What is the effect of maternal eating disorders on pregnancy outcome,
birth defects and developmental delays?
Kristle Neuhalfen, PA-S and Patricia Bunton, MS, PA-C
Department of Physician Assistant
College of Health Professions, Wichita State University
INTRODUCTION
RESULTS
DISCUSSION
The prenatal period is critical in determining the quality
of fetal development as well as how the infant
responds and develops outside of the womb after
birth.
Factors such as physical and emotional
maternal stress and substance abuse during
pregnancy have all been linked to increase risk of
harm to an infant during development. During critical
times of prenatal development certain physiologic
structures and systems are considered to be highly
plastic and easily influenced by the environment the
mother provides for the fetus.
After periods of
plasticity have passed, certain stages in the child’s
development are anatomically fixed. A birth defect is
something that develops while the baby is maturing in
the womb, most commonly occurs during the first 3
months of pregnancy and detected within the first year
of life. Because eating disorders as outlined in the
DSM-IV occur primarily in women of childbearing age,
one might suspect that eating disorders and
pregnancy often occur simultaneously. The literature
to date concerning pregnancy outcome in women with
eating disorders is not definitive.
• The occurrence of congenital malformations was
associated with eating disorders in two Level 3
articles and one Level 2. There was no association
between found in two Level 3 articles. Congenital
malformations included 1 undescended testicle, 2
ocular abnormalities with visual impairment, 3 heart
defects, 1 cleft palate and 1 cleft lip.
• The most significant finding was in altered
pregnancy outcomes. One Level 1, three Level 2,
two Level 3 and one Level 4 articles showed an
association between maternal eating disorders and
altered pregnancy outcome. One Level 2 and two
Level 4 did not.
• One Level 3 and one Level 4 showed an
association between rates of developmental delay
and eating disorders. One Level 4 showed no
association with developmental delay.
The evidence evaluating the occurrence of birth
defects was very weak and contained no Level 1
articles. There was not enough evidence available in
the literature to make a statement concerning the
occurrence of developmental delays due to lack of
Level 1 studies. The majority of studies made an
effort to eliminate confounding factors. There seems
to be an association with maternal eating disorders
and the the risk of altered pregnancy outcomes.
Some studies had unequal populations of anorexia
nervosa and bulimia nervosa patients, therefore
results may not apply equally for both types of
disorders. Further research may want to study the
two disorders separately. Due to public stereotyping
and shame associated with these diseases, many
cases go undiagnosed, leaving many unanswered
questions as to the effect of eating disorders on the
unborn.
METHODS
This was an evidence-based literature review using
the following inclusion criteria:
• Women meeting DSM-IV criteria for anorexia
nervosa, bulimia nervosa and eating disorders not
otherwise specified
• Studies must have made an attempt to eliminate
confounding factors such as cigarette smoking or
chronic disease
• All articles were published in peer reviewed journals
from 1980 to present
Fifteen articles met the inclusion criteria and were
evaluated for the occurrence of fetal birth defects,
developmental delays and adverse pregnancy
outcomes.
Table 1: Number of articles reviewed and outcomes
Fetal
Birth
Defects*
Delayed
Developmental
Progression**
Adverse
Pregnancy
Outcome***
No association
with eating
disorders
2
2
7
Association
with eating
disorders
1
1
3
*Includes problems encountered with the infant that may effect how the
body looks or works.
**Includes abnormalities in the progression of developmental milestones
i.e. sitting, crawling, walking and speech of single words.
***Includes terminated pregnancies and spontaneous abortions.
CONCLUSIONS
• Women with eating disorders, including anorexia
nervosa, bulimia nervosa and eating disorders not
otherwise specified, may be at increased risk for
adverse pregnancy outcome when compared to
women without eating disorders.
• No association between developmental delay in
the infant beyond 6 months and women with eating
disorders was found.
• No association in the occurence of fetal birth
defects and women with eating disorders was
found.
• Women with active disease should be advised to
avoid pregnancy until the eating disorder is in
remission to decrease the risk of unfavorable
pregnancy outcomes.