CPG for Eating Disorders

TREATMENT OF EATING DISORDERS INSPECIAL CASES9.20. What is the treatment for eating disorders inspecial situations such as pregnancy and delivery?Evidence on the considerations that should be acknowledged when the patient is pregnant orgiving birth has been extracted from the NICE guide (2004) 30 .Summary of the EvidenceCPG 30CPG 30CPG 30CPG 30CPG 30Pregnancy with purging practices or pregnancy with overweight or obesity inan eating disorder is specific risk situations. Delivery can also be considered arisk situation that can lead to the onset of an eating disorder (Crow, 2008 333 ;Franko, 1993 334 ; Fairburn, 1990 335 ).In a follow-up study of patients with AN (N=140), fertility was reduced by athird of what was expected, prematurity doubled and perinatal mortality was sixtimes greater than in people without an eating disorder (Brinch, 1988) 336 .In another follow-up study of 66 pregnant women with AN, these patientspresented a higher percentage of C-sections and prematurity than the groupwithout eating disorders (Bulik, 2008) 337 .In a study conducted on pregnant women with AN, monitoring of the foetus’weight was performed. The foetus’s growth was slow, especially in the lasttrimester (Treasure, 1988) 338 .Pregnant women with AN have high risk of presenting premature deliveries.There are case-series that suggest the difficulties encountered by women withAN to feed their infants (Russell, 1998 339 ; WezelMeijle, 1989 340 ), while otherstudies report abnormal growth of these children (Hodes, 1997) 341 .RecommendationsD 9.20.1. Pregnant patients with AN, whether it is the first episode or a relapse,require intensive prenatal care with adequate nutrition and follow-up offoetal development. (Adopted from recommendation 6.4.8.1. of the NICEguide).D 9.20.2. Pregnant women with eating disorders require careful follow-upthroughout pregnancy and the postpartum period. (Adopted fromrecommendation 7.5.10.1. of the NICE guide).CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS173