O-179 Pregnancy outcomes in women with anorexia nervosa: a North American population-based study
Authors: Feferkorn I , Badeghiesh A , Baghlaf H , Dahan M.H 
Published: June 2022

Abstract

Study question
What implications does anorexia nervosa (AN) have on pregnancy outcomes in a North American population (NAP)?

Summary answer
Anorexia nervosa is associated with substantial increased risk of 500% in SGA, 270% in preterm delivery and 335% in placental abruption in a NAP.

What is known already
While considered by many a contraindication to fertility treatment, many women with AN do conceive with the help of reproductive medicine and spontaneously. This could be either because of lack of proper screening for anorexia nervosa (as studies show), or this being a lifelong disease. Many fertility specialists are faced with the dilemma of treating women who are undernourished, or if by refusing to do so, possibly preventing these patients the joy of parenthood. Most data regarding the consequences of AN on pregnancy complications, comes from Northern Europe and data from North America is lacking.

Study design, size, duration
A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS), was performed. A dataset of all deliveries between 2004 and 2014 inclusively, was created. Within this group, all deliveries to women who had a diagnosis of AN during pregnancy were identified as part of the study group (n = 214), and the remaining deliveries comprised the reference group (n = 9,096,574).

Participants/materials, setting, methods
Descriptive analyses were performed to compare the demographic features among both groups, Chi-squared test or Fisher’s exact test were used when appropriate. Multivariate logistic regression analysis was performed to calculate unadjusted and adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CI). According to Tri-Council Policy statement(2018), IRB approval was not required, given data was anonymous and publicly available.

Main results and the role of chance
Women diagnosed with AN were more likely to be white, of higher income, to be smokers, have thyroid disease or diagnosed with another psychiatric disorder (p &lt; 0.05 all). No difference was found in the rates of hypertensive diseases of pregnancy, gestational diabetes mellitus, incidence of placenta previa, need for cesarean section, postpartum hemorrhage or chorioamnionitis(P&gt;.05, all). Women with AN had a higher frequency of preterm delivery (aOR 2.70 CI 1.69-4.3, p &lt; 0.001) and placental abruption (aOR 3.35 CI 1.36-8.26, p = 0.009). The incidence of small for gestational age neonates was shockingly higher in the AN group (aOR 5.00 CI 2.93-8.53, p &lt; 0.001).

Limitations, reasons for caution
The limitations of our study are its retrospective nature and the fact that it relies on an administrative database. The severity of AN could not be assessed, nor could compliance with treatment.

Wider implications of the findings
Women with AN often conceive through ovulation induction. Fertility specialist should be aware of the magnitude of adverse outcomes related to pregnancy in women with AN, with a 500% increase in SGA 500% compared to a control population, and likely contributing to the increase in preterm delivery.

Trial registration number
not applicable