Pregnancy in anorexia nervosa--an oxymoron that has become reality

In the last decade there has been a significant increase in the incidence of pregnancy in patients suffering from anorexia nervosa. This change is partly explained by the social processes that constitute a significant factor in the etiology of the disease. Yearning for thinness as representing the values of control and success has become a major cultural desire and this swept into a vortex of the disease many sexually active women at childbearing age, which was rare in anorexic patients in the past. Additionally, because amenorrhea is a common condition in anorexia nervosa, pregnancy during active disease seems to be an impossible oxymoron. While some patients succeed in conceiving spontaneously, fertility clinics provide an alternative solution for those who have difficulties conceiving. It seems that fertility professionals have little knowledge about anorexia nervosa and even when they diagnose it, the dilemma as to whether to refuse to treat these patients is not easy to solve. Pregnancy in anorectic patients during active disease puts the fetus at increased risk for complications during pregnancy and labor. Common complications are spontaneous abortion and growth retardation. One must take into consideration that underweight pregnant women require a professional eating disorders assessment and, if indeed it turns out that anorexia nervosa is active, it is necessary to refer her to an eating disorders clinic for treatment and to define the pregnancy as a pregnancy at-risk.