Vasiliu Octavian
Department of Psychiatry, Dr. Carol Davila University Emergency Central Military Hospital, Bucharest, Romania.
Front Psychol. 2023 Jun 19;14:1168696. doi: 10.3389/fpsyg.2023.1168696. eCollection 2023.
The importance of detecting eating disorders (EDs) during pregnancy cannot be overemphasized, because of the major negative effects this pathology has on both maternal and fetal health. Based on a rapid review including primary and secondary reports, PN may still be considered an elusive diagnosis entity, that partially overlaps with other EDs, either well-defined, like anorexia nervosa, or still in search of their own diagnosis criteria, like orthorexia nervosa. Neurochemical and hormonal factors, psychological and social mechanisms, along with lifestyle changes create a very complex framework for clinicians interested in defining the typical features of pregorexia nervosa (PN). The personal history of EDs is considered one of the most important risk factors for PN. The core diagnostic criteria for this entity are, so far, lack of gaining weight during pregnancy, an excessive focus on counting calories and/or intense physical exercising with a secondary decrease of interest in the fetus's health, lack of acceptance of the change in body shape during pregnancy, and pathological attention for own body image. Regarding the treatment of PN, nutritional and psychosocial interventions are recommended but no specific therapeutic strategies for this disorder have been detected in the literature. Psychotherapy is considered the main intervention for pregnant women with associated EDs and mood disorders, as the pharmacological agents could have teratogenic effects or insufficient data to support their safety in this population. In conclusion, taking into consideration the methodological limitations of a rapid review, data supporting the existence of PN were found, mainly regarding tentative diagnostic criteria, risk factors, and pathophysiological aspects. These data, corroborated with the importance of preserving optimal mental health in a vulnerable population, e.g., pregnant women, justify the need for further research focused on finding specific diagnostic criteria and targeted therapeutic approaches.
孕期发现饮食失调（EDs）的重要性再怎么强调都不为过，因为这种病症会对母婴健康产生重大负面影响。基于一项包括一级和二级报告的快速综述，妊娠神经性厌食（PN）可能仍被视为一种难以捉摸的诊断实体，它与其他饮食失调部分重叠，这些饮食失调要么定义明确，如神经性厌食症，要么仍在寻找自身诊断标准，如orthorexia nervosa（暂未找到确切对应中文术语，可直译为“健康食品强迫症”）。神经化学和激素因素、心理和社会机制，以及生活方式的改变，为想要界定妊娠神经性厌食（PN）典型特征的临床医生构建了一个非常复杂的框架。饮食失调的个人史被认为是妊娠神经性厌食（PN）最重要的风险因素之一。到目前为止，该实体的核心诊断标准包括孕期体重未增加、过度关注计算卡路里和/或剧烈体育锻炼，继而对胎儿健康的兴趣降低、不接受孕期体型的变化，以及对自身身体形象的病态关注。关于妊娠神经性厌食（PN）的治疗，建议采取营养和心理社会干预措施，但文献中尚未发现针对该病症的具体治疗策略。心理治疗被认为是患有相关饮食失调和情绪障碍的孕妇的主要干预措施，因为药物制剂可能有致畸作用，或者缺乏支持其在该人群中安全性的数据。总之，考虑到快速综述的方法学局限性，发现了支持妊娠神经性厌食（PN）存在的数据，主要涉及初步诊断标准、风险因素和病理生理学方面。这些数据，再加上在弱势群体（如孕妇）中保持最佳心理健康的重要性，证明有必要进一步开展研究，重点是寻找具体的诊断标准和有针对性的治疗方法。
