Eating disorders symptoms in pregnancy: A longitudinal study of women with recent and past eating disorders and obesity

Abstract

Objective

To determine the impact of pregnancy on eating disorders (ED) symptoms using data from a large prospective, community-based cohort study.

Methods

Women (12,254) were classified according to whether they had a recent or past history of ED, were obese before pregnancy, or constituted part of the general population control group. We evaluated self-induced vomiting (SIV), laxative use, exercise behavior, and appraisals about weight gain during pregnancy, as well as dieting, and shape and weight concern before and during pregnancy.

Results

Women with a recent episode of ED dieted, used laxatives, reported SIV, and exercised more than other groups during pregnancy. They were also more likely to report ED cognitions in pregnancy and their weight and shape concern scores remained high during pregnancy. Women with past ED were also more likely than controls to have some ED behaviors and/or concerns about weight gain during pregnancy.

Conclusions

Women with a recent ED continued to have some ED symptoms in pregnancy, albeit fewer compared to before pregnancy. Although at a lower level, women with a past history of ED also had ED symptoms in pregnancy. Screening for ED symptoms during pregnancy may provide a useful opportunity for engagement in treatment and to reduce behaviors that might be detrimental to the foetus.

Introduction

Eating disorders (ED) affect about 5–7% of women of child-bearing age. Previous studies have tried to clarify the impact of pregnancy on ED symptoms; however, this largely remains unclear. Two different hypotheses have been postulated and have resulted from previous literature. The first is that eating behaviors (and associated symptoms if relevant) will improve during the early part of the pregnancy because of concern for the well-being of the foetus. The second is that the weight gain during pregnancy may exacerbate or rekindle latent weight and shape concerns which may lead to a relapse of the ED in the post-partum period.

In general, previous studies have shown a decrease in ED symptoms between the first and third trimester of pregnancy in women with an active ED at conception (in particular bulimia nervosa—BN) [1], [2], [3]. One study on 15 women with ED, however, reported a worsening or continuation of symptoms in pregnancy in women with either anorexia nervosa (AN) or BN who were symptomatic at conception [4].

Three recent longitudinal studies followed up women treated for ED. One investigated women who had received treatment for AN (26 pregnancies) and BN (56 pregnancies), some of whom had an active ED at conception [5] and found that in the majority of cases bulimic symptoms improved during pregnancy and for a period of time after the birth. However, some ED behaviors did not change significantly, i.e., self-induced vomiting (SIV), overconcern with body image, compulsive exercise, and restrictive eating. ED symptoms did not decrease during pregnancy in women with AN. The other two studies followed up women who had received treatment for BN and investigated the changes in bulimic symptoms during pregnancy. In one, although bingeing and purging improved during pregnancy, the number of women completely abstinent from these behaviors did not change with pregnancy and body dissatisfaction worsened during pregnancy [6]. The second reported a nonsignificant decrease in ED symptomatology in the year of childbirth, with a trend towards lower levels of symptomatology [7].

Most studies in the literature are difficult to interpret as they rely on small samples, with heterogeneous, poorly described cases, and often use retrospective outcome measures or reports of ED symptomatology. There are many unanswered questions: there is little information on pregnancy outcomes in women with AN and it is uncertain what the outcomes are for women with a past vs. a recent history of ED. Moreover, only one study has compared women with ED to control subjects.

This study sought to examine the presence in pregnancy of ED behaviors, as well as levels of shape and weight concern in women with a recent episode of ED, women with a past history of ED, and obese and nonobese controls. Our secondary aim was to compare the risk of occurrence of ED behaviors and cognitions in pregnancy amongst subgroups of women with different ED. In order to do so we used data from a well-characterized longitudinal cohort (the Avon Longitudinal Study of Parents and Children—ALSPAC). The inclusion of an obese control group aimed to determine whether the effect of pregnancy on eating behaviors and weight and shape concerns is specific to eating disordered women or shared by women at high risk for weight and shape concern (obese women). We hypothesized that women with a recent episode of ED would be more likely to report ED behaviors in pregnancy compared to other groups; and that obese women would have lower rates of ED behaviors. We also hypothesized that women with recent and past ED and obese women would report similar levels of weight and shape concern and abnormal cognitions about weight gain in pregnancy. We also hypothesized that amongst women with ED, women with recent AN or BN would be more likely to report ED symptoms and cognitions compared to women with past AN or BN.