Short Communication
Effects of pregnancy on eating attitudes and disorders: A prospective study

https://doi.org/10.1016/j.jpsychores.2005.03.002Get rights and content

Abstract

The aim of this prospective study was to investigate the effects of pregnancy on eating disorders (ED), dietary habits and body image perception. One hundred and fifty pregnant women were interviewed between the period January 2001 and May 2003. Ninety-seven women completed the study and were divided in three subgroups: pregnant women with a positive history of dieting (n=37), pregnant women with a positive history of dieting with a complete diagnosis of a current ED (n=11) and pregnant women with a negative history either of dieting or ED (control group; n=49). Age, education and parity were equally distributed in all three groups.

To verify if pregnancy exerts a specific protective effect, a battery of psychometric tests was administered to women at 12° (T0), 22° (T1), and 34° pregnancy weeks (T2), and 2 days (T3) and 4 months (T4) after delivery, respectively.

The study showed a quadratic trend for ED, subthreshold ED and body satisfaction, with a general improvement in the middle of pregnancy and a return to previous levels after delivery. Some interesting significant differences came out among the groups.

Introduction

Pregnancy represents a decisive phase of women's cycle of life, a turning point that may change previous adaptations [1]. Frequently, women report a generalized feeling of well-being during pregnancy once early physical symptoms, such as nausea and vomiting, have passed. However, some researchers highlighted the fact that anxiety and mood disorders may worsen, in a manner indirectly mediated by psychosocial stressors [2], [3].

During pregnancy, the woman has to cope with significant physical body changes [4]: She has to face a size increase, which can lead to a modification of her body image.

Several studies investigated the negative reactions pertaining to changes of body image. Fairburn and Welch [5] show that a history of previous irregular dietary habits is related to binge episodes during pregnancy and dissatisfaction of body modifications. Again, Stein and Fairburn [6] and Lacey and Smith [7] observed that the worries about weight and body image worsen during pregnancy and after the delivery.

Walker [8] stressed that the degree of dissatisfaction about weight gain and body image is related to a previous high body mass index (BMI).

On the other hand, numerous studies confirm positive reactions to the changes in the body shape during the pregnancy. Matsuhashi-Yuko and Felice [9] reported that pregnant women showed an elevated degree of self-esteem and a more positive acceptance of their body image.

Abraham et al. [10] found that pregnant women paid less attention to body weight and caloric intake than do nonpregnant women, suggesting the presence of a psychological legitimising to increase eating during pregnancy.

Davies and Wardle [11] compared a group of pregnant women with a nonpregnant group using the Eating Disorder Inventory-2 (EDI-2; [12]) and showed that the pregnant group was more satisfied with body image, weight and impulse to thinness.

Baker et al. [13] compared eating habits before, during and after pregnancy, underlining that women with a history of eating restrictions were unsatisfied about body image and weight and their feelings worsened in late pregnancy and after delivery.

Benton-Hardy and Lock [14], Steward et al. [15] and Rand et al. [16] stated that eating disorders (ED) may occur in pregnant adolescents, and women with anorexia nervosa can develop a worsening symptomatology in pregnancy.

In different groups of patients with anorexia nervosa, Blais et al. [17] and Larsson and Andersson-Ellstrom [18] demonstrated a significant reduction in purging and dieting behaviour during pregnancy, followed by a relapse 6 months after delivery.

Lacey and Smith [7] described a reduction of the bulimic behaviour during the first 6 months of pregnancy. However, a relapse occurred in the postpartum period, with worsening of the ED in comparison with the preconception period. This can be attributed to a fear of damaging the fetus [19]. Hollifield and Hobdy [20], Conrad et al. [21] and Kye [22] described a few case reports of bulimic women, whose symptomatology worsened.

The present study analysed the influence of pregnancy on body image perception in relation to eating habits and disorders.

We analysed how pregnancy influences the course of a current ED, body image perception and satisfaction, in three groups of women: (a) with a history of past irregular dietary habits in the previous 5 years; (b) with a current diagnosed bulimia nervosa or anorexia nervosa, bingeing and purging type; (c) normal women.

Section snippets

Sample

The study was conducted in the Departments of Obstetrics and Gynaecology and Psychiatry, at the General and University Hospital of Udine, Italy.

During the period between January 2001 and May 2003, a group of 150 pregnant women in their first 12 weeks of pregnancy were consecutively interviewed, at the time of their first obstetrical ultrasound.

Exclusion criteria included the presence of psychotic disorders, medical complications and history of addiction. Informed consent was obtained from all

Results

Only 109 of the original 150 selected women completed the study and were available for analysis.

Of the 41 dropouts, 15 withdrew their informed consent after the first test battery. The others had a spontaneous miscarriage (n=18) or underwent a voluntary interruption of pregnancy for foetal malformations (n=8). Of the 109 participants who entered the study, 12 were excluded for final analysis because their tests were incomplete.

Age, education, gravidity and BMI values were equally distributed in

Discussion and conclusions

Eating disorders in pregnancy have been the subject of several studies. Most studies evaluating the course of ED symptoms during pregnancy have reported a substantial improvement and, in the majority of cases, a return to prepregnancy symptom levels or even a worsening of symptoms in the postpartum period. However, the reasons for the improvement of ED during pregnancy are not fully understood. Our study showed how ED, subthreshold eating disturbances and body satisfaction tend to improve

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