Systematic review
No effectiveness studies on treatment of eating disorders in pregnancy
Systematic review
|Updated
We searched systematically for effectiveness studies. We found no studies where treatment interventions for pregnant women with eating disorder were evaluated.
Key message
Eating disorders are serious conditions which also impact on pregnancy, birth and the health of mother and child. Amongst Norwegian women in the age group 15 to 44, 0.3 percent have anorexia, 2 percent bulimia and 3 percent have binge eating disorder. In this systematic review we summarise research on the effect of treatment and follow up of pregnancy for women with an eating disorders (anorexia, bulimia, binge eating or unspecified eating disorder).
We searched systematically for effectiveness studies. We found no studies where treatment interventions for pregnant women with eating disorder were evaluated.
We found a few studies on treatment of women with bulimia who had given birth. These studies did not include pregnant women and were not included in our review. None of the studies were of sufficient quality to yield reliable information about the effects of the offered treatments (cognitive therapy, web based group therapy or video –feedback intervention).
Surveying pregnant women with eating disorder without offering treatment, is ethically problematic. Controlled trials are needed to evaluate the effect of treatments for pregnant women with eating disorders. There are some treatments that show effect for some people with eating disorders , as cognitive therapy and family therapy. We do not know which treatments have best effect for mother and child in pregnancy with eating disorders.
Summary
Background
The Norwegian Directorate of Health is revising the National guidelines for eating disorders. Eating disorder is the mental illness with highest death rates. Pregnant women with eating disorder are vulnerable and in the more serious cases the illness may affect both to the mother and to the baby.
There is limited knowledge on treatment of eating disorder in pregnancy.
The Norwegian Institute of Public Health estimates the prevalence of eating disorder amongst Norwegian women aged 15 to 44 years to 0.3 percent with anorexia, 2 percent with bulimia, and 3 percent with binge eating disorder.
Eating disorder have been found to be associated with miscarriages, diabetes and premature births. An association has also been shown between eating disorders, and anorexia and intrauterine growth retardation.
We have addressed the following question in a systematic review:
For pregnant women with eating disorder, what is the effect of treatment- and follow up-interventions on the weight of the mother and the baby?
Which treatment- and follow up-interventions are most effective for pregnant women with eating disorder on improving
- symptoms of bulimia
- nutritional status
- depressive symptoms?
Method
First we searched for systematic reviews that had been published the last five years. We searched the following databases: Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment Database (HTA), MEDLINE, EMBASE, PsycINFO and Cinahl. We did not find any systematic reviews of studies on the effectiveness of relevant interventions.
We then searched for studies on effect in the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO and Cinahl. In addition to the electronic searches we also read the reference lists of identified reviews to look for studies with interventions.
The searched was conducted in February 2015.
To be included in this systematic review the studies should either be systematic reviews of high quality or single studies with a prospective design and control group. The study population in the studies should be pregnant women with an eating disorder (anorexia, bulimia, binge eating or unspecified eating disorder). They should be offered some form of structured treatment and follow up (such as psychological treatment) with focus on acceptable weight gain in mothers and babies, and relief of symptoms of the eating disorder and depression in the mother. The control group could be receiving usual care.
Two people independently screened titles and abstracts according to the inclusion criteria. Chosen references were screened in full text, also independently.
Results
The litterature search ended with 3552 references that we screened by reading of titles and abstracts. Eighteen references were reviewed in full text. We did not find any studies, neither systematic reviews or single studies, that met our inclusion criteria.
Discussion
If pregnant women with eating disorder require specific treatment that is different to that of other populations with eating disorder it is necessary to evaluate the treatment given in pregnancy in effectiveness trials. Until such documentation is available, pregnant women with eating disorder should be treated and followed like non-pregnant people with eating disorder.
We found a few intervention studies of women with bulimia who had given birth. We did not include them in our review as they did not include pregnant women. In addition, none of the studies were of good sufficient quality to yield reliable information about the effects of the offered treatments (cognitive therapy, web based group therapy or video –feedback intervention at mealtimes with small children).
Surveying pregnant women with eating disorder without offering treatment, is ethically problematic. Controlled trials are needed to evaluate the effect of treatments for pregnant women with eating disorders.
Conclusion
We did not find any studies where the effectiveness of treatments given to pregnant women with eating disorder were evaluated. An eating disorder can be a serious condition, and pregnant with such disorders should be offered treatment. Insights about prevalences and risk prognosis is not sufficient. Treatments that have been shown to be effective in some people with eating disorder (such as group therapy, family therapy, cognitive therapy, admission) should be trailed in studies where pregnant women with eating disorders take part.