Department of Obstetrics and Gynecology, Shiga University of Medical Science.
Department of Obstetrics and Gynecology, Omihachiman Community Medical Center.
Tohoku J Exp Med. 2020 Apr;250(4):191-200. doi: 10.1620/tjem.250.191.
Eating disorders are common psychiatric disorders among women of reproductive age, and the prevalence of eating disorders has been increasing over time in Japan and other countries. The aim of the present study was to assess perinatal outcomes in maternal anorexia nervosa in Japan and to explore methods to improve perinatal outcomes. This study consists of a case series describing 13 single pregnancies of 11 women with a history of anorexia nervosa, and a cross-sectional study comparing 13 cases with 240 healthy controls. In the case group, nine cases conceived while underweight, including three who had fertility treatment. Anorexia symptoms during pregnancy were quite common, and pregnant smokers presented with extremely disturbed eating behaviors. In a cross-sectional study, premature birth and the standard deviations from the mean birth weight and mean head circumference at birth were evaluated as outcome measures. The adjusted odds ratios or the adjusted differences between two means for the above outcomes were estimated by two approaches: multivariate models and matching analysis. Statistical analysis showed that maternal anorexia nervosa was associated with an increased risk of premature birth and symmetric growth restriction mediated by low pre-pregnancy body mass index and poor gestational weight gain which were adjusted as confounders. Smoking during pregnancy was a potential indicator of abnormal eating behavior and could be predictive of poor perinatal outcomes. We therefore conclude that remission of anorexia nervosa before pregnancy could improve perinatal outcomes through both normal nutrition and smoking cessation. Fertility treatment while underweight is not recommended.
进食障碍是育龄妇女中常见的精神障碍，在日本和其他国家，进食障碍的患病率一直在上升。本研究旨在评估日本神经性厌食症产妇的围产期结局，并探讨改善围产期结局的方法。本研究包括一项病例系列研究，描述了 11 名有神经性厌食症病史的妇女的 13 例单胎妊娠，以及一项病例对照研究，比较了 13 例病例和 240 例健康对照。在病例组中，有 9 例是在体重不足的情况下怀孕的，其中包括 3 例接受了生育治疗。怀孕期间常见厌食症状，孕妇吸烟者表现出严重的进食行为障碍。在横断面研究中，早产和出生体重、头围的均值离差被评估为结局指标。通过两种方法（多变量模型和匹配分析）估计上述结局的调整比值比或两个均值的调整差异。统计分析表明，神经性厌食症与早产风险增加以及由低孕前体重指数和妊娠体重增加不良介导的对称生长受限有关，这些因素被调整为混杂因素。怀孕期间吸烟是异常进食行为的潜在指标，可能预示着围产期结局不佳。因此，我们得出结论，神经性厌食症在怀孕前缓解可以通过正常营养和戒烟来改善围产期结局。不建议在体重不足的情况下进行生育治疗。
