A new study by University of North Carolina at Chapel Hill and Norwegian researchers has found that women with anorexia nervosa are much more likely to have both unplanned pregnancies and induced abortions than women who don't have the serious eating disorder.
These results may be driven by a mistaken belief among women with anorexia that they can't get pregnant because they are either not having menstrual periods at all or are having irregular periods, said Cynthia M. Bulik, PhD, the study's lead author and director of the UNC Eating Disorders Program.
"Anorexia is not a good contraceptive," Bulik said. "Just because you're not menstruating, or because you're menstruating irregularly, doesn't mean you're not at risk for becoming pregnant."
Physicians and other health care providers need to be aware of this as well, Bulik said. Doctors who treat women and adolescent girls, in particular, "need to make sure that they have the conversation about sexuality and contraception as clearly with patients with anorexia as they do with all other girls and women." In addition, providers who take care of pregnant women need to know when their patients have an eating disorder in order to provide appropriate care. Screening for eating disorders during prenatal visits would be an excellent first step, Bulik said.
In the study, published in the November 2010 issue of the journal Obstetrics & Gynecology, Bulik and study co-authors analyzed data collected from 62,060 women as part of the Norwegian Mother and Child Cohort Study. There were 62 women in this sample who reported having anorexia nervosa.
The differences between women with anorexia and women with no eating disorder were striking. The average age of the mothers at delivery was 26.2 years in women with anorexia, compared with 29.9 years in the referent group of women without eating disorders. Fifty percent of women with anorexia reported unplanned pregnancies, compared with 18.9 percent, while 24.2 percent of women with anorexia reported having induced abortions in the past, compared to 14.6 percent.
Co-authors of the study from UNC are Elizabeth R. Hoffman, an MD, PhD student, and biostatistician Ann Von Holle, MS. Co-authors from the Norwegian Institute of Public Health are Leila Torgersen, PhD, Camilla Stoltenberg, MD, drMed; and Ted Reichborn-Kjennerud, MD, drMed.
- Cynthia M. Bulik, Elizabeth R. Hoffman, Ann Von Holle, Leila Torgersen, Camilla Stoltenberg, Ted Reichborn-Kjennerud. Unplanned Pregnancy in Women With Anorexia Nervosa. Obstetrics & Gynecology, 2010; 116 (5): 1136 DOI: 10.1097/AOG.0b013e3181f7efdc
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