Anorexia in pregnancy - TOG article Flashcards
What is the increase in perinatal mortality rate in women with anorexia nervosa?
6x
What is the prevalence of anorexia nervosa?
0.3-1%
Sub-threshold - 5-7%
Ratio 9:1 female:male
What are the hormonal changes seen in anorexia nervosa?
Low gonadotrophins Low oestrogen Higher cortisol (2dry to prolonged fasting)
What is the mortality rate of anorexia nervosa?
5% per decade
What are the pernatal epigenetic risk factors for anorexia nervosa?
Prematurity SGA Birth trauma Maternal PET Placental infarction Neonatal cardiac problems Hyporeactivity
What are the fetal effects of women in remission at conception or mild disease pre-pregnancy?
Tend to have uncompicated pregnancies but body image dissatisfaction likely to remain high
What is the relapse rate in pregnancy and what factors make it more likely?
22% in one study
Lower educational attainment
Hx of miscarriage
Active disease at conception
What are the spontaneous/clomiphene pregnancy rates?
83% spontaneous
17% clomid
small study
What are the antenatal effects of anorexia nervosa on pregnancy?
Late diagnosis of pregnancy HG and VTE associated FGR in T3 - if poor mat weight gain; catch up growth PN Anxiety Anaemia Fetal abnormality Miscarriage (30vs16%) PROM
What are the intrapartum effects of anorexia nervosa on pregnancy?
Increased c/s rate (esp active disease)
Lower rate instrumental
Problems with epis repair
What are the postpartum effects of anorexia nervosa on pregnancy?
2/3 return to pre-pregnancy symptoms by 6-9/12
40% have comorbid affective disorder
>90% problem with bonding (maladjustment) 13% control
Difficulties breastfeeding
Which MDT members should be involved in the care of women with anorexia nervosa?
Obs MW and GP Eating disorder specialist Dietician Perinatal mental health team Obs anaesthetist Imaging specialist
What do NICE recommend as the screening questions for anorexia nervosa at booking?
Do you think you have eating problems?
Do you worry excessively about your weight?
By how much should women with anorexia nervosa increase their calorie intake?
350kcal/day in T2
500kcal/day in T3
What antenatal/intrapartum care should women have with anorexia nervosa?
Baseline bloods - liver, pancreas, renal Serial USS Obs anaesthetic review Medication review Psychotherapy May require SSRI if appropriate C/S only for obstetric reasons Consider IV rehydration Care when dosing drugs e.g. GA/LA
