Let's consider eating disorders and pregnancy. This may seem like a rather bizarre discussion topic for someone with all the maternal instincts of King Herod, but recent events at work sparked my interest in this topic. My inspiration was the fact that a number of patients (eight at the last count) have become pregnant over the last few months, and the only thing other than an eating disorder linking them, has been the fact that they've all seen the same ( female!) therapist.
Assuming the therapist in question is not an undeclared fertility goddess, and so ruling her out as the missing link, I wanted to know whether this incidence was normal amongst eating disordered patients. Available literature in recent years provided some interesting facts, ranging from the use of repeated pregnancies and abortions to provide a similar function to bingeing and vomiting (El-Mallakh and Tasman 1991) to the effects an eating disorder can have on mother and child (see below), but was unable to provide rates.
The majority of eating disordered patients tend to be female and of childbearing age, so we should perhaps not be surprised by a high incidence of pregnancy in this population. There is a tendency to assume that anorexics cannot become pregnant as their amenorrhea implies anovulation. However, pregnancy without return of menstruation has been reported many times. Anorexia nervosa is not an infallible contraceptive. For instance, Bonne et al. (1996) report two cases where a diagnosis of anorexia led to delayed recognition of pregnancy, because the bloated abdomen, amenorrhea, nausea, vomiting and fatigue were assumed to be symptoms of anorexia. In one, the unwanted pregnancy was not identiยฎed until after the cut-off for a termination, causing the patient considerable distress.
In anorexia sufferers, where the pregnancy is recognized and wanted, various complications for both mother (inadequate weight gain, miscarriage) and child (low birth weight, delayed development, or premature births) can occur (Franko and Walton 1993). One study reports twice the expected rate of prematurity, and six times the expected rate of prenatal mortality (Brinch et al., 1988), in an anorexic population where 72 per cent had recovered.