Bulik and coworkers (2009) studied pregnancy outcomes in almost 36,000 Norwegian women screened for eating disorders. Approximately 0.1 percent had anorexia nervosa, 0.85 percent had bulimia nervosa, and 5.1 percent reported a binge-eating disorder. This 6-percent pregnancy prevalence is similar to the 6-month prevalence for nonpregnant individuals (National Institute of Mental Health, 2016). he last subtype had a higher risk for large-for-gestational age neonates with a concomitantly increased cesarean delivery rate. All eating disorders begin with the desire to be slim, and women with chronic eating disorders may migrate between subtypes (Andersen, 2009).
Early pregnancy complication rates are increased with both eating disorders, but especially in women with bulimia nervosa (Andersen, 2009; Hofman, 2011). Generally, eating disorder symptoms improve during pregnancy, and remission rates may reach 75 percent. In contrast, typical cases of hyperemesis gravidarum may actually be a new or relapsing case of bulimia nervosa or of binge-purge type anorexia nervosa (Torgerson, 2008). As perhaps expected, anorexia is associated with low-birthweight neonates (Micali, 2007). Additional risks associated with eating disorders include poor wound healing and diiculties with breastfeeding (Andersen, 2009). At a minimum, closely monitoring gestational weight gain in women with a suspected history of an eating disorder seems prudent.
Care for these women involves a multidisciplinary team that includes an obstetrician, mental health provider, and either dietician or nutritionist (American Dietetic Association, 2006).
Psychological treatment is the cornerstone for treatment in women with eating disorders and frequently includes cognitivebehavioral therapy. Anorexia nervosa oten responds to motivational interactions with meal planning (Cardwell, 2013). After delivery, women with eating disorders are more prone to postpartum depression. Women with bulimia are at particular risk for disease rebound ater delivery because of body image concerns.
hese disorders are characterized by the chronic use of certain coping mechanisms in an inappropriate, stereotyped, and maladaptive manner. hey are rigid and unyielding personality traits. The American Psychiatric Association (2013) recognizes three clusters of personality disorders: 1.
Paranoid, schizoid, and schizotypal personality disorders, which are characterized by oddness or eccentricity.
2.
Histrionic, narcissistic, antisocial, and borderline disorders, which are all characterized by dramatic presentations along with self-centeredness and erratic behavior.
3.
Avoidant, dependent, compulsive, and passive-aggressive personalities, which are characterized by underlying fear and anxiety.
Genetic and environmental factors are important in the genesis of these disorders, whose prevalence may be as high as 20 percent. lthough management is through psychotherapy, most afected individuals do not recognize their problem, and thus only 20 percent seek help. In an observational study of 202 women with borderline personality disorder, De Genna during the most severe trajectory of their illness. hey are at increased risk for teen and unintended pregnancies.
Personality disorders during pregnancy are probably no diferent than in nonpregnant women. Akman and colleagues (2007) reported that avoidant, dependent, and obsessive-compulsive disorders are associated with an excessive prevalence of postpartum major depression. Magnusson and associates (2007) found a link between some personaliy traits-not disordersand excessive alcohol consumption, but not necessarily addiction or dependence. Conroy and coworkers (2010) found that a mother's ability to care for her newborn was impaired only when a personality disorder was coupled with depression.