Unplanned Pregnancy in Women With Anorexia Nervosa

Abstract

Objective To compare the frequency with which unplanned pregnancies occur in individuals with anorexia nervosa (AN) relative to women without eating disorders in the large Norwegian Mother and Child Cohort Study. Method In a sample of 62,060 women, 62 reported AN. Using data from a questionnaire completed by all participating mothers, we compared mother’s age at birth and the frequency with which mothers reported their index pregnancy as being unplanned. Results AN women were younger (26.2 years; SD=4.76) than women with no eating disorder (29.9 years; SD=4.60) at the time of birth. Significantly more women with AN (50.0%) reported unplanned pregnancy than women in the referent group (18.9%). After adjustment for maternal age and infertility treatment, the relative risk (RR) of unplanned pregnancy in individuals with AN was 2.11 (95% confidence interval [CI]=1.64–2.72). Induced abortion was also significantly more common in women with AN than referent women (24.2% versus 14.6%). Conclusion The higher rate of unplanned pregnancy and abortion in women with AN is of clinical concern as absent or irregular menstruation may be misinterpreted as decreasing risk of pregnancy.

Eating disorders, pregnancy, and the postpartum period:Findings from the Norwegian Mother and Child Cohort Study (MoBa)

“…In less developed countries, abortion practices to manage unintended pregnancies may not be accessible or may be unsafe. A MoBa investigation by our group (27) found a greater than two-fold higher rate of unintended pregnancies among women with AN compared with referent women. One possible reason for this may be that health professionals and patients assume incorrectly that pregnancy cannot occur in the context of absent or irregular menstruation leading to lower contraception use (28).…”

“…This may preprogram metabolism and neurotransmission in offspring, although offspring growth rates in infancy were not higher (55). Another important finding from MoBa research has been the higher prevalence of unintended pregnancies among women with AN pre-pregnancy relative to women in the general population (27). …”

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

“…Despite the association between EDs and fertility difficulties, women with a history of EDs are often still able to conceive (Bulik et al, 2010), and are more likely to identify a pregnancy as unintended (Watson et al, 2014). It is important to note that both biological and social mechanisms shape reproductive choices and outcomes of women with EDs (Barber, 2000; Newson, Postmes, Lea, & Webley, 2005).…”

British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017

“…. (Newport et al, 2005) National Institute for Health and Care Excellence, 2014 (Bulik et al, 2010;Easter et al, 2011;Micali et al, 2014). Routine pre-conception advice and psycho-education should therefore be provided.…”