Pan Jeremy Ryan, Li Tina Yutong, Tucker Danny, Chen Kai Yang
Townsville Hospital and Health Service, Townsville, QLD, Australia.
College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.
J Eat Disord. 2022 Feb 16;10(1):25. doi: 10.1186/s40337-022-00551-8.
It is a common misconception that women with active anorexia nervosa (AN) are less likely to conceive. Pregnancies in women with AN are considered high risk. The purpose of this systematic review was to explore pregnancy complications in women with active AN, including maternal, fetal, and neonatal complications.
The authors conducted a systematic review in accordance with PRISMA statement guidelines with stringent selection criteria to include studies on patients with active AN during pregnancy.
There were 21 studies included in our review. Anaemia, caesarean section, concurrent recreational substance use, intrauterine growth restriction, preterm birth, small-for-gestation (SGA) birth, and low birth weight were the most reported pregnancy complications in women with active AN, while the rates of gestational diabetes and postpartum haemorrhage were lower.
Women with active AN have a different profile of pregnancy complications comparing to malnourished women and women in starvation. We recommend early discussion with women diagnosed with AN regarding their fertility and pregnancy complications. We recommend clinicians to aim to improve physical and psychological symptoms of AN as well as correction of any nutritional deficiency ideally prior to conception. Management of pregnancies in women with active AN requires regular monitoring, active involvement of obstetricians and psychiatrist. Paediatric follow-up postpartum is recommended to ensure adequate feeding, wellbeing and general health of the infants. Psychiatric follow-up is recommended for mothers due to risk of worsening symptoms of AN during perinatal period.
有一种常见的误解，认为患有活动性神经性厌食症（AN）的女性受孕几率较低。AN女性的怀孕被视为高风险。本系统评价的目的是探讨患有活动性AN的女性的妊娠并发症，包括母体、胎儿和新生儿并发症。
作者按照PRISMA声明指南进行系统评价，采用严格的选择标准纳入关于孕期患有活动性AN患者的研究。
我们的评价纳入了21项研究。贫血、剖宫产、同时使用消遣性药物、宫内生长受限、早产、小于胎龄（SGA）出生和低出生体重是患有活动性AN的女性中报告最多的妊娠并发症，而妊娠期糖尿病和产后出血的发生率较低。
与营养不良的女性和饥饿的女性相比，患有活动性AN的女性的妊娠并发症情况有所不同。我们建议与被诊断患有AN的女性尽早讨论她们的生育能力和妊娠并发症。我们建议临床医生的目标是在受孕前理想地改善AN的身体和心理症状以及纠正任何营养缺乏。对患有活动性AN的女性的妊娠管理需要定期监测，产科医生和精神科医生积极参与。建议产后进行儿科随访，以确保婴儿的充足喂养、健康和总体健康。由于围产期AN症状有加重的风险，建议对母亲进行精神科随访。
