of obstetric complications (preeclampsia, preterm birth, perinatal deaths, small for gestational age (SGA), large for gestational age (LGA), Caesarean sections, and 5-min Apgar score) were acquired for 532 births of women with ED and 43,657 births of non-ED women. Multivariable regression in generalized estimating equations was used to account for clusters within women as they contributed multiple births to the dataset. RESULTS After adjusting for parity, maternal age, marital status, and year of delivery, lifetime history of anorexia nervosa was associated with increased odds of having offspring who were SGA (Odds ratio (OR) 2.7, 95% Confidence Interval (CI) 1.4-5.2). Women with a lifetime history of bulimia nervosa had higher odds of having a Caesarian section (OR 1.7 95% CI 1.1-2.5). Women with EDNOS/sub-threshold ED had a higher likelihood of having a low Apgar score at 5 min (OR 3.1, 95% CI 1.1-8.8). CONCLUSION Our study corroborates available evidence on the associations between maternal ED and adverse obstetric outcomes.
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Affiliation(s)
- Trine Tetlie Eik-Nes
- Department of Mental Health, Norwegian University for Science and Technology, Trondheim, Norway.,Department of Mental Health and Addiction, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Julie Horn
- Department of Public Health and Nursing, Norwegian University for Science and Technology, Trondheim, Norway.,Department of Obstetrics and Gynecology, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Susanne Strohmaier
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Turid L Holmen
- Department of Public Health and Nursing, Norwegian University for Science and Technology, Trondheim, Norway
| | - Nadia Micali
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Switzerland.,Division of Child and Adolescent Psychiatry, Department of Child and Adolescent Health, Geneva University Hospital, Geneva, Switzerland.,UCL-Institute of Child Health, Child and Adolescent Mental Health Palliative care and Pediatrics Section, London, UK
| | - Sigrid Bjørnelv
- Department of Mental Health, Norwegian University for Science and Technology, Trondheim, Norway.,Department of Mental Health and Addiction, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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Barriers to identifying eating disorders in pregnancy and in the postnatal period: a qualitative approach. BMC Pregnancy Childbirth 2018; 18:114. [PMID: 29759082 PMCID: PMC5952825 DOI: 10.1186/s12884-018-1745-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 04/15/2018] [Indexed: 12/28/2022] Open
Abstract
Background Eating Disorders (ED) are mental health disorders that typically effect women of childbearing age and are associated with adverse maternal and infant outcomes. UK healthcare guidance recommends routine enquiry for current and past mental illness in antenatal and postnatal care for all women, and that pregnant women with a known ED are offered enhanced monitoring and support. Midwives and health visitors are ideally placed to identify and support women with ED as they are often the primary point of contact during the antenatal and postnatal periods. However, research on the barriers to identifying ED in the perinatal period is limited. This study aimed to understand the barriers to disclosure and identification of ED in pregnancy and postnatally as perceived by women with past or current ED, and midwives and health visitors working in the UK National Health Service. Methods Two studies were undertaken: mixed-measures survey of pregnant and postnatal women with current or past ED; focus groups with student and qualified midwives and health visitors. Results Five themes emerged on the barriers to disclosure in pregnancy as perceived by women: stigma, lack of opportunity, preference for self-management, current ED symptomatology and illness awareness. Four themes were identified on the barriers to identification of ED in pregnancy and in the postnatal period as perceived by health professionals: system constraints, recognition of role, personal attitudes, and stigma and taboo. Conclusions Several barriers to the identification of ED during and after pregnancy were described, the main factors were stigma and poor professional training. Perinatal mental health is becoming increasingly prioritised within national policy initiatives; however, ED continue to be neglected and increased awareness is needed. Similarly, clinical guidance aimed at responding to the rising prevalence of obesity focus on changing nutrition but not on assessing for the presence of ED behaviours that might be affecting nutrition. Improving education and training for health professionals may contribute to reducing stigma and increase confidence in identifying ED. The barriers identified in this research need to be addressed if recognition and response to women with ED during the perinatal period is to improve. Electronic supplementary material The online version of this article (10.1186/s12884-018-1745-x) contains supplementary material, which is available to authorized users.
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32
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Bye A, Mackintosh N, Sandall J, Easter A, Walker M. Supporting women with eating disorders during pregnancy and the postnatal period. ACTA ACUST UNITED AC 2018. [DOI: 10.12968/johv.2018.6.5.224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Amanda Bye
- Research co-ordinator, King's College London
| | - Nicola Mackintosh
- Associate professor in social science applied to health, University of Leicester
| | - Jane Sandall
- Professor of social science and women's health, King's College London
| | - Abigail Easter
- Senior post-doctoral research fellow, Eating Disorders and Pregnancy Research Team, King's College London
| | - Melita Walker
- Perinatal mental health lead, Institute of Health Visiting
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33
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Pubertas tarda bei hypogonadotropem Hypogonadismus. GYNAKOLOGISCHE ENDOKRINOLOGIE 2018. [DOI: 10.1007/s10304-018-0186-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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34
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Holmes S. Responses to warnings about the impact of eating disorders on fertility: a qualitative study. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:670-686. [PMID: 29466825 DOI: 10.1111/1467-9566.12676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Eating disorders (EDs) have often been discussed as a risk to reproductive health. But existing research is quantitative in nature, paying no attention to issues of patient experience. In discussing data from 24 semi-structured interviews, this article draws on sociological approaches to medical 'risk' and feminist approaches to EDs to explore how women with experience of an ED responded to fertility warnings within treatment contexts. In doing so, it is suggested that responses to fertility warnings offer unique insight into the potentially damaging limitations of biomedical approaches to eating problems and their focus on EDs as individual 'pathologies' (rather than culturally embedded expressions of gendered embodiment). At best warnings are seen as making problematic assumptions about the aspirations of female patients, which may curtail feelings of agency and choice. At worst, they may push women further into destructive bodily and eating practices, and silence the distress that may be articulated by an ED.
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Affiliation(s)
- Su Holmes
- Department of Film, TV and Media, University of East Anglia, Norwich, UK
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35
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Tabler J, Utz RL, Smith KR, Hanson HA, Geist C. Variation in reproductive outcomes of women with histories of bulimia nervosa, anorexia nervosa, or eating disorder not otherwise specified relative to the general population and closest-aged sisters. Int J Eat Disord 2018; 51:102-111. [PMID: 29331083 PMCID: PMC6599590 DOI: 10.1002/eat.22827] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study seeks to examine the long-term reproductive consequences of eating disorders (ED), to assess variation in reproductive outcomes by ED type, and to examine reproductive differences between women with previous ED diagnosis and their discordant sisters. METHOD Using a sample of women with previous ED diagnosis generated by the Utah Population Database, this study compares the fecundity (parity) and age at first birth of women by ED subtype (bulimia nervosa [BN], anorexia nervosa [AN], and ED not otherwise specified [EDNOS]) (n = 1,579). We also employed general population match case-control, and discordant sibling pair analyses, to estimate the magnitude of association between EDs and reproductive outcomes. RESULTS Women previously diagnosed with AN or EDNOS experienced delayed first birth (HRR = 0.33, HRR = 0.34, respectively) and lower parity (IRR = 0.19, IRR = 0.22, respectively) relative to BN (p < .05), the general population (p < .05), and closest-aged sisters (p < .05). Women previously diagnosed with BN experienced more moderate reductions and delays to their reproduction, and had similar reproductive outcomes as their discordant sisters. DISCUSSION Clinicians should consider ED type and family fertility histories when addressing the long-term reproductive health needs of women with prior AN, BN, or EDNOS diagnosis. Women previously diagnosed with AN or EDNOS likely experience the greatest reductions and delays in reproduction across their lifespan. Reproductive health screenings may be especially critical for the wellbeing of women with a history of AN or EDNOS.
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Affiliation(s)
- Jennifer Tabler
- Department of Sociology and Anthropology, The University of Texas Rio Grande Valley, Edinburg, Texas
| | - Rebecca L. Utz
- Department of Sociology, University of Utah, Salt Lake City, Utah
| | - Ken R. Smith
- Department of Family and Consumer Studies, Pedigree and Population Resource, University of Utah, Salt Lake City, Utah,Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Heidi A. Hanson
- Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah,Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Claudia Geist
- Department of Sociology, University of Utah, Salt Lake City, Utah,Division of Gender Studies, University of Utah, Salt Lake City, Utah
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Barona M, Taborelli E, Corfield F, Pawlby S, Easter A, Schmidt U, Treasure J, Micali N. Neurobehavioural and cognitive development in infants born to mothers with eating disorders. J Child Psychol Psychiatry 2017; 58:931-938. [PMID: 28452420 DOI: 10.1111/jcpp.12736] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Although recent research has focused on the effects of maternal eating disorders (EDs) on children, little is known about the effect of maternal EDs on neurobiological outcomes in newborns and infants. This study is the first to investigate neurobehavioural regulation and cognitive development in newborns and infants of mothers with EDs. METHODS Women with an active and past ED and healthy controls were recruited to a prospective longitudinal study during their first trimester or second trimester of pregnancy. Newborns and infants of mothers with ED were compared with newborns and infants of healthy controls on (a) neurobehavioural dysregulation using the Brazelton Neonatal Behavioural Assessment Scale at 8 days postpartum (active ED, n = 15; past ED, n = 20; healthy controls, n = 28); and (b) cognitive development using the Bayley Scales of Infant and Toddler Development at 1-year postpartum (active ED, n = 18; past ED, n = 19; healthy controls, n = 28). In order to maintain the largest possible sample at each time point, sample size varied across time points. RESULTS Newborns of mothers with an active ED had worse autonomic stability when compared with newborns of healthy controls [B = -0.34 (-1.81, -0.26)]. Infants of mothers with a past ED had poorer language [B = -0.33 (-13.6, -1.9)] and motor development [B = -0.32 (-18.4, -1.3)] compared with healthy controls. CONCLUSIONS Children of mothers with ED display neurobehavioural dysregulation early after birth and poorer language and motor development at 1 year. These characteristics suggest evidence of early neurobiological markers in children at risk. Differential outcomes in children of women with active versus past ED suggest that active symptomatology during pregnancy might have an effect on physiological reactivity while cognitive characteristics might be more stable markers of risk for ED.
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Affiliation(s)
| | | | - Freya Corfield
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, KCL, London, UK
| | - Susan Pawlby
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, KCL, London, UK
| | - Abigail Easter
- Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, KCL, London, UK
| | - Ulrike Schmidt
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, KCL, London, UK
| | - Janet Treasure
- Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, KCL, London, UK
| | - Nadia Micali
- Institute of Child Health, UCL, London, UK.,Department of Psychiatry, Icahn Medical School at Mount Sinai, New York, NY, USA.,Mindich Child Health and Development Institute, Icahn Medical School at Mount Sinai, New York, NY, USA
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Schmidt U, Sharpe H, Bartholdy S, Bonin EM, Davies H, Easter A, Goddard E, Hibbs R, House J, Keyes A, Knightsmith P, Koskina A, Magill N, McClelland J, Micali N, Raenker S, Renwick B, Rhind C, Simic M, Sternheim L, Woerwag-Mehta S, Beecham J, Campbell IC, Eisler I, Landau S, Ringwood S, Startup H, Tchanturia K, Treasure J. Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05160] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BackgroundAnorexia nervosa (AN) is a severe psychiatric condition and evidence on how to best treat it is limited.ObjectivesThis programme consists of seven integrated work packages (WPs) and aims to develop and test disseminable and cost-effective treatments to optimise management for people with AN across all stages of illness.MethodsWP1a used surveys, focus groups and a pre–post trial to develop and evaluate a training programme for school staff on eating disorders (EDs). WP1b used a randomised controlled trial (RCT) [International Standard Randomised Controlled Trial Number (ISRCTN) 42594993] to evaluate a prevention programme for EDs in schools. WP2a evaluated an inpatient treatment for AN using case reports, interviews and a quasi-experimental trial. WP2b used a RCT (ISRCTN67720902) to evaluate two outpatient psychological therapies for AN. WP3 used a RCT (ISRCTN06149665) to evaluate an intervention for carers of inpatients with AN. WP4 used actimetry, self-report and endocrine assessment to examine physical activity (PA) in AN. WP5 conducted a RCT (ISRCTN18274621) of an e-mail-guided relapse prevention programme for inpatients with AN. WP6 analysed cohort data to examine the effects of maternal EDs on fertility and their children’s diet and growth. WP7a examined clinical case notes to explore how access to specialist ED services affects care pathways and user experiences. Finally, WP7b used data from this programme and the British Cohort Study (1970) to identify the costs of services used by people with AN and to estimate annual costs of AN for England.ResultsWP1a: a brief training programme improved knowledge, attitudes and confidence of school staff in managing EDs in school. WP1b: a teacher-delivered intervention was feasible and improved risk factors for EDs in adolescent girls. WP2a: both psychological therapies improved outcomes in outpatients with AN similarly, but patients preferred one of the treatments. WP2b: the inpatient treatment (Cognitive Remediation and Emotional Skills Training) was acceptable with perceived benefits by patients, but showed no benefits compared with treatment as usual (TAU). WP3: compared with TAU, the carer intervention improved a range of patient and carer outcomes, including carer burden and patient ED symptomatology. WP4: drive to exercise is tied to ED pathology and a desire to improve mood in AN patients. PA was not increased in these patients. WP5: compared with TAU, the e-mail-guided relapse prevention programme resulted in higher body mass index and lower distress in patients at 12 months after discharge. WP6: women with an ED had impaired fertility and their children had altered dietary and growth patterns compared with the children of women without an ED. WP7a: direct access to specialist ED services was associated with higher referral rates, lower admission rates, greater consistency of care and user satisfaction. WP7b: the annual costs of AN in England are estimated at between £45M and £230M for 2011.ConclusionsThis programme has produced evidence to inform future intervention development and has developed interventions that can be disseminated to improve outcomes for individuals with AN. Directions for future research include RCTs with longer-term outcomes and sufficient power to examine mediators and moderators of change.Trial registrationCurrent Controlled Trials ISRCTN42594993, ISRCTN67720902, ISRCTN06149665 and ISRCTN18274621.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ulrike Schmidt
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Helen Sharpe
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Savani Bartholdy
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Eva-Maria Bonin
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Helen Davies
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Abigail Easter
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Institute of Child Health, University College London, London, UK
| | - Elizabeth Goddard
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Rebecca Hibbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jennifer House
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Alexandra Keyes
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Pooky Knightsmith
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Antonia Koskina
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Nicholas Magill
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jessica McClelland
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Nadia Micali
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Institute of Child Health, University College London, London, UK
| | - Simone Raenker
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Bethany Renwick
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Charlotte Rhind
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Lot Sternheim
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sabine Woerwag-Mehta
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jennifer Beecham
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Iain C Campbell
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ivan Eisler
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sabine Landau
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Helen Startup
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Predictors and long-term health outcomes of eating disorders. PLoS One 2017; 12:e0181104. [PMID: 28700663 PMCID: PMC5507321 DOI: 10.1371/journal.pone.0181104] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/25/2017] [Indexed: 12/12/2022] Open
Abstract
Anorexia and bulimia nervosa may have long-term effects on overall and reproductive health. We studied predictors of self-reported eating disorders and associations with later health events. We estimated odds ratios (ORs) for these associations in 47,759 participants from the Sister Study. Two percent (n = 967) of participants reported a history of an eating disorder. Risk factors included being non-Hispanic white, having well-educated parents, recent birth cohort (OR = 2.16, 95% confidence interval [CI]: 2.01–2.32 per decade), and having a sister with an eating disorder (OR = 3.68, CI: 1.92–7.02). As adults, women who had experienced eating disorders were more likely to smoke, to be underweight, to have had depression, to have had a later first birth, to have experienced bleeding or nausea during pregnancy, or to have had a miscarriage or induced abortion. In this descriptive analysis, we identified predictors of and possible long-term health consequences of eating disorders. Eating disorders may have become more common over time. Interventions should focus on prevention and mitigation of long-term adverse health effects.
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McAllister-Williams RH, Baldwin DS, Cantwell R, Easter A, Gilvarry E, Glover V, Green L, Gregoire A, Howard LM, Jones I, Khalifeh H, Lingford-Hughes A, McDonald E, Micali N, Pariante CM, Peters L, Roberts A, Smith NC, Taylor D, Wieck A, Yates LM, Young AH. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol 2017; 31:519-552. [PMID: 28440103 DOI: 10.1177/0269881117699361] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Decisions about the use of psychotropic medication in pregnancy are an ongoing challenge for clinicians and women with mental health problems, owing to the uncertainties around risks of the illness itself to mother and fetus/infant, effectiveness of medications in pregnancy and risks to the fetus/infant from in utero exposure or via breast milk. These consensus guidelines aim to provide pragmatic advice regarding these issues. They are divided into sections on risks of untreated illness in pregnancy; general principles of using drugs in the perinatal period; benefits and harms associated with individual drugs; and recommendations for the management of specific disorders.
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Affiliation(s)
- R Hamish McAllister-Williams
- 1 Institute of Neuroscience, Newcastle University, Newcastle, UK.,2 Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David S Baldwin
- 3 Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,4 University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Abby Easter
- 6 Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eilish Gilvarry
- 2 Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.,7 Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Vivette Glover
- 8 Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Lucian Green
- 9 Ealing, Hounslow, Hammersmith & Fulham Perinatal Mental Health Service, West London Mental Health Trust, London, UK
| | - Alain Gregoire
- 3 Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,10 Hampshire Perinatal Mental Health Service, Winchester, UK
| | - Louise M Howard
- 11 Section of Women's Mental Health, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,12 South London and Maudsley NHS Foundation Trust, London, UK
| | - Ian Jones
- 13 National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Hind Khalifeh
- 11 Section of Women's Mental Health, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,12 South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Elizabeth McDonald
- 15 Royal College of Psychiatrists, London, UK.,16 East London Foundation Trust, London, UK.,17 Tavistock and Portman NHS Foundation Trust, London, UK
| | - Nadia Micali
- 18 Behavioural and Brain Sciences Unit, GOSH Institute of Child Health, University College London, London, UK
| | - Carmine M Pariante
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,19 Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Ann Roberts
- 20 St Martin's Healthcare Services CIC, Leeds, UK.,21 Hertfordshire Partnership University NHS Foundation Trust, Hatfield, Hertfordshire, UK.,22 Postgraduate School of Medicine, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Natalie C Smith
- 23 Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, County Durham, UK
| | - David Taylor
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,24 Institute of Pharmaceutical Science, King's College London, London, UK
| | - Angelika Wieck
- 25 Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.,26 University of Manchester, Manchester, UK
| | - Laura M Yates
- 27 UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,28 Institute of Genetic Medicine, Newcastle University, Newcastle, UK
| | - Allan H Young
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,19 Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Nguyen AN, de Barse LM, Tiemeier H, Jaddoe VWV, Franco OH, Jansen PW, Voortman T. Maternal history of eating disorders: Diet quality during pregnancy and infant feeding. Appetite 2016; 109:108-114. [PMID: 27889494 DOI: 10.1016/j.appet.2016.11.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/09/2016] [Accepted: 11/22/2016] [Indexed: 02/06/2023]
Abstract
We studied associations of maternal history of eating disorders (EDs) with diet quality of pregnant women and their infants, and breastfeeding practices. We included 6196 mother-child pairs from Generation R, a population-based cohort in the Netherlands. Maternal history of lifetime EDs was assessed during pregnancy with a questionnaire. Dietary intake during pregnancy and in infancy was assessed with food-frequency questionnaires and diet quality scores were calculated, reflecting adherence to dietary guidelines. Breastfeeding practices were assessed with questionnaires at 2, 6, and 12 months. We observed that, after adjustment for socioeconomic and lifestyle factors, women with a history of EDs had a higher diet quality than women without a history of EDs (B = 0.24 SD, 95%CI: 0.15; 0.33). Mothers with a history of EDs were less likely to breastfeed (unadjusted OR = 0.68, 95%CI: 0.51; 0.93), although no longer statistically significant after adjustment (OR = 0.75, 95%CI: 0.55; 1.03). These findings suggest that mothers with a history of EDs seem slightly less likely to initiate breastfeeding, however, this warrants further investigation. At the age of 1 year, infants of mothers with a history of EDs had a higher diet quality (B = 0.15 SD, 95%CI: 0.02; 0.27). We conclude that mothers with a history of EDs and their infants have a relative good diet quality, although follow-up studies are needed to assess long-term associations with diet in later childhood and adolescence.
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Affiliation(s)
- Anh N Nguyen
- Department of Epidemiology, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Lisanne M de Barse
- Department of Epidemiology, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands; The Generation R Study Group, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry / Psychology, Erasmus MC-University Medical Center, PO Box 2060, 3000 CB Rotterdam, The Netherlands; Department of Psychiatry, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- Department of Epidemiology, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands; The Generation R Study Group, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Department of Pediatrics, Erasmus MC-University Medical Center, PO Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Pauline W Jansen
- Department of Child and Adolescent Psychiatry / Psychology, Erasmus MC-University Medical Center, PO Box 2060, 3000 CB Rotterdam, The Netherlands; Institute of Psychology, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands; The Generation R Study Group, Erasmus MC-University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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Boisseau CL. Identification and management of eating disorders in gynecology: menstrual health as an underutilized screening tool. Am J Obstet Gynecol 2016; 215:572-578. [PMID: 27422054 DOI: 10.1016/j.ajog.2016.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/18/2016] [Accepted: 07/05/2016] [Indexed: 02/01/2023]
Abstract
Eating disorders are life-threatening conditions that disproportionately affect females, often during child-bearing years. Although the endocrinological and reproductive sequelae of these conditions often fall within the treatment purview of obstetrician-gynecologists, the assessment of eating pathology is challenging and often not part of routine clinical care. This commentary focuses on one of the common presenting symptoms of eating disorders in women, menstrual dysfunction, and discusses considerations for its clinical management in gynecology. Assessment of menstrual status provides a natural starting point for provider-patient discussion of disordered eating and weight behavior. Routine screening for eating disorders is critical and must be universal given the serious long-term consequences of these disorders.
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O'Brien KM, Whelan DR, Sandler DP, Weinberg CR. Eating Disorders and Breast Cancer. Cancer Epidemiol Biomarkers Prev 2016; 26:206-211. [PMID: 27756775 DOI: 10.1158/1055-9965.epi-16-0587] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/21/2016] [Accepted: 09/23/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Eating disorders such as anorexia nervosa and bulimia nervosa affect overall and reproductive health and may also affect breast cancer risk. We studied the association between self-reported eating disorders and breast cancer risk in a prospective cohort study. METHODS In 2003-2009, the Sister Study enrolled women ages 35-74 years who had a sister with breast cancer but had never had it themselves. Using data from 47,813 women, we estimated adjusted HRs and 95% confidence intervals (CI) for the association between eating disorders and invasive breast cancer over a median of 5.4 years of follow-up. RESULTS Three percent (n = 1,569) of participants reported a history of an eating disorder. Compared with women who never had an eating disorder, women who reported eating disorders in the past had reduced breast cancer risk (HR = 0.62; 95% CI, 0.42-0.92). CONCLUSIONS In this large prospective, observational cohort study, we observed an inverse association between having a history of an eating disorder and invasive breast cancer. IMPACT Historical eating disorders may be associated with a long-term reduction in breast cancer risk. Cancer Epidemiol Biomarkers Prev; 26(2); 206-11. ©2016 AACR.
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Affiliation(s)
- Katie M O'Brien
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Denis R Whelan
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina.,Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Clarice R Weinberg
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina.
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43
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Eating disorders in children and adolescents: what does the gynecologist need to know? Curr Opin Obstet Gynecol 2016; 28:381-92. [DOI: 10.1097/gco.0000000000000317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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44
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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; 89:308-23. [PMID: 26493834 DOI: 10.1111/papt.12076] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 07/12/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to examine in depth the individual experience of transition from pregnancy to motherhood, among women with current eating disorders (EDs), focusing on differences between the first and subsequent pregnancies. DESIGN AND METHODS We analysed the narratives of 12 women with severe ED during pregnancy using interpretative phenomenological analysis. We employed a sequential structure, and the emerging themes were ordered according to consecutive pregnancy stages. RESULTS Our results indicate that experiences of pregnancy vary across pregnancy stages and in the first pregnancy compared to subsequent pregnancies. In particular, during their first pregnancy women with an ED seem to experience an inner conflict and questioned the continuity of their ED identity leading them to be more open to change. CONCLUSIONS The first pregnancy, during its early stages, should be considered a potentially unique window for intervention for women with current ED. PRACTITIONER POINTS Eating disorders (EDs) are known to seriously affect fertility, pregnancy, and pregnancy outcomes. Our research sheds a light on experiences of pregnancy in women with ED and ultimately helps to define a window for intervention. Our findings have important implications in understanding mechanisms of relapse in the post-partum period and consequently could help in tailoring an adequate intervention for women with ED and in preventing ED relapse.
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Affiliation(s)
- Emma Taborelli
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College of London, UK
| | - Abigail Easter
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College of London, UK
| | - Rosalind Keefe
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College of London, UK
| | - Ulrike Schmidt
- Eating Disorders Research Unit, Institute of Psychiatry, King's College London, UK
| | - Janet Treasure
- Eating Disorders Research Unit, Institute of Psychiatry, King's College London, UK
| | - Nadia Micali
- Behavioural and Brain Sciences Unit, Institute of Child Health, University College of London, UK
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45
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Larsen PS, Nybo Andersen AM, Olsen EM, Micali N, Strandberg-Larsen K. What's in a Self-report? A Comparison of Pregnant Women with Self-reported and Hospital Diagnosed Eating Disorder. EUROPEAN EATING DISORDERS REVIEW 2016; 24:460-465. [DOI: 10.1002/erv.2464] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/11/2016] [Accepted: 07/04/2016] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Else Marie Olsen
- Section of Social Medicine, Department of Public Health; University of Copenhagen; Denmark
| | - Nadia Micali
- Behavioral and Brain Sciences Unit; University College London, Institute of Child Health; UK
- Department of Psychiatry; Icahn School of Medicine at Mount Sinai; New York NY USA
- Mindich Child Health and Development Institute; Icahn School of Medicine at Mount Sinai; New York NY USA
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46
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Kimmel M, Ferguson E, Zerwas S, Bulik C, Meltzer-Brody S. Obstetric and gynecologic problems associated with eating disorders. Int J Eat Disord 2016; 49:260-75. [PMID: 26711005 PMCID: PMC5683401 DOI: 10.1002/eat.22483] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This article summarizes the literature on obstetric and gynecologic complications associated with eating disorders. METHOD We performed a comprehensive search of the current literature on obstetric and gynecologic complications associated with eating disorders using PubMed. More recent randomized-controlled trials and larger data sets received priority. We also chose those that we felt would be the most relevant to providers. RESULTS Common obstetric and gynecologic complications for women with eating disorders include infertility, unplanned pregnancy, miscarriage, poor nutrition during pregnancy, having a baby with small head circumference, postpartum depression and anxiety, sexual dysfunction and complications in the treatment for gynecologic cancers. There are also unique associations by eating disorder diagnosis, such as earlier cessation of breastfeeding in anorexia nervosa; increased polycystic ovarian syndrome in bulimia nervosa; and complications of obesity as a result of binge eating disorder. DISCUSSION We focus on possible biological and psychosocial factors underpinning risk for poor obstetric and gynecological outcomes in eating disorders. Understanding these factors may improve both our understanding of the reproductive needs of women with eating disorders and their medical outcomes. We also highlight the importance of building multidisciplinary teams to provide comprehensive care to women with eating disorders during the reproductive years.
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Affiliation(s)
- M.C. Kimmel
- Department of Psychiatry, University of North Carolina-Chapel Hill Chapel Hill, North Carolina,Correspondence to: M.C. Kimmel, Department of Psychiatry, University of North Carolina-Chapel Hill Chapel Hill, North Carolina.
| | - E.H. Ferguson
- Department of Psychiatry, University of North Carolina-Chapel Hill Chapel Hill, North Carolina
| | - S. Zerwas
- Department of Psychiatry, University of North Carolina-Chapel Hill Chapel Hill, North Carolina
| | - C.M. Bulik
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - S. Meltzer-Brody
- Department of Psychiatry, University of North Carolina-Chapel Hill Chapel Hill, North Carolina
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47
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Micali N, Stemann Larsen P, Strandberg-Larsen K, Nybo Andersen AM. Size at birth and preterm birth in women with lifetime eating disorders: a prospective population-based study. BJOG 2015; 123:1301-10. [DOI: 10.1111/1471-0528.13825] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2015] [Indexed: 11/27/2022]
Affiliation(s)
- N Micali
- Behavioural and Brain Sciences Unit; Institute of Child Health; UCL; London UK
- Department of Psychiatry and Mindich Child Health and Development Institute; Icahn Medical School at Mount Sinai; New York NY USA
| | - P Stemann Larsen
- Section of Social Medicine; Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - K Strandberg-Larsen
- Section of Social Medicine; Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - A-M Nybo Andersen
- Section of Social Medicine; Department of Public Health; University of Copenhagen; Copenhagen Denmark
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48
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Barbosa Magalhaes I, Corcos M, Pham Scottez A. Pompe à GnRH : la grossesse à l’épreuve de l’anorexie mentale ? Eur Psychiatry 2015. [DOI: 10.1016/j.eurpsy.2015.09.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Il est fréquent de penser que les femmes souffrant de trouble des conduites alimentaires (TCA) ne peuvent pas être enceintes (aménorrhée, irrégularités du cycle ovulatoire), mais plusieurs études [1–3] révèlent un nombre croissant de femmes souffrant d’un TCA parmi la population ayant recours aux divers traitements de l’infertilité. La stimulation ovarienne par pompe à GnRH est l’un des traitements de l’infertilité, étant très efficace avec un taux de réussite de 91,8 % , il a été conçu pour les femmes présentant une aménorrhée de type hypothalamohypophysaire, dont les deux principales causes sont le syndrome de Kalmann et un apport calorique insuffisant. L’objectif de cette étude est de diagnostiquer la prévalence d’un TCA parmi une population de femmes ayant recours à la pompe à GnRH. Nous avons créé un groupe « étude » constitué de femmes sous ce type de traitement, et un groupe « contrôle », constitué de femmes sous traitement par d’autres méthodes de procréation médicalement assistée (PMA). Nous avons utilisé le « Composite International Diagnostic Interview » (CIDI), un hétéro-questionnaire capable de diagnostiquer la présence d’un TCA, actuel ou passé. Chaque groupe est constitué de 21 patientes. Parmi les femmes en traitement sous pompe à GnRH, 20 sur 21 présentent un diagnostic positif de TCA, soit 95,2 % du groupe. Parmi celles traitant leur infertilité par d’autres méthodes de PMA, ce diagnostic a été établi chez seulement 5, soit 23,8 % du groupe (p = 0,00002). En conclusion de cette étude, nous souhaitons alerter la communauté scientifique et médicale : la périnatalité chez les femmes souffrant d’un TCA est un enjeu de santé publique. Il nous paraît nécessaire d’effectuer un dépistage dans les PMA et l’accès de ces femmes doit être réfléchi en cas d’un TCA actif. De plus, nous recommandons la mise en place d’équipes multidisciplinaires spécialisées pour les accompagner pendant le processus de périnatalité/maternité.
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49
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Mustelin L, Raevuori A, Bulik CM, Rissanen A, Hoek HW, Kaprio J, Keski-Rahkonen A. Long-term outcome in anorexia nervosa in the community. Int J Eat Disord 2015; 48:851-9. [PMID: 26059099 DOI: 10.1002/eat.22415] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 02/27/2015] [Accepted: 03/27/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Few studies have assessed outcomes of anorexia nervosa (AN) outside clinical settings. We aimed to assess mortality, recovery, and socio-demographic outcomes of AN in a community sample. METHOD Women in the nationwide FinnTwin16 cohort (born 1975-1979) were followed for 10 years after baseline diagnostic assessment (mean age at follow-up 34 years, N = 2188). We compared women with lifetime DSM-IV AN (N = 40) with unaffected women from the same cohort. RESULTS None of the women with AN had died and 88% were weight-recovered (BMI ≥ 18.5 kg/m(2) ), but their mean BMI (22.0 kg/m(2) ) was lower than among unaffected women (24.0 kg/m(2) , p = 0.008). University degrees (38 vs. 29%, p = 0.26), sickness absence during the past year (median 5 vs. 3 days, p = 0.21), or unemployment or disability pension (5 vs. 4%, p = 0.62) did not significantly differ between AN probands and their unaffected peers. More women with AN were still studying (15 vs. 4%, p = 0.003), and half of them had children, as compared to 66% of unaffected women (p = 0.05). DISCUSSION The long-term prognosis of AN in the community appears promising. Weight-restoration is common and socio-demographic outcomes are generally favorable. However, women with a history of AN may be less likely to have children.
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Affiliation(s)
- Linda Mustelin
- Department of Public Health, University of Helsinki, Finland.,Departments of Psychiatry and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anu Raevuori
- Department of Public Health, University of Helsinki, Finland.,Department of Adolescent Psychiatry, Helsinki University Central Hospital, Helsinki, Finland.,Institute of Clinical Medicine, Child Psychiatry, University of Turku, Finland.,National Institute for Health and Welfare, Helsinki, Finland
| | - Cynthia M Bulik
- Departments of Psychiatry and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Aila Rissanen
- Department of Psychiatry, Helsinki University Central Hospital, Finland
| | - Hans W Hoek
- Parnassia Psychiatric Institute, The Hague, The Netherlands.,Department of Psychiatry, Groningen University, The Netherlands.,Department of Epidemiology, Columbia University, New York
| | - Jaakko Kaprio
- Department of Public Health, University of Helsinki, Finland.,National Institute for Health and Welfare, Helsinki, Finland.,Institute for Molecular Medicine Finland FIMM, University of Helsinki, Finland
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Assens M, Ebdrup NH, Pinborg A, Schmidt L, Hougaard CO, Hageman I. Assisted reproductive technology treatment in women with severe eating disorders: a national cohort study. Acta Obstet Gynecol Scand 2015; 94:1254-61. [DOI: 10.1111/aogs.12727] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 08/04/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Maria Assens
- Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - Ninna H. Ebdrup
- Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - Anja Pinborg
- Department of Obstetrics & Gynecology; University of Copenhagen; Hvidovre Hospital; Hvidovre Denmark
| | - Lone Schmidt
- Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | | | - Ida Hageman
- Psychiatric Center Copenhagen; Copenhagen University Hospital; Copenhagen Denmark
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