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Pregorexia

Pregorexia. Julia Humphrey B.S. Nutrition & Dietetics Central Washington University. What is Pregorexia. Termed by the media Woman who develops an eating disorder during pregnancy Woman previously diagnosed with an eating disorder who becomes pregnant

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Pregorexia

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  1. Pregorexia Julia Humphrey B.S. Nutrition & Dietetics Central Washington University

  2. What is Pregorexia • Termed by the media • Woman who develops an eating disorder during pregnancy • Woman previously diagnosed with an eating disorder who becomes pregnant • Severe restriction of calories and/or excessive exercise during or after pregnancy to either avoid or aid in weight loss • Pressure to lose baby weight • Pressure to not gain weight at all

  3. Possible Cause • Comments from family & friends about weight • Similar cause as Anorexia Nervosa • Control, perfectionism, or coping mechanism • Chemical imbalances in brain • Anxiety • Continuing ED • Fear of becoming fat during pregnancy • Personal Issues suppressed until pregnancy

  4. Most Common Characteristics • Secrecy • Denial, the baby is safe • Anxious • Focusing on weight, not health

  5. Warning Signs • A documented history of eating disorders • Talking about the pregnancy as if it were not real • Focusing on calorie counts instead of general health • Eating alone • Skipping meals • A weak or nonexistent support system

  6. Maggie Baumann • Guest blogger on Momlogic.com • I stuck vigilantly to my disordered "rules," living in fear-based chaos filled with secrecy and shame • “regimented exercise schedule and an extreme preoccupation with monitoring my calorie consumption” • "I am not going to gain a lot of weight and I am not going to allow my body to get 'big' like I felt happened with my first pregnancy."

  7. Under-Nutrition During Pregnancy • Associated with: • Low birth weight • Pre-term delivery • Intrauterine growth restriction • Low APGAR scores • Fetal origins hypothesis • Programming during early development • stroke, hypertension, obesity, glucose intolerance and cardiovascular disease risk

  8. Low Weight Gain During Pregnancy • Normal: 25-35 lbs • Less than 25 lbs increases risk of • Cesarean Delivery • Miscarriage • Pre-term delivery • Low birth weight babies • Smaller infant head circumference • Post partum depression

  9. Weight Gain Pattern • Anorexics – typically resembles normal pregnancy • Initial weight gain & total weight gain lower • Bulimics – either very little weight gain during pregnancy or too much weight gain • Increased risk of • Preeclampsia • Large for gestational age • Cesarean delivery

  10. I Am AWoman and I’m Pregnant • Study of 18 Taiwanese women in third trimester • Population and culture of ideal “thinness” is similar to US • Completed a demographic questionnaire and interview • Approx 50% of the women emphasized dissatisfaction with their overall appearance • More than 50% of the women received disapproval by the husband which lead to negative thoughts about their bodies

  11. Study of 6 Anorexic Women • UCLA Eating Disorders Clinic • 6 women previously diagnosed with anorexia (DSM III criteria) who became pregnant • Interviews given during pregnancy and 3-4 months after giving birth • Positive attention from being pregnant opposed to negative from having an ED • “forced” to take better care of themselves. • Irritability & depression during first 5-8 lbs • Fear that body would not return to normal • All women returned to anorexic thinking after birth

  12. Eating Habits During Pregnancy • 1992, WarnefordHospital. Oxford, United Kingdom • 100 Primigravid women • Interviewed twice • Early to mid pregnancy & third trimester • Aim was to describe the changes in eating w/ pregnancy • Eating Disorders Examination (EDE) • Decreased dietary restraint in early pregnancy • Increased dietary restraint in late pregnancy • Increased concern about shape in late pregnancy

  13. Media Influence • Not a common cause • Celebrities back to “bikini ready” weeks after giving birth • Heidi Klum 2009 walking runway in VS fashion show 5 weeks after giving birth • Pressure driven by thin pregnant celebrities who are already under pressure to stay thin

  14. Complications With Pregorexia • Miscarriage • Intrauterine growth retardation • Neurological problems : ADD, seizures • Vitamin deficiency • Baby will get what needs; expense of the mother (calcium) • Too much exercise = decreased oxygen for baby= neurological problems

  15. Treatment • Multidisciplinary approach • Obstetrical health care providers • Nurses • Dietetians • Therapists • Family Members • Cognitive-Behavioral Techniques • Important to monitor following birth

  16. Previously diagnosed With ED • Some women with eating disorders actually report feeling better while they’re pregnant • Feel forced to take better care of themselves • Aiding in recovery

  17. Limitations • ADA position paper • Pregorexia is uncommon • We see more in the opposite direction • ED undetected during pregnancy • Doctors not educated

  18. Future Research • Needs to be done • Controversial • Longitudinal study • Difficult b/c of secrecy and denial

  19. Resources • Chang S, Chao Y, Kenney N. I Am a Woman and I’m Pregnant: Body Image of Women in Taiwan During the Third Trimester of Pregnancy. Birth: Issues in Perinatal Care. 2006; 33; 2; 147-153 • DeVader S, Neeley H, Myles T, Leet T. Evaluation of Gestational Weight Gain Guidelines for Women With Normal Prepregnancy Body Mass Index. American College of Obstetricians and Gynecologists. 2007; 110; 4; 745-751 • Dublin Business School. I’m Not Fat, I’m Pregnanct: An Examination of the Prevalence and Causation of Pregorexia in Ireland. 16 April 2010. 1-54 • Fairburn C, Stein A, Jones R. Eating Habits and Eating Disorders During Pregnancy. Psychosomatic Medicine. 1992; 54; 665-672 • Franko D, Spurrell E. Detection and Management of Eating Disorders During Pregnancy. Obstetrics and Gynecology. 2000; 95; 6; 942-946 • Godfrey K, Barker D. Fetal Nutrition and Adult Disease. The American Journal of Clinical Nutrition. 2000; 71; 1344S-1352S. • James D. Eating Disorders, Fertility, and Pregnancy: Relationships and Complications. The Journal of Perinatal and Neonatal Nursing. 2001; 15; 2; 36-48 • Kouba S, Hallstrom T, Lindholm C, Hirschberg A. Pregnancy and Neonatal Outcomes in Women With Eating Disorders. The American College of Obstetricians and Gynecologists. 2005; 105;2; 255-260. • Matthews F, Yudkin P, Neil A. Influence of Maternal Nutrition on Outcome of Pregnancy: Prospective Cohort Study. British Medical Journal. 1999; 319; 339-343 • Namir S, Melman K, Yager J. Pregnancy in Restricter-Type Anorexia Nervosa: A Sudy of Six Women. International Journal of Eating Disorders. 1986; 5;5;837-845 • Nohr E, Vaeth M, Baker J, Sorensen T, Olsen J, Rasmussen K. Combined Associations of Prepregnancy Body Mass Index and Gestational Weight Gain with the Outcome of Pregnancy. The American Journal of Clinical Nutrition. 2008; 87; 1750-1759

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