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Eating Disorders Are a Risk to Fertility
Much attention is focused on the growing rates of obesity and how it affects a woman’s fertility. However, recent research and health care professionals are shedding light on the impact of eating disorders such as anorexia and bulimia, which affect as many as 10 million women in the United States alone, according to the National Eating Disorders Association.
CGD, a blogger for FertilityAuthority, is a psychologist in private practice in New York City specializing in the treatment of eating and addictive disorders. "In my experience, medical professionals fail to raise issues related to fertility with eating disorder patients, even when symptoms such as amenorrhea are present,” she says. “Clearly, current medical stability is of primary concern; however infertility is typically glossed over when discussing long term health concerns, leading patients to believe that they have little to worry about in terms of their long term fertility."
Health professionals know that eating disorders can cause disruption to a woman's menstrual cycle, with substantial weight loss leading to hormonal changes that might prevent ovulation. However, until now there has been little research into how eating disorders might affect fertility.
In a study to be published BJOG: An International Journal of Obstetrics and Gynaecology, researchers at Kings College London and University College London asked 11,088 pregnant women to complete questionnaires at 12 and 18 weeks pregnant. They then compared women with lifetime anorexia and bulimia to the group as a whole to assess the impact of eating disorders on attitudes about fertility and pregnancy. They found that a higher proportion of women (39.5 percent) with a history of anorexia and bulimia took longer than six months to conceive compared to the general population (25 percent). And women with anorexia and bulimia were more than twice as likely (6.2 percent) than the general population (2.7 percent) to have received fertility treatment or help to conceive.
Interestingly, however, at 18 weeks gestation, the women with anorexia were more likely to report that their current pregnancy was unplanned (41.5 percent) compared with 28.6 percent of women in the general population.
"This research highlights that there are risks to fertility associated with eating disorders,” says Abigail Easter, the lead author of the study from the Instiute of Psychiatry at King’s College London. “However, the high rates of unplanned pregnancies in women with a history of anorexia suggest that women may be underestimating their chances of conceiving.
Eating disorders were also linked to negative feelings about the pregnancy — women with anorexia and bulimia were more than twice as likely (9.8 percent) than the general population (3.8 percent) to report feeling unhappy when they found out they were pregnant.
“Pregnancy can be a really difficult time for women with eating disorders, and both mother and baby can have a higher risk of pregnancy and birth complications, such as miscarriage and premature deliveries,” Easter says.
It is essential for women with eating disorders to seek treatment for the disorder before thinking of becoming pregnant to ensure that they are able to adequately care and feed their bodies during pregnancy.
"To ensure the best care and advice can be provided for women with eating disorders who want to conceive, it's really important that they discuss their eating habits and behaviors with their health care provider before planning a pregnancy,” Easter says. “For health care providers, it's also important to know that women with a history of eating disorders will continue to require additional care and support during and after their pregnancy."
Additionally, says CGD, “mothers need to be careful about messages about food and body that are transmitted to their children through their attitudes and actions."