Institute of Child Health

Eating disorders are associated with fertility problems, unplanned pregnancies and negative attitudes to pregnancy, finds new research from King’s College London and UCL, published today in BJOG: An International Journal of Obstetrics and Gynaecology.

Women with lifetime anorexia and bulimia were investigated against a general population of women to assess the impact of their eating disorder.  The study looked at 11,088 women from the Avon Longitudinal Study of Parents and Children (ALSPAC). Women were asked to complete questionnaires at 12 and 18 weeks gestation.

Of the total number of women, 171 (1.5%) had anorexia at some point in their life, 199 (1.8%) had bulimia and an additional 82 (0.7%) had suffered from both conditions. The remaining 10,636 (96%) formed the general population comparison group.  The study found that women with anorexia and bulimia were more than twice as likely (6.2%) than the general population (2.7%) to have received treatment or help to conceive their current pregnancy.

At 18 weeks' gestation, women were asked if their current pregnancy was intentional. In the general population, 71.4% said there pregnancy was intentional compared to 58.5% of women with anorexia.  Women with a history of anorexia and bulimia took longer than six months to conceive (39.5%) compared to the general population (25%). However, women in the eating disorder groups were no more likely to take longer than 12 months to conceive than the general population.

In addition, at 18 weeks' gestation all participants were asked how they felt when they discovered that they were pregnant and how they currently felt about their pregnancy. The majority of women reported feeling overjoyed/pleased when they discovered that they were pregnant (71%). However, eating disorders were linked to negative feelings about pregnancy.  In women with anorexia and bulimia negative feelings remained stronger at 18 weeks' gestation. Furthermore, women with lifetime anorexia more frequently viewed motherhood as a personal sacrifice.

Abigail Easter, Institute of Psychiatry, Kings College London and co-author of the paper said:

“This research highlights the risks to fertility associated with eating disorders. Pregnancy can be a difficult time for women with eating disorders and this is the first time feelings about pregnancy have been looked at amongst this group of women.

“Women planning a pregnancy should ideally seek treatment for their eating disorder symptoms prior to conception.  Health professionals should be aware of eating disorders when assessing fertility and providing treatment for this.”

Dr Nadia Micali, UCL Institute of Child Health, and co-author added:

“Health professionals are often unaware of the effects of eating disorders on pregnancy and fertility. Women with a history of anorexia for example are more likely to have unplanned pregnancies. This has now been replicated in three large studies and has important repercussions on the level of antenatal and postnatal care they will need.”

Professor Philip Steer, BJOG editor-in-chief said:

“This research looks at how women with eating disorders are feeling when they are pregnant which has important clinical consequences. They will require more support during the antenatal and postnatal period.”

[With thanks to Royal College of Obstetricians and Gynaecologists]