Short CommunicationEffects of pregnancy on eating attitudes and disorders: A prospective study
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
References (29)
- et al.
Adolescent body image during pregnancy
J Adolesc Health
(1991) - et al.
Body image and dieting in pregnancy
J Psychosom Res
(1994) - et al.
Worsening of symptoms of bulimia nervosa during pregnancy
Psychosomatics
(2003) A study of the psychological process of pregnancy and of the earliest mother–child relationship
Psychoanal Study Child
(1961)- et al.
Mood changes during pregnancy and the postpartum period: development of a biopsychosocial model
Acta Psychiatr Scand
(2004) - et al.
Well-being and sense of coherence during pregnancy
Acta Obstet Gynecol Scand
(2004) - et al.
The psychological experience of pregnancy
Int J Psychiatry Med
(1987) - et al.
The impact of pregnancy on eating habits and attitudes to shape and weight
Int J Eat Disord
(1990) - et al.
Eating habits and attitude in the postpartum period
Psychosom Med
(1996) - et al.
Bulimia nervosa. The impact of pregnancy on mother and baby
Br J Psychiatry
(1987)
Weight-related distress in the early months after childbirth
West J Nurs Res
Attitudes to body weight, weight gain and eating behavior in pregnancy
J Psychosom Obstet Gynaecol
Eating disorder inventory-2: professional manual
Eating attitudes and behaviours in pregnancy and postpartum: global stability versus specific transitions
Soc Behav Med
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Eating disorders in pregnancy
2021, Revista Medica Clinica Las CondesDisordered eating from pregnancy to the postpartum period: The role of psychosocial and mental health factors
2021, AppetiteCitation Excerpt :In this cohort study that examined women during pregnancy and the postpartum period, disordered eating increased on average from the middle-end pregnancy (T2) to the early postpartum period (T3) in the total sample. An increase in disordered eating during the postpartum period agrees with previous literature and confirms the necessity of studies exploring factors associated with this increase (Crow et al., 2008; Easter et al., 2015; Rocco et al., 2005). Two patterns of increasing disordered eating were noteworthy: the ‘sub-clinical’ group consisting of women who presented with sub-clinical disordered eating at T2 and disordered eating above clinical cut off at T3, and the ‘increasing risk’ group, including women with low disordered eating at T2 but a significant increase to sub-clinical levels at T3.