ABSTRACT
The eating disorders – anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED) and eating disorders not otherwise specified (EDNOS) – are common in young women in developed countries. The average prevalence rates for anorexia nervosa and bulimia nervosa are 0.3% and 1%, respectively,1 in young Western women, but are higher – up to 5-7 % of young women – if partial syndromes are included. The onset of these disorders typically is in adolescence or young adulthood (i.e. in a critical phase of women’s reproductive life). These disorders are not self-limiting and many have a chronic course with notable psychiatric and medical comorbidities and sequelae. Menstrual abnormalities and fertility problems are common in those significantly underweight or with severely disrupted eating, i.e. those who binge, purge and starve alternately. Psychological factors also contribute to reproductive problems. Core psychological symptoms typically found across the whole spectrum of eating disorders include a morbid fear of fatness and a strong belief that their self-worth is exclusively tied to their weight, shape or appearance. This makes the prospect of weight gain during pregnancy terrifying for many of these patients and their attitude to breastfeeding may be more negative than that of other women. These women often have had problematic attachments to their own mothers2 and the role of being a mother themselves may not be straightforward for them. Thus, the effects of any eating disorder during pregnancy are not limited to the woman alone and it is important to consider the effects the illness may have
upon the child. In the first part of our chapter we will review the impact of eating disorders on fertility, pregnancy and the puerperium. We will separately consider the effects on the mother and the child. In the second part we will address clinical practice issues.
