Family Matters

Why are Anorexics More Likely to Have Unplanned Pregnancies and Abortions?

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Many women — and doctors too — believe that women with anorexia stop menstruating. First of all, that’s not true. And secondly, here’s a quick fertility refresher: just because a woman doesn’t get her period doesn’t mean she’s not ovulating.

Still, it’s likely that fertility misconceptions — pardon the pun — are behind the results of new research published in the November issue of the journal Obstetrics & Gynecology that shows women with anorexia nervosa are far more likely to have unplanned pregnancies and abortions. (More on Family-Focused Therapy Works Better for Teens with Eating Disorders)

Researchers studied 62,060 women who participated in the Norwegian Mother and Child Cohort Study. Just 62 women identified themselves as anorexic. Half reported unplanned pregnancies, compared to 19% in the women without eating disorders; 24% of the anorexic women said they’d had an abortion, in comparison to 15% in the other group. The anorexic women were also younger than the other women when they delivered babies: 26.2 versus 29.9 years old.

“It wasn’t just a subtle difference,” says Cynthia Bulik, the study’s lead author and director of the eating disorders program at the University of North Carolina at Chapel Hill. “It was really a whopping difference. We have got a public health message we’ve got to get out there.” (More on Do Parents Discriminate Against Their Own Chubby Children?)

That message — that anorexic women, who make up 1% of the U.S. population, can and do get pregnant — needs to be targeted to three audiences: the women, their partners and their physicians.

“Some of the most severe cases of anorexia I’ve seen have continued to have periods,” says Bulik, who says it’s not known why some anorexics cease menstruating while others continue. Amennhorea, or lack of menstruation, is currently a diagnostic criterion for anorexia nervosa.  But when the next iteration of the handbook of psychiatric illness, the Diagnostic and Statistical Manual of Mental Disorders (DSM), is completed in 2013, that may no longer be the case. “It’s probably going to change because it’s such an unreliable indication,” says Bulik. (More on Orthorexia: Can Healthy Eating Be a Disorder?)

As for babies born to anorexic women, the data on outcomes is all over the map. In general, they have smaller babies and more birth complications and tend to give up breast-feeding earlier. The moms-to-be, not surprisingly, rarely gain adequate weight. They need extra support and counseling, from the time before they get pregnant until well into the post-partum period. One program trying to address that need is Nurture, a pilot program run by clinicians at UNC and Virginia Commonwealth University for moms with a history of eating disorders. The moms learn about parenting and, in particular, about how to feed their children. “There are plenty of moms who dilute formula or give kids who are way too young skim milk because they’re so worried about excess weight gain in their children,” says Bulik. “They’re so worried about passing eating disorders on to their children that they’ve lost their compass.

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