Eating Disorders Affect Fertility, Pregnancy

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Anorexia, Bulimia Linked to More Infertility, Unplanned Pregnancies

By Salynn Boyles
WebMD Health News

Reviewed by Laura J. Martin, MD

Aug. 5, 2011 -- Women with anorexia or bulimia or a history of eating disorders have more fertility problems, unplanned pregnancies, and negative feelings about having a child than women with no such history, a new study from the United Kingdom finds.

Researchers from King's College London and the University College London examined data from surveys of more than 11,000 pregnant women, including about 500 with a history of anorexia nervosa, bulimia, or both conditions.

Although women with a history of eating disorders were no more likely than other women to take longer than a year to conceive, a higher percentage did take more than six months to achieve a pregnancy (39% vs. 25%).

Infertility Treatment More Common With Eating Disorders

Women who reported having an eating disorder in the present or past were more than twice as likely to have received treatment to help them conceive (6% vs. 2.7%).

Among the other findings in the self-reported, survey-based study:

• 41% of women with past or current eating disorders reported that their pregnancies were unplanned, compared to 28% of women with no such history.
• Although the majority of women reported being happy to discover they were pregnant (71%), women with anorexia or bulimia were more than twice as likely to report feeling unhappy about their pregnancies (10% vs. 4%).
• Women with an eating disorder or history of one were also more than twice as likely to consider motherhood a "personal sacrifice."

The study, published online this week in the international obstetrics and gynecology journal BJOG, is the largest ever conducted in the U.K. examining the impact of eating disorders on fertility and attitudes about pregnancy.

Study researcher Abigail Easter says the findings highlight the need to provide extra support to women with current or prior eating disorders before conception and during pregnancy.

"We know that many women with a history of an eating disorder often feel unable to inform health care professionals of their illness," she tells WebMD. "When planning a pregnancy or becoming pregnant we would encourage women with eating disorders, even if it was in the past, to discuss this with their doctors."

Rate of Unplanned Pregnancies a Surprise

Easter says the researchers were surprised to find such a high rate of unintended pregnancies among women with a history of eating disorders.

Women with eating disorders often have infrequent periods or no periods at all. Although conceiving is often more difficult under these conditions, it is not impossible or even all that uncommon, Easter says.

"Women with eating disorders can underestimate their chances of conceiving and not take adequate measures of birth control," Easter tells WebMD. "The contraceptive pill may also not be an appropriate form of contraception for someone with bulimia who regularly self-induces vomiting as a means of controlling weight."

Imperial College London professor emeritus Philip Steer, MD, who is editor-in-chief of BJOG, says it is important for health care professionals to recognize that women with a history of eating disorders may have more negative feelings associated with pregnancy and childbirth, compared to other women.

He agrees that they may also need more support.

"Women with eating disorders are often very intelligent and successful, so providers could easily fail to recognize that they may need extra nurturing during pregnancy and even after giving birth," he says. "This research shows that an eating disorder history should be seen as a warning sign that a woman may have additional challenges associated with pregnancy."

SOURCES: Easter, A., British Journal of Obstetrics and Gynecology (BJOG), published online Aug. 3, 2011.Abigail Easter, BSc, section of eating disorders, department of psychological medicine and psychiatry, King's College, London.Philip Steer, MD, BSc, professor emeritus in obstetrics and gynecology, Imperial College London; editor-in-chief, BJOG.News release, BJOG. ©2011 WebMD, LLC. All Rights Reserved.